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Vennarini S, Colombo F, Mirandola A, Chiaravalli S, Orlandi E, Massimino M, Casanova M, Ferrari A. Clinical Insight on Proton Therapy for Paediatric Rhabdomyosarcoma. Cancer Manag Res 2023; 15:1125-1139. [PMID: 37842128 PMCID: PMC10576457 DOI: 10.2147/cmar.s362664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023] Open
Abstract
This paper offers an insight into the use of Proton Beam Therapy (PBT) in paediatric patients with rhabdomyosarcoma (RMS). This paper provides a comprehensive analysis of the literature, investigating comparative photon-proton dosimetry, outcome, and toxicity. In the complex and multimodal scenario of the treatment of RMS, clear evidence of the therapeutic superiority of PBT compared to other modern photon techniques has not yet been demonstrated; however, PBT can be considered an excellent treatment option, in particular for young children and patients with specific primary sites, such as the head and neck area (and especially the parameningeal regions), genito-urinary, pelvic, and paravertebral regions. The unique depth-dose characteristics of protons can be exploited to achieve significant reductions in normal tissue doses and may allow an escalation of tumour doses and greater sparing of normal tissues, thus potentially improving local control while at the same time reducing toxicity and improving quality of life. However, access of children with RMS (and more in general with solid tumors) to PBT remains a challenge, due to the limited number of available proton therapy installations.
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Affiliation(s)
- Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Francesca Colombo
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, Italy
| | - Alfredo Mirandola
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
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2
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Sparber-Sauer M, Ferrari A, Spunt SL, Vokuhl C, Casey D, Lautz TB, Meyer WH, Walterhouse DO, Pajtler KW, Alaggio R, Schmidt A, Safwat A, Timmermann B, Dall'Igna P, Chen S, Weiss AR, Orbach D. The significance of margins in pediatric Non-Rhabdomyosarcoma soft tissue sarcomas: Consensus on surgical margin definition harmonization from the INternational Soft Tissue SaRcoma ConsorTium (INSTRuCT). Cancer Med 2023. [PMID: 36744538 DOI: 10.1002/cam4.5671] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/05/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Margin status following surgery in children, adolescents, and young adults with soft tissue sarcomas is controversial and has been defined differently by various specialties, with definitions changing over time and by cooperative group. The International Soft Tissue Sarcoma Consortium (INSTRuCT) is a collaboration of the Children's Oncology Group (COG) Soft Tissue Sarcoma Committee, European pediatric Soft Tissue sarcoma Study Group (EpSSG), and the European Cooperative Weichteilsarkom Studiengruppe (CWS) devoted to improving patient outcomes by pooling and mining cooperative group clinical trial data. METHODS The INSTRuCT non-rhabdomyosarcoma soft tissue sarcoma (NRSTS) working group aimed to develop international harmonized recommendations regarding surgical margin assessment and definitions in children and adolescents with soft tissue tumors. RESULTS AND CONCLUSION This review addresses accepted principles and areas of controversy, including the perspectives of surgeons, pathologists, radiation oncologists, and pediatric oncologists, to develop a framework for building common guidelines for future research.
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Affiliation(s)
- Monika Sparber-Sauer
- Klinikum der Landeshauptstadt Stuttgart gKAöR, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pädiatrie 5 (Pädiatrische Onkologie, Hämatologie, Immunologie), Stuttgart, Germany.,Medizinische Fakultät der Universität Tübingen, Tübingen, Germany
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Sheri L Spunt
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Christian Vokuhl
- Section of Pediatric Pathology, University of Bonn, Bonn, Germany
| | - Dana Casey
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
| | - Timothy B Lautz
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - William H Meyer
- Jimmy Everest Section of Pediatric Hematology Oncology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - David O Walterhouse
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Kristian W Pajtler
- Hopp-Children's Cancer Center, NCT Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Rita Alaggio
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andreas Schmidt
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Akmal Safwat
- Oncology Department and Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Germany
| | - Patrizia Dall'Igna
- Pediatric Surgery, Department of Emergencies and Organ Transplantation, University of Bari, Bari, Italy
| | - Sonja Chen
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Aaron R Weiss
- Department of Pediatrics, Maine Medical Center, Portland, Maine, United States
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), PSL University, Institut Curie, Paris, France
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3
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Park M, Lee JA, Jin HY, Kim JY, Park JW, Kim JH, Kang HG, Park SY, Park EY, Park HJ, Park BK. Clinical characteristics and long-term outcomes of rhabdomyosarcoma in Korean children, adolescents and young adults: a single-center experience. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04192-x. [DOI: 10.1007/s00432-022-04192-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/06/2022] [Indexed: 11/28/2022]
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4
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Casey DL, Mandeville H, Bradley JA, Ter Horst SAJ, Sheyn A, Timmermann B, Wolden SL. Local control of parameningeal rhabdomyosarcoma: An expert consensus guideline from the International Soft Tissue Sarcoma Consortium (INSTRuCT). Pediatr Blood Cancer 2022; 69:e29751. [PMID: 35484997 DOI: 10.1002/pbc.29751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 12/19/2022]
Abstract
The International Soft Tissue Sarcoma Database Consortium (INSTRuCT) consists of a collaboration between the Children's Oncology Group (COG) Soft Tissue Sarcoma Committee, the European pediatric Soft Tissue Sarcoma Study Group (EpSSG), and the Cooperative Weichteilsarkom Studiengruppe (CWS). As part of the larger initiative of INSTRuCT to provide consensus expert opinions for clinical treatment of pediatric soft tissue sarcoma, we sought to provide updated, evidenced-based consensus guidelines for local treatment of parameningeal rhabdomyosarcoma using both existing literature as well as recommendations from the relevant cooperative group clinical trials. Overall, parameningeal rhabdomyosarcoma represents a distinctly challenging disease to treat, given its location near many critical structures in the head and neck, frequently advanced local presentation, and predilection for local failure. Definitive chemoradiation remains the standard treatment approach for parameningeal rhabdomyosarcoma, with surgery often limited to biopsy or salvage therapy for recurrent disease. In this consensus paper, we specifically discuss consensus guidelines and evidence for definitive local management with radiotherapy, with a focus on imaging for radiotherapy planning, dose and timing of radiation, approach for nodal irradiation, various radiation techniques, including proton therapy, and the limited role of surgical resection.
