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Chhabra AM, Snider JW, Kole AJ, Stock M, Holtzman AL, Press R, Wang CJ, Li H, Lin H, Shi C, McDonald M, Soike M, Zhou J, Sabouri P, Mossahebi S, Colaco R, Albertini F, Simone CB. Proton Therapy for Spinal Tumors: A Consensus Statement From the Particle Therapy Cooperative Group. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00507-8. [PMID: 39181272 DOI: 10.1016/j.ijrobp.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/29/2024] [Accepted: 04/03/2024] [Indexed: 08/27/2024]
Abstract
PURPOSE Proton beam therapy (PBT) plays an important role in the management of primary spine tumors. The purpose of this consensus statement was to summarize safe and optimal delivery of PBT for spinal tumors. METHODS AND MATERIALS The Particle Therapy Cooperative Group Skull Base/Central nervous system/Sarcoma Subcommittee consisting of radiation oncologists and medical physicists with specific expertise in spinal irradiation developed expert recommendations discussing treatment planning considerations and current approaches in the treatment of primary spinal tumors. RESULTS Computed tomography simulation: factors that require significant consideration include (1) patient comfort, (2) setup reproducibility and stability, and (3) accessibility of appropriate beam angles. SPINE STABILIZATION HARDWARE If present, hardware should be placed with cross-links well above/below the level of the primary tumor to reduce the metal burden at the level of the tumor bed. New materials that can reduce uncertainties include polyether-ether-ketone and composite polyether-ether-ketone-carbon fiber implants. FIELD ARRANGEMENT Appropriate beam selection is required to ensure robust target coverage and organ at risk sparing. Commonly, 2 to 4 treatment fields, typically from posterior and/or posterior-oblique directions, are used. TREATMENT PLANNING METHODOLOGY Robust optimization is recommended for all pencil beam scanning plans (the preferred treatment modality) and should consider setup uncertainty (between 3 and 7 mm) and range uncertainty (3%-3.5%). In the presence of metal hardware, use of an increased range uncertainty up to 5% is recommended. CONCLUSIONS The Particle Therapy Cooperative Group Skull Base/Central nervous system/Sarcoma Subcommittee has developed recommendations to enable centers to deliver PBT safely and effectively for the management of primary spinal tumors.
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Affiliation(s)
- Arpit M Chhabra
- Department of Radiation Oncology, New York Proton Center, New York, New York.
| | - James W Snider
- Department of Radiation Oncology, South Florida Proton Therapy Institute, Delray Beach, Florida
| | - Adam J Kole
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama
| | - Markus Stock
- Department of Medical Physics, EBG MedAustron, Wiener Neustadt, Austria
| | - Adam L Holtzman
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Robert Press
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
| | - C Jake Wang
- Department of Radiation Oncology, Willis Knighton Cancer Center, Shreveport, Louisiana
| | - Heng Li
- Department of Medical Physics, Johns Hopkins, Baltimore, Maryland
| | - Haibo Lin
- Department of Radiation Oncology, New York Proton Center, New York, New York
| | - Chengyu Shi
- Department of Medical Physics, City of Hope, Irvine, California
| | - Mark McDonald
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Michael Soike
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama
| | - Jun Zhou
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Pouya Sabouri
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sina Mossahebi
- Department of Medical Physics, Maryland Proton Treatment Center, Baltimore, Maryland
| | - Rovel Colaco
- Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Francesca Albertini
- Department of Medical Physics, Paul Scherrer Institut, Würenlingen, Switzerland
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
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2
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Bronk JK, McAleer MF, McGovern SL, Lassen-Ramshad Y, Safwat A, Daw NC, Rainusso N, Mahajan A, Grosshans DR, Paulino AC. Comprehensive radiotherapy for pediatric Ewing Sarcoma: Outcomes of a prospective proton study. Radiother Oncol 2024; 195:110270. [PMID: 38583721 DOI: 10.1016/j.radonc.2024.110270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/20/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND PURPOSE Patients with Ewing Sarcoma (EWS) are treated with multimodality therapy which includes radiation therapy (RT) as an option for local control. We report on the efficacy after proton radiation therapy (PRT) to the primary site for localized and metastatic EWS. MATERIALS AND METHODS Forty-two children with EWS (33 localized, 9 metastatic) treated between 2007 and 2020 were enrolled on 2 prospective registry protocols for pediatric patients undergoing PRT. PRT was delivered by passive scatter (74 %), pencil-beam scanning (12 %) or mixed technique (14 %). Treated sites included the spine (45 %), pelvis/sacrum (26 %), skull/cranium (14 %), extraosseous (10 %), and chest wall (5 %). Median radiation dose was 54 Gy-RBE (range 39.6-55.8 Gy-RBE). Patients with metastatic disease received consolidative RT to metastatic sites (4 at the time of PRT to the primary site, 5 after completion of chemotherapy). Median follow-up time was 47 months after PRT. RESULTS The 4-year local control (LC), progression-free survival (PFS), and overall survival (OS) rates were 83 %, 71 %, and 86 %, respectively. All local failures (n = 6) were in-field failures. Tumor size ≥ 8 cm predicted for inferior 4-year LC (69 % vs 95 %, p = 0.04). 4-year PFS and OS rates were not statistically different in patients with localized versus metastatic disease (72 % vs 67 %, p = 0.70; 89 % vs 78 %, p = 0.38, respectively). CONCLUSION In conclusion, LC for pediatric patients with EWS treated with PRT was comparable to that of historical patients who received photon-RT. Tumor size ≥ 8 cm predicted increased risk of local failure. Patients with metastatic disease, including non-pulmonary only metastases, received radiation therapy to all metastatic sites and had favorable survival outcomes.
