1
|
Sütterlin AL, Demmert M, Kovács G, Claviez A, Schulz C, Lauten M. Interventional radiotherapy (brachytherapy) achieves very good long-term quality of life in children and adolescents with soft-tissue sarcoma. Pediatr Blood Cancer 2020; 67:e28464. [PMID: 32706504 DOI: 10.1002/pbc.28464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/16/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Effective local therapy (surgery, radiation) and systemic multidrug chemotherapy are mandatory for curing childhood sarcoma. The standard radiation therapy for pediatric patients with soft-tissue sarcoma (STS) is external beam radiotherapy (EBRT). Because EBRT may cause long-term side effects with adverse effects on the patients' health and quality of life (QoL), alternative strategies are required. Interventional radiotherapy (IRT; brachytherapy) is established as a standard treatment for several tumors in adulthood. Single-center series have reported low levels of late effects and improved QoL in survivors treated with IRT in childhood. However, IRT is still applied infrequently in pediatric patients. METHODS Thirty patients with STS were treated with IRT between 1992 and 2012 at the University Hospital Schleswig Holstein, Germany. Five patients were lost to follow-up, and 25 patients (mean age at time of data collection 24.8 years [range, 10.7-36.1]) could be analyzed focusing on overall survival and QoL (EORTC-C30 questionnaire). For more detailed information regarding general and health-specific questions, a separate questionnaire was developed. RESULTS Nineteen of 25 patients were alive 13.4 [1.6-25.2] years after first cancer disease, and the three-year overall survival was 76% (SE, 0.09). The score of QoL/global health status (76.2 [16.6-100]) in our patients outvalues the European (66.1) and equals the German (75.9) reference value. CONCLUSION IRT is an effective treatment option for pediatric patients with localized STS. Its role among other radiation dose-sparing techniques such as proton beam therapy has to be defined in prospective studies.
Collapse
Affiliation(s)
- Anna Lotte Sütterlin
- Department of Pediatric and Adolescent Medicine, Pediatric Hematology and Oncology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Martin Demmert
- Department of Pediatric and Adolescent Medicine, Pediatric Hematology and Oncology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - György Kovács
- Department of Radiotherapy, Interdisciplinary Brachytherapy Unit, University Hospital Schleswig Holstein, Lübeck, Germany.,Gemelli INTERACTS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alexander Claviez
- Department of Pediatric and Adolescent Medicine, Pediatric Hematology and Oncology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Christian Schulz
- Department of Radiotherapy, University Hospital Schleswig Holstein, Kiel, Germany
| | - Melchior Lauten
- Department of Pediatric and Adolescent Medicine, Pediatric Hematology and Oncology, University Hospital Schleswig Holstein, Lübeck, Germany
| |
Collapse
|
2
|
Demoor-Goldschmidt C, Claude L, Carrie C, Bolle S, Helfre S, Alapetite C, Jouin A, Padovani L, Ducassou A, Vigneron C, Le Prisé É, Huchet A, Stefan D, Kerr C, Nguyen TD, Truc G, Chapet S, Bondiau PY, Coche B, Muracciole X, Laprie A, Noël G, Leseur J, Habrand JL, Potet H, Ruffier A, Supiot S, Mahé MA, Bernier V. [French organization of paediatric radiation treatment: Results of a survey conducted by the radiotherapy Committee of the French Society of Paediatric Cancers (SFCE)]. Cancer Radiother 2016; 20:395-9. [PMID: 27421622 DOI: 10.1016/j.canrad.2016.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/22/2016] [Accepted: 05/06/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Radiotherapy is a rare indication in paediatric oncology, with 800 to 900 children in treatment per year in France. Child cancers represent approximately 1% of cancers in France and half occur before the age of 5 years. Paediatric radiation requires appropriate tools, local, time and specific training. In France, in 2015, 18 centres are accredited by the French National Cancer Institute (INCa) for this activity. MATERIAL AND METHODS Survey conducted in February 2015 on the care of children (0 to 18 years) in radiotherapy departments in France. The survey was sent to the radiation oncologists involved in the 18 centres. The questions concerned the qualitative and quantitative aspect, medical and organizational aspects, and the involvement of assistant practitioners in the management of this activity. RESULTS Seventeen centres responded. In 2014, 889 children under 18 were treated in radiotherapy departments. These departments are working together with one to four paediatric oncology departments. Regarding access to general anaesthesia: three centres perform one to seven treatment(s) under anaesthesia per year, three centres eight to ten treatments under anaesthesia per year, three centres ten to 24 treatments under anaesthesia per year and nine centres out of 17 use hypnosis techniques. In terms of human resources, in 2015, 29 radiation therapists have a paediatric radiotherapy activity. Involvement of assistant practitioners is growing and specific training are desired. Regarding treatment preparation and delivery, 13 centres have specific paediatric contentions, 14 of 16 centres employ radiation intensity modulated if dosimetry is more satisfying with 11 regularly to the craniospinal irradiation. Radiotherapy on moving areas with respiratory gating or hypofractionation is under developed. CONCLUSION Paediatric radiation therapy is a specific activity requiring a dedicated management, both in human, organizational, medical and scientific aspects.