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Affiliation(s)
- Dana L Casey
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - Henry Mandeville
- Royal Marsden NHS Foundation Trust, London, UK.,Institute of Cancer Research, London, UK
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida, USA
| | - Simone A J Ter Horst
- Department of Radiology, University Medical Center Utrecht, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Anthony Sheyn
- Department of Surgery, Division of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Essen, Germany
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Pediatric radiotherapy for thoracic and abdominal targets: organ motion, reported margin sizes, and delineation variations – a systematic review. Radiother Oncol 2022; 173:134-145. [DOI: 10.1016/j.radonc.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 05/09/2022] [Accepted: 05/26/2022] [Indexed: 11/21/2022]
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6
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Bradley JA, Indelicato DJ, Uezono H, Morris CG, Sandler E, de Soto H, Mailhot Vega RB, Rotondo R. Patterns of Failure in Parameningeal Alveolar Rhabdomyosarcoma. Int J Radiat Oncol Biol Phys 2020; 107:325-333. [DOI: 10.1016/j.ijrobp.2020.01.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 12/19/2022]
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7
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Indelicato DJ, Rotondo RL, Krasin MJ, Mailhot Vega RB, Uezono H, Bradfield S, Agarwal V, Morris CG, Bradley JA. Outcomes Following Proton Therapy for Group III Pelvic Rhabdomyosarcoma. Int J Radiat Oncol Biol Phys 2020; 106:968-976. [DOI: 10.1016/j.ijrobp.2019.12.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/19/2019] [Accepted: 12/21/2019] [Indexed: 01/20/2023]
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8
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Chen C, Dorado Garcia H, Scheer M, Henssen AG. Current and Future Treatment Strategies for Rhabdomyosarcoma. Front Oncol 2019; 9:1458. [PMID: 31921698 PMCID: PMC6933601 DOI: 10.3389/fonc.2019.01458] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/05/2019] [Indexed: 12/31/2022] Open
Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children, and can be subcategorized histologically and/or based on PAX-FOXO1 fusion gene status. Over the last four decades, there have been no significant improvements in clinical outcomes for advanced and metastatic RMS patients, underscoring a need for new treatment options for these groups. Despite significant advancements in our understanding of the genomic landscape and underlying biological mechanisms governing RMS that have informed the identification of novel therapeutic targets, development of these therapies in clinical trials has lagged far behind. In this review, we summarize the current frontline multi-modality therapy for RMS according to pediatric protocols, highlight emerging targeted therapies and immunotherapies identified by preclinical studies, and discuss early clinical trial data and the implications they hold for future clinical development.
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Affiliation(s)
- Celine Chen
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heathcliff Dorado Garcia
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Monika Scheer
- Pediatrics 5, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Anton G. Henssen
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Experimental and Clinical Research Center (ECRC) of the MDC and Charité Berlin, Berlin, Germany
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Indelicato DJ, Rotondo RL, Mailhot Vega RB, Uezono H, Bradfield S, Agarwal V, Hol ML, Bradley JA. 45 GyRBE for group III orbital embryonal rhabdomyosarcoma. Acta Oncol 2019; 58:1404-1409. [PMID: 31530120 DOI: 10.1080/0284186x.2019.1627412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Purpose: Despite widespread concerns of radiotherapy toxicity in children with head and neck tumors, recent Children's Oncology Group (COG) findings suggest that the use of 45 Gy results in an unacceptably high rate of local recurrences in patients with low-risk orbital rhabdomyosarcoma. We therefore evaluated outcomes in our pediatric patients who received 45 GyRBE using proton therapy. Material and methods: To assess disease control and toxicity, we reviewed the medical records of 30 children (≤21 years old) with COG stage 1, group III embryonal orbital rhabdomyosarcoma enrolled on a prospective outcome study and treated with proton therapy between 2007 and 2018. Results: Median age at the time of radiation was 4.8 years old. Twenty-one and nine patients received ifosfamide- and cyclophosphamide-based chemotherapy according to their respective cooperative group regimens. Median duration between the start of induction chemotherapy and radiation was 12 weeks. Two patients had a complete response to induction chemotherapy and two had stable disease. Twenty-six patients had a partial response to induction chemotherapy, with a median volume reduction of 66%. With a median follow-up of 4.0 years (range, 0.5-9.5 years), we observed 1 local failure 6 months following treatment in a patient who had a partial response to cyclosphophomide-based induction chemotherapy. The 5-year local control, progression-free survival, and overall survival rates were 97%, 97%, and 100%, respectively. Serious late toxicities included 18 patients with cataracts, 4 with exposure keratoconjunctivitis resulting in permanently reduced visual acuity, and 1 with chronic sinusitis. Conclusion: 45 GyRBE offers effective local control for most patients with group III orbital rhabdomyosarcoma. The delivery of proton therapy to the postinduction tumor volume plus a small margin can mitigate early- and intermediate-term toxicity, but side effects still occur and long-term data are needed to demonstrate the dosimetric advantage of proton therapy.
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Affiliation(s)
- Daniel J. Indelicato
- Department of Radiation Oncology, College of Medicine, University of Florida, Jacksonville, FL, USA
| | - Ronny L. Rotondo
- Department of Radiation Oncology, College of Medicine, University of Florida, Jacksonville, FL, USA
| | - Raymond B. Mailhot Vega
- Department of Radiation Oncology, College of Medicine, University of Florida, Jacksonville, FL, USA
| | - Haruka Uezono
- Department of Radiation Oncology, College of Medicine, University of Florida, Jacksonville, FL, USA
| | - Scott Bradfield
- Department of Pediatric Oncology, Nemours Children’s Health System, Jacksonville, FL, USA
| | - Vibhuti Agarwal
- Department of Pediatric Oncology, Nemours Children’s Health System, Jacksonville, FL, USA
| | - Marinka L. Hol
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Julie A. Bradley
- Department of Radiation Oncology, College of Medicine, University of Florida, Jacksonville, FL, USA
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10
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Doyen J, Jazmati D, Geismar D, Frisch S, Schleithoff SS, Vermeren X, Scheer M, Blase C, Tippelt S, Timmermann B. Outcome and Patterns of Relapse in Childhood Parameningeal Rhabdomyosarcoma Treated With Proton Beam Therapy. Int J Radiat Oncol Biol Phys 2019; 105:1043-1054. [PMID: 31419513 DOI: 10.1016/j.ijrobp.2019.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/03/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The standard of care of childhood parameningeal rhabdomyosarcoma (pRMS) is chemotherapy and local radiation therapy. Protons are increasingly being used to decrease late effects. The aim of the present study is to analyze the pattern of relapse and the correlation with dosimetric factors in pRMS treated with proton therapy. METHODS AND MATERIALS This retrospective evaluation includes children treated in our institution for pRMS. Information on demographics, treatment, tumor characteristics, and toxicities and outcome was prospectively collected within the in-house registry. For patients presenting with local relapse, a fusion of the dosimetry with magnetic resonance imaging displaying site and geometry of recurrence was performed. RESULTS Median follow-up time was 2.9 years (0.5-4.7). Forty-six patients were identified in our institution between July 2013 and November 2017. Main characteristics of patients were as follows: 56.5% male, median age 5.1 years (1.3-17.5), 39.1% alveolar histology, 26.1%, 52.2%, 8.7%, and 13% patients with subgroup risk classification D, E/F/G, H, or metastatic, respectively, median total prescribed dose 55.8 Gy (50.4-56.4). Estimated 2-year local control, metastasis-free survival, event-free survival, and overall survival were 83.8%, 87.8%, 76.9%, and 88.9%, respectively. No acute or late local toxicity exceeding grade 3 was observed. Risk-group was identified as prognostic factor for metastasis-free survival in univariate analysis but not in multivariate analysis (trend: P = .09). In this cohort, dosimetric factors did not correlate with outcome. Isolated local failure happened in 5 of the 11 relapses. Local relapses were matched with dosimetry for 6 patients: 4 of them occurred in the high dose volume and 2 in the intermediate or low dose volume. CONCLUSIONS Proton therapy was effective and well feasible even in a critical cohort. Still, local relapse within the target volume of the radiation therapy remains an important issue in pRMS and new treatment strategies are needed.