Collapse
Affiliation(s)
- C Demoor-Goldschmidt
- Radiothérapie, institut de cancérologie de l'Ouest-Nantes, boulevard Jacques-Monod, 44800 Saint-Herblain, France; Inserm U1018, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - L Claude
- Radiothérapie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - C Carrie
- Radiothérapie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - S Bolle
- Radiothérapie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - S Helfre
- Radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - C Alapetite
- Radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Jouin
- Radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - L Padovani
- Radiothérapie, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - A Ducassou
- Radiothérapie, IUCT Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - C Vigneron
- Radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67000 Strasbourg, France
| | - É Le Prisé
- Radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - A Huchet
- Radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France
| | - D Stefan
- Radiothérapie, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - C Kerr
- Radiothérapie, institut du cancer de Montpellier, 208, avenue des Apothicaires, 34298 Montpellier, France
| | - T-D Nguyen
- Radiothérapie, institut Jean-Godinot, 1, rue du Général-Koenig, 51100 Reims, France
| | - G Truc
- Radiothérapie, institut Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - S Chapet
- Radiothérapie, Corad, hôpital Bretonneau, CHRU de Tours, 2 boulevard Tonnellé, 37000 Tours, France
| | - P-Y Bondiau
- Radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06100 Nice, France
| | - B Coche
- Radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - X Muracciole
- Radiothérapie, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - A Laprie
- Radiothérapie, IUCT Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - G Noël
- Radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67000 Strasbourg, France
| | - J Leseur
- Radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - J-L Habrand
- Radiothérapie, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - H Potet
- Radiothérapie, institut Jean-Godinot, 1, rue du Général-Koenig, 51100 Reims, France
| | - A Ruffier
- Radiothérapie, Corad, hôpital Bretonneau, CHRU de Tours, 2 boulevard Tonnellé, 37000 Tours, France
| | - S Supiot
- Radiothérapie, institut de cancérologie de l'Ouest-Nantes, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - M-A Mahé
- Radiothérapie, institut de cancérologie de l'Ouest-Nantes, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - V Bernier
- Radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67000 Strasbourg, France
| |
Collapse
|
3
|
Oertel S, Niethammer AG, Krempien R, Roeder F, Eble MJ, Baer C, Huber PE, Kulozik A, Waag KL, Treiber M, Debus J. Combination of external-beam radiotherapy with intraoperative electron-beam therapy is effective in incompletely resected pediatric malignancies. Int J Radiat Oncol Biol Phys 2006; 64:235-41. [PMID: 16257132 DOI: 10.1016/j.ijrobp.2005.06.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2005] [Revised: 06/20/2005] [Accepted: 06/22/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE Intraoperative electron-beam radiotherapy (IOERT) has been applied for local dose escalation in over 1,400 patients in Heidelberg since 1991. Among these were 30 children, in 18 of whom IOERT was employed in radiation treatment with external-beam radiotherapy (EBRT) on account of incomplete resection. We address the question whether IOERT is able to compensate for microscopic or macroscopic tumor residue if employed in the overall radiation regimen. METHODS AND MATERIALS The data of the aforementioned 18 children were analyzed with regard to local recurrence, overall survival, and complication rates. All children suffered from either sarcomas or neuroblastomas. In all children, IOERT was employed for local dose escalation after or before EBRT. RESULTS After a median follow-up of 60.5 months, 15 of the treated children are alive. One local failure has been observed. Six children show clinically significant late morbidity, including the loss of a treated limb (Radiation Therapy Oncology Group Grade 4 [RTOG 4]), a severe nerve lesion (RTOG 3), an orthopedic complication (RTOG 2), a ureteral stenosis (not clinically significant), and a kidney hypotrophy (not clinically significant). In 1 child a fracture due to radionecrosis (RTOG 4) was diagnosed; however, in the follow-up, local tumor relapse was diagnosed as another possible reason for the fracture. CONCLUSIONS Regarding the low incidence of local failure, IOERT seems to be able to compensate incomplete tumor resection in childhood sarcoma and neuroblastoma patients. The incidence of late morbidity is low enough to justify the employment of IOERT as part of the radiation treatment regimen for pediatric patients.
Collapse
Affiliation(s)
- Susanne Oertel
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|