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Affiliation(s)
- Jérôme Doyen
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), Germany; Department of Radiation Oncology, Centre Antoine-Lacassagne, University of Côte d'Azur, Fédération Claude Lalanne, Nice, France.
| | - Danny Jazmati
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), Germany
| | - Dirk Geismar
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), Germany, German Cancer Consortium (DKTK)
| | - Sabine Frisch
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), Germany
| | - Stefanie Schulze Schleithoff
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), Germany
| | - Xavier Vermeren
- West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), University Hospital Essen, Germany
| | - Monika Scheer
- Pediatrics 5 (Oncology, Hematology, Immunology), Olgahospital, Klinikum Stuttgart, Stuttgart, Germany; Cooperative Weichteilsarkomstudiengruppe (CWS) Olgahospital, Pädiatrisches Zentrum der Landeshauptstadt, Klinikum Stuttgart, Germany; Department of Pediatric and Oncology, University Hospital of Stuttgart, Germany
| | - Christoph Blase
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), Germany; AnästhesieNetz Rhein-Ruhr, Bochum, Germany
| | - Stephan Tippelt
- Department of Pediatric Oncology and Hematology, Pediatrics III, University Hospital Essen, Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), Germany, German Cancer Consortium (DKTK)
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Gesche J, Beckert S, Neunhoeffer F, Kachanov D, Königsrainer A, Seitz G, Fuchs J. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: A safe treatment option for intraperitoneal rhabdomyosarcoma in children below 5 years of age. Pediatr Blood Cancer 2019; 66:e27517. [PMID: 30362235 DOI: 10.1002/pbc.27517] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/19/2018] [Accepted: 10/02/2018] [Indexed: 11/07/2022]
Abstract
Advanced and relapsed intraperitoneal rhabdomyosarcomas in young children represent an oncological challenge and options for local tumor control are limited. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is commonly used in advanced peritoneal tumors in adults. However, no studies are available regarding CRS and HIPEC in young children. We report our experiences treating six patients with intraperitoneal rhabdomyosarcoma with CRS and HIPEC using cisplatin and doxorubicin focusing on safety and outcomes. No procedure-associated mortalities occurred and no major short- or long-term toxicities were recorded. All patients showed no evidence of disease after 12-month median (7-41) follow-up.
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Affiliation(s)
- Jens Gesche
- Department of Pediatric Surgery, University Children's Hospital, Tuebingen, Germany
| | - Stefan Beckert
- Department of General, Visceral and Transplant Surgery, Comprehensive Cancer Center, University of Tuebingen, Tuebingen, Germany
| | - Felix Neunhoeffer
- Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany
| | - Denis Kachanov
- Department of Clinical Oncology, National Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev Samory, Moscow, Russia
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, Comprehensive Cancer Center, University of Tuebingen, Tuebingen, Germany
| | - Guido Seitz
- Department of Pediatric Surgery, University Hospital Giessen/Marburg, Marburg, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery, University Children's Hospital, Tuebingen, Germany
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12
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Excessive Treatment Failures in Patients With Parameningeal Rhabdomyosarcoma With Reduced-dose Cyclophosphamide and Delayed Radiotherapy. J Pediatr Hematol Oncol 2018; 40:387-390. [PMID: 29683960 PMCID: PMC6520047 DOI: 10.1097/mph.0000000000001188] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pediatric patients with parameningeal rhabdomyosarcoma and high-risk features are recommended to receive radiotherapy at initiation of protocol therapy due to concerns about the increased risk of local and leptomeningeal failure from treatment delay. We report our early experience on a multi-institutional prospective trial incorporating delayed primary site radiation and reduced dose cyclophosphamide in all patients with parameningeal tumors. We observed an excessive number of locoregional treatment failures following this approach and have subsequently amended our trial to move radiation therapy upfront for those patients with high-risk features. We suggest that investigators should be vigilant for treatment failure given our early prospective experience with delayed radiotherapy and reduced dose cyclophosphamide.
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13
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Ludmir EB, Paulino AC, Grosshans DR, McAleer MF, McGovern SL, Huh WW, Okcu MF, Harrell LM, Mahajan A. Regional Nodal Control for Head and Neck Alveolar Rhabdomyosarcoma. Int J Radiat Oncol Biol Phys 2018; 101:169-176. [DOI: 10.1016/j.ijrobp.2018.01.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/27/2017] [Accepted: 01/16/2018] [Indexed: 12/11/2022]
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14
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Ahn JS, Flanagan M. Alveolar rhabdomyosarcoma in the cerebrospinal fluid. Diagn Cytopathol 2018; 46:772-775. [PMID: 29663721 DOI: 10.1002/dc.23948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/03/2018] [Accepted: 03/29/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Janice S. Ahn
- Department of Pathology; West Virginia University, PO Box 9203; Morgantown West Virginia
| | - Melina Flanagan
- Department of Pathology; West Virginia University, PO Box 9203; Morgantown West Virginia
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15
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Adherence to Treatment, Response and Patterns of Failure in Pediatric Parameningeal Rhabdomyosarcoma: Experience From a Tertiary Cancer Care Center From India. J Pediatr Hematol Oncol 2017; 39:e62-e68. [PMID: 28060113 DOI: 10.1097/mph.0000000000000745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The study was aimed at evaluating adherence to treatment protocol and outcome in pediatric parameningeal rhabdomyosarcoma (PM-RMS). We analyzed the characteristics, treatment administered, outcomes and patterns of failure of pediatric PM-RMS, who were treated with multimodality therapy between January 2005 and December 2013.Univariate and multivariate analysis (MVA) was completed to evaluate the impact of various prognostic factors. Thirty-seven patients were treated at our institution. Majority of them had the primary disease in paranasal sinuses (n=13). Majority of the patients belonged to group III (n=30) and stage III (n=24). The overall response rate to treatment was 52.5% (n=21). At a mean follow-up of 19.1 months, 23 patients developed disease progression. The actuarial rates of failure-free survival and overall survival (OS) at 2 years were 40% and 67.5%, respectively. Patients who received >20 weeks of intended chemotherapy schedule (P=0.02) and had complete response to first-line treatment (P=0.0004) were found to have superior failure-free survival on MVA. Complete response was the lone determinant of superior OS on MVA (P=0.006). Majority of patients with PM-RMS present with advanced stage disease. Response to first-line treatment is a significant predictor of superior progression-free survival and OS in these patients.
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Yuan G, Yao H, Li X, Li H, Wu L. Stage 1 embryonal rhabdomyosarcoma of the female genital tract: a retrospective clinical study of nine cases. World J Surg Oncol 2017; 15:42. [PMID: 28173865 PMCID: PMC5297139 DOI: 10.1186/s12957-017-1110-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 02/01/2017] [Indexed: 12/15/2022] Open
Abstract
Background The aim of the study is to investigate the clinical features, treatments, and prognosis of stage 1 embryonal rhabdomyosarcoma of the female genital tract. Methods A retrospective analysis was performed on nine cases of stage 1 embryonal rhabdomyosarcoma of the female genital tract. Clinical characteristics, treatments, recurrence, and prognosis were analyzed. Results Of the nine patients with embryonal rhabdomyosarcoma, three originated from the vagina and six from the cervix. For the eight patients who initially received surgery, the median survival time was 88 months. As for the six patients that received adjuvant chemotherapy, five of them who received six or more cycles of treatment achieved tumor-free survival and the survival time ranged from 9 to 228 months. The remaining patient, who declined further treatment after two cycles of chemotherapy, relapsed 11 months following the surgery and died 3 months later. Out of the nine patients, only one was initially treated with chemotherapy, and achieved complete remission, but relapsed 21 months later. After a combination of surgery and chemotherapy, this patient remained tumor-free for total of 117 months. Conclusions Patients with early stage embryonal rhabdomyosarcoma of the female genital tract have good prognosis, and the combination of surgery and chemotherapy can lead to better outcomes.
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Affiliation(s)
- Guangwen Yuan
- Department of Gynecologic Oncology, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Science, No 17 Panjiayuan South Street, Chaoyang District, Beijing, China
| | - Hongwen Yao
- Department of Gynecologic Oncology, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Science, No 17 Panjiayuan South Street, Chaoyang District, Beijing, China
| | - Xiaoguang Li
- Department of Gynecologic Oncology, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Science, No 17 Panjiayuan South Street, Chaoyang District, Beijing, China
| | - Hongjun Li
- Department of Gynecologic Oncology, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Science, No 17 Panjiayuan South Street, Chaoyang District, Beijing, China
| | - Lingying Wu
- Department of Gynecologic Oncology, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Science, No 17 Panjiayuan South Street, Chaoyang District, Beijing, China.
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17
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Kieran K, Shnorhavorian M. Current standards of care in bladder and prostate rhabdomyosarcoma. Urol Oncol 2016; 34:93-102. [PMID: 26776454 DOI: 10.1016/j.urolonc.2015.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/21/2015] [Accepted: 12/21/2015] [Indexed: 11/25/2022]
Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue tumor in children, and 15% to 20% arise from the genitourinary tract. Multicenter collaborative studies have improved survival substantially, and in addition to excellent oncologic control, current treatment focuses on organ preservation and minimization of late treatment effects. The multiple modalities needed to treat RMS dictate that treating physicians must be familiar with the disease as well as the goals and possible sequelae of treatment with chemotherapy, radiotherapy, and surgery. This article discusses the current standards of care for bladder and prostate RMS.
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Abstract
A malignant tumor of striated muscle origin, rhabdomyosarcoma (RMS) is a childhood tumor that has benefited from nearly 30 years of multimodality therapy, culminating in a >70% overall 5-year survival. Prognosis for RMS is dependent on primary tumor site, age, completeness of resection, presence and number of metastatic sites, histology, and biology of the tumor cells. Multimodality treatment is based on risk stratification according to pre-treatment stage, postoperative group, histology, and site. Unique to RMS is the concept of postoperative clinical grouping that assesses the completeness of disease resection and takes into account lymph node evaluation at both the regional and metastatic basins. At all sites, if complete operative resection of disease is accomplished, including microscopic disease, survival is improved. Therefore, the surgeon plays a vital role in determining risk stratification for treatment, local control of the primary tumor and overall outcome for the patient with RMS.
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Affiliation(s)
- Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH.
| | - Jörg Fuchs
- Universitätsklinik für Kinder- und Jugendmedizin, Lehrstuhl für Kinderchirurgie und Kinderurologie, Vizepräsident der Deutschen Gesellschaft für Chirurgie, Tübingen, Germany
| | - David Rodeberg
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC
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19
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Ladra MM, Wang KKH, Terezakis SA. Pencil-beam scanning for pediatric rhabdomyosarcoma: Promise and precautions. Pediatr Blood Cancer 2016; 63:1698-9. [PMID: 27299982 DOI: 10.1002/pbc.26103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 05/12/2016] [Accepted: 05/12/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Matthew M Ladra
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ken Kang-Hsin Wang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Stephanie A Terezakis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
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20
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Vern-Gross TZ, Indelicato DJ, Bradley JA, Rotondo RL. Patterns of Failure in Pediatric Rhabdomyosarcoma After Proton Therapy. Int J Radiat Oncol Biol Phys 2016; 96:1070-1077. [PMID: 27742542 DOI: 10.1016/j.ijrobp.2016.08.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/12/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To report on the patterns of failure in children with rhabdomyosarcoma treated with proton therapy. PATIENTS AND METHODS Between February 2007 and November 2013, 66 children with a median age of 4.1 years (range, 0.6-15.3 years) diagnosed with nonmetastatic rhabdomyosarcoma were treated with proton therapy. Clinical target volume 1 was defined as the prechemotherapy tumor plus a 1-cm anatomically constrained margin. Clinical target volume 2 was defined as the postchemotherapy tumor (or tumor bed) plus a 0.5-cm anatomically constrained margin, further expanded to encompass potential pathways of spread, including soft tissue infiltrated with tumor at diagnosis. RESULTS Of the 66 children, 11 developed locally progressive disease at a median of 16 months (range, 14-32 months), for an actuarial 2-year local control rate of 88%. Among the children who progressed, median age and tumor size at diagnosis were 6.7 years (range, 0.6-16 years) and 6 cm (range, 2-8 cm), respectively. Of the recurrences, 64% and 36% were embryonal and alveolar, respectively. Disease progression was observed in 7 (64%) parameningeal, 2 (18%) head and neck (other), and 2 (18%) bladder/prostate subsites. At diagnosis, 8 of 11 patients who developed a recurrence were Intergroup Rhabdomyosarcoma Study stage 3, and all 11 were group III. Of the relapses, 100% (11 of 11) were confirmed as in-field within the composite 95% isodose line. One of the 11 patients (9%) developed a new simultaneous regional nodal recurrence outside of the previously treated radiation field. CONCLUSION Early data suggest that the sharp dosimetric gradient associated with proton therapy is not associated with an increased risk of marginal failure. Routine use of a 0.5- to 1-cm clinical target volume 1/2 margin with highly conformal proton therapy does not compromise local control in children diagnosed with rhabdomyosarcoma with unfavorable risk features.
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Affiliation(s)
- Tamara Z Vern-Gross
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida.
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida
| | - Ronny L Rotondo
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida
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21
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Gurtner K, Baumann M. [Proton therapy of pediatric rhabdomyosarcoma: Same tumor control as photon therapy, with less adverse effects]. Strahlenther Onkol 2015; 191:814-6. [PMID: 26385859 DOI: 10.1007/s00066-015-0878-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kristin Gurtner
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - Michael Baumann
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
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22
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Dantonello TM, Stark M, Timmermann B, Fuchs J, Selle B, Linderkamp C, Handgretinger R, Hagen R, Feuchtgruber S, Kube S, Kosztyla D, Kazanowska B, Ladenstein R, Niggli F, Ljungman G, Bielack SS, Klingebiel T, Koscielniak E. Tumour volume reduction after neoadjuvant chemotherapy impacts outcome in localised embryonal rhabdomyosarcoma. Pediatr Blood Cancer 2015; 62:16-23. [PMID: 25263634 DOI: 10.1002/pbc.25207] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 07/07/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Response (tumour volume reduction) to induction chemotherapy has been used to stratify secondary local and systemic treatment of Intergroup Rhabdomyosarcoma Study Group III (IRSG-III) embryonal rhabdomyosarcoma (RME) in consecutive CWS-trials. To evaluate its actual impact we studied response-related treatment and outcomes. PROCEDURE Patients with IRSG-III RME <21 years and non-response (NR, <33% volume reduction) in five consecutive CWS-trials were analysed and compared with partial responders (PAR, ≥ 33% reduction). The NR was reviewed and sub-classified as Objective Response (OR, <0%-33% reduction) or Stable/Progressive Disease (SPD). RESULTS Fifty-nine of 529 patients had NR (n = 34 OR, n = 25 SPD). Primary risk-factors including age, tumour size, and TN-classification did not differ between NR and PAR groups but NR had more patients with unfavourable sites comparatively (P = 0.04). There were no differences in primary risk-factors between OR and SPD. Significant factors associated with poor outcome in multivariate analysis were NR, TN-classification, age >10 years, tumour size >5 cm and therapy in older trials. After response assessment n = 24 NR continued to receive induction chemotherapy, n = 32 received other combinations and n = 3 no further chemotherapy. Forty-two non-responders were irradiated, and the tumours were completely resected in n = 20. After a median follow-up of 8 years, 34 NR are alive. Seventeen of 21 failures leading to disease-related deaths were locoregional. The five-year overall survival rate (OS) was 76 ± 4% for PAR, 79 ± 14% for OR, but only 40 ± 19% for SPD (P < 0.001). CONCLUSION Response to induction chemotherapy appears to be an important surrogate marker of poor outcome in patients with SPD largely due to ineffective local control.
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Affiliation(s)
- Tobias M Dantonello
- Paediatrics 5 (oncology, hematology, immunology), Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
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23
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Ladra MM, Szymonifka JD, Mahajan A, Friedmann AM, Yong Yeap B, Goebel CP, MacDonald SM, Grosshans DR, Rodriguez-Galindo C, Marcus KJ, Tarbell NJ, Yock TI. Preliminary results of a phase II trial of proton radiotherapy for pediatric rhabdomyosarcoma. J Clin Oncol 2014; 32:3762-70. [PMID: 25332253 DOI: 10.1200/jco.2014.56.1548] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This prospective phase II study was designed to assess disease control and to describe acute and late adverse effects of treatment with proton radiotherapy in children with rhabdomyosarcoma (RMS). PATIENTS AND METHODS Fifty-seven patients with localized RMS (age 21 years or younger) or metastatic embryonal RMS (age 2 to 10 years) were enrolled between February 2005 and August 2012. All patients were treated with chemotherapy based on either vincristine, actinomycin, and cyclophosphamide or vincristine, actinomycin, and ifosfamide-based chemotherapy and proton radiation. Surgical resection was based on tumor site and accessibility. Common Terminology Criteria for Adverse Events, Version 3.0, was used to assess and grade adverse effects of treatment. Concurrent enrollment onto Children's Oncology Group or European Pediatric Sarcoma Study Group protocols was allowed. All pathology and imaging were reviewed at the treating institution. RESULTS Median follow-up was 47 months (range, 14 to 102 months) for survivors. Five-year event-free survival (EFS), overall survival (OS), and local control (LC) were 69%, 78%, and 81%, respectively, for the entire cohort. The 5-year LC by risk group was 93% for low-risk and 77% for intermediate-risk disease. There were 13 patients with grade 3 acute toxicity and three patients with grade 3 late toxicity. There were no acute or late toxicities higher than grade 3. CONCLUSION Five-year LC, EFS, and OS rates were similar to those observed in comparable trials that used photon radiation. Acute and late toxicity rates were favorable. Proton radiation appears to represent a safe and effective radiation modality for pediatric RMS.
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Affiliation(s)
- Matthew M Ladra
- Matthew M. Ladra, Jackie Szymonifka, Alison M. Friedmann, Beow Yong Yeap, Claire Goebel, Shannon M. MacDonald, Nancy J. Tarbell, Torunn I. Yock Massachusetts General Hospital, Harvard Medical School;, Carlos Rodriguez-Galindo, Karen J. Marcus, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Anita Mahajan and David Grosshans, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jackie D Szymonifka
- Matthew M. Ladra, Jackie Szymonifka, Alison M. Friedmann, Beow Yong Yeap, Claire Goebel, Shannon M. MacDonald, Nancy J. Tarbell, Torunn I. Yock Massachusetts General Hospital, Harvard Medical School;, Carlos Rodriguez-Galindo, Karen J. Marcus, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Anita Mahajan and David Grosshans, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anita Mahajan
- Matthew M. Ladra, Jackie Szymonifka, Alison M. Friedmann, Beow Yong Yeap, Claire Goebel, Shannon M. MacDonald, Nancy J. Tarbell, Torunn I. Yock Massachusetts General Hospital, Harvard Medical School;, Carlos Rodriguez-Galindo, Karen J. Marcus, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Anita Mahajan and David Grosshans, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alison M Friedmann
- Matthew M. Ladra, Jackie Szymonifka, Alison M. Friedmann, Beow Yong Yeap, Claire Goebel, Shannon M. MacDonald, Nancy J. Tarbell, Torunn I. Yock Massachusetts General Hospital, Harvard Medical School;, Carlos Rodriguez-Galindo, Karen J. Marcus, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Anita Mahajan and David Grosshans, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Beow Yong Yeap
- Matthew M. Ladra, Jackie Szymonifka, Alison M. Friedmann, Beow Yong Yeap, Claire Goebel, Shannon M. MacDonald, Nancy J. Tarbell, Torunn I. Yock Massachusetts General Hospital, Harvard Medical School;, Carlos Rodriguez-Galindo, Karen J. Marcus, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Anita Mahajan and David Grosshans, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Claire P Goebel
- Matthew M. Ladra, Jackie Szymonifka, Alison M. Friedmann, Beow Yong Yeap, Claire Goebel, Shannon M. MacDonald, Nancy J. Tarbell, Torunn I. Yock Massachusetts General Hospital, Harvard Medical School;, Carlos Rodriguez-Galindo, Karen J. Marcus, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Anita Mahajan and David Grosshans, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shannon M MacDonald
- Matthew M. Ladra, Jackie Szymonifka, Alison M. Friedmann, Beow Yong Yeap, Claire Goebel, Shannon M. MacDonald, Nancy J. Tarbell, Torunn I. Yock Massachusetts General Hospital, Harvard Medical School;, Carlos Rodriguez-Galindo, Karen J. Marcus, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Anita Mahajan and David Grosshans, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David R Grosshans
- Matthew M. Ladra, Jackie Szymonifka, Alison M. Friedmann, Beow Yong Yeap, Claire Goebel, Shannon M. MacDonald, Nancy J. Tarbell, Torunn I. Yock Massachusetts General Hospital, Harvard Medical School;, Carlos Rodriguez-Galindo, Karen J. Marcus, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Anita Mahajan and David Grosshans, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carlos Rodriguez-Galindo
- Matthew M. Ladra, Jackie Szymonifka, Alison M. Friedmann, Beow Yong Yeap, Claire Goebel, Shannon M. MacDonald, Nancy J. Tarbell, Torunn I. Yock Massachusetts General Hospital, Harvard Medical School;, Carlos Rodriguez-Galindo, Karen J. Marcus, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Anita Mahajan and David Grosshans, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karen J Marcus
- Matthew M. Ladra, Jackie Szymonifka, Alison M. Friedmann, Beow Yong Yeap, Claire Goebel, Shannon M. MacDonald, Nancy J. Tarbell, Torunn I. Yock Massachusetts General Hospital, Harvard Medical School;, Carlos Rodriguez-Galindo, Karen J. Marcus, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Anita Mahajan and David Grosshans, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nancy J Tarbell
- Matthew M. Ladra, Jackie Szymonifka, Alison M. Friedmann, Beow Yong Yeap, Claire Goebel, Shannon M. MacDonald, Nancy J. Tarbell, Torunn I. Yock Massachusetts General Hospital, Harvard Medical School;, Carlos Rodriguez-Galindo, Karen J. Marcus, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Anita Mahajan and David Grosshans, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Torunn I Yock
- Matthew M. Ladra, Jackie Szymonifka, Alison M. Friedmann, Beow Yong Yeap, Claire Goebel, Shannon M. MacDonald, Nancy J. Tarbell, Torunn I. Yock Massachusetts General Hospital, Harvard Medical School;, Carlos Rodriguez-Galindo, Karen J. Marcus, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Anita Mahajan and David Grosshans, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Egas-Bejar D, Huh WW. Rhabdomyosarcoma in adolescent and young adult patients: current perspectives. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2014; 5:115-25. [PMID: 24966711 PMCID: PMC4069040 DOI: 10.2147/ahmt.s44582] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Rhabdomyosarcoma (RMS), a malignant tumor of mesenchymal origin, is the third most common extracranial malignant solid tumor in children and adolescents. However, in adults, RMS represents <1% of all solid tumor malignancies. The embryonal and alveolar histologic variants are more commonly seen in pediatric patients, while the pleomorphic variant is rare in children and seen more often in adults. Advances in the research of the embryonal and alveolar variants have improved our understanding of certain genes and biologic pathways that are involved in RMS, but much less is known for the other variants. Multimodality therapy that includes surgery and chemotherapy with or without radiation therapy is the mainstay of treatment for RMS. Improvements in the risk stratification of the pediatric patients based on presurgical (primary tumor site, tumor size, regional lymph node involvement, presence of metastasis) and postsurgical parameters (completeness of resection or presence of residual disease or metastasis) has allowed for the treatment assignment of patients in different studies and therapeutic trials, leading to increases in 5-year survival from 25%–70% over the past 40 years. However, for adult patients, in great part due to rarity of the disease and the lack of consensus on optimal treatment, clinical outcome is still poor. Many factors have been implicated for the differing outcomes between pediatric RMS versus adult RMS, such as the lack of standardized treatment protocols for adult RMS patients and the increased prevalence of advanced presentations. Now that there are increased numbers of survivors, we can appreciate the sequelae from therapy in these patients, such as bone growth abnormalities, endocrinopathies, and infertility. Improvements in risk stratification have led to clinical trials using lower doses of chemotherapy or radiation therapy with the intention of decreasing the incidence of side effects without compromising survival outcome.
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Affiliation(s)
- Daniela Egas-Bejar
- Division of Pediatrics, The Children's Cancer Hospital, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Winston W Huh
- Division of Pediatrics, The Children's Cancer Hospital, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Ge X, Huang DS, Shi JT, Ma JM. Multidisciplinary Collaborative Therapy for 30 Children with Orbital Rhabdomyosarcoma. Asian Pac J Cancer Prev 2013; 14:4641-6. [DOI: 10.7314/apjcp.2013.14.8.4641] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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