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Affiliation(s)
- Julianna K Bronk
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States.
| | - Mary Frances McAleer
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Susan L McGovern
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Akmal Safwat
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Najat C Daw
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nino Rainusso
- Department of Pediatrics, Division of Hematology-Oncology, Baylor College of Medicine and Texas Children's Hospital Cancer and Hematology Centers, Houston, TX, United States
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - David R Grosshans
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Arnold C Paulino
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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3
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Foster-Thomas E, Aznar M, Brennan B, O’Malley L. Proton beam therapy and dentofacial development in paediatric cancer patients: A scoping review. Int J Part Ther 2024; 12:100107. [PMID: 38952615 PMCID: PMC11215291 DOI: 10.1016/j.ijpt.2024.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 07/03/2024] Open
Abstract
Purpose It is known that radiation to dentofacial structures during childhood can lead to developmental disturbances. However, this appears to be a relatively subordinated research subject. For this reason, this review aims to establish the current evidence base on the effect of PBT on dentofacial development in paediatric patients treated for cancer in the head and neck region. Materials and methods A comprehensive search was undertaken to identify both published and unpublished studies or reports. A single reviewer completed initial screening of abstracts; 2 independent reviewers completed secondary screening and data extraction. A narrative synthesis was then conducted. Results 82 records were screened in total, resulting in 11 included articles. These articles varied in terms of study design and reporting quality. Owing to both poor study reporting and limited patient numbers, it is not possible to determine the effect of cancer diagnosis, chronological age at treatment, radiation dose or treatment modality on the incidence of facial deformation or dental development anomalies. Conclusion Disturbances in dentofacial development are an under-reported toxicity in paediatric cancer survivors treated with PBT to the head and neck. There is a need for more research on dentofacial toxicity reporting, focused on the impact of treatment age, radiation dose, concurrent therapies, and the subsequent impact on quality of life.
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Affiliation(s)
- Emma Foster-Thomas
- NIHR Doctoral Fellow in Restorative Dentistry, Manchester University NHS Foundation Trust, UK
| | - Marianne Aznar
- Adaptive Radiotherapy, University of Manchester, Division of Clinical Cancer Science, School of Medical Sciences, UK
| | - Bernadette Brennan
- Consultant Paediatric Oncologist, Royal Manchester Children’s Hospital, UK
| | - Lucy O’Malley
- Health Services Research, School of Medical Sciences, The University of Manchester, UK
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Zarghooni K, Bratke G, Landgraf P, Simon T, Maintz D, Eysel P. The Diagnosis and Treatment of Osteosarcoma and Ewing's Sarcoma in Children and Adolescents. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:405-412. [PMID: 37097079 PMCID: PMC10437036 DOI: 10.3238/arztebl.m2023.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 06/24/2022] [Accepted: 03/22/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Osteosarcoma and Ewing's sarcoma in children and adolescents require age-specific interdisciplinary diagnosis and treatment to achieve optimal therapeutic outcomes. METHODS The diagnosis and treatment of malignant bone tumors in childhood and adolescence are presented in the light of publications retrieved by a selective search, pertinent guidelines, and the authors' extensive experience in an interdisciplinary cancer center. RESULTS Bone sarcomas make up approximately 5% of all malignancies in children and adolescents; the most common types are Ewing's sarcoma and osteosarcoma. Patients are often not referred to a specialized center until long after the onset of symptoms, as they and their physicians rarely consider the possibility of a bone tumor, and the symptoms are often trivialized. Bone pain of unknown origin, swelling, and functional limitations should be investigated with conventional x-rays. Lesions of unclear origin should be biopsied after a meticulous clinical and radiologic evaluation. Multimodal treatment consists of neo - adjuvant chemotherapy, limb-preserving resection if possible, and radiotherapy where indicated. In multicenter studies, patients with osteosarcoma achieve event-free survival in 64% of cases if their disease is localized, and 28% if it is metastatic; the corresponding figures for patients with Ewing's sarcoma are 80% and 27%, respectively. CONCLUSION With implementation of the current treatment recommendations, most children and adolescents with malignant bone tumors can be treated successfully with curative intent. These patients should be referred to a sarcoma center for diagnosis and treatment.
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Affiliation(s)
- Kourosh Zarghooni
- Department of Orthopedics and Trauma Surgery, Helios Hospital Hildesheim, Germany
- Department of Orthopedics and Trauma Surgery, University Hospital Cologne, Germany
| | - Grischa Bratke
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany
| | - Pablo Landgraf
- Department of Pediatric Oncology, University Hospital Cologne, Germany
| | - Thorsten Simon
- Department of Pediatric Oncology, University Hospital Cologne, Germany
| | - David Maintz
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, University Hospital Cologne, Germany
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Hwang E, Gaito S, France A, Crellin AM, Thwaites DI, Ahern V, Indelicato D, Timmermann B, Smith E. Outcomes of Patients Treated in the UK Proton Overseas Programme: Non-central Nervous System Group. Clin Oncol (R Coll Radiol) 2023; 35:292-300. [PMID: 36813694 DOI: 10.1016/j.clon.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/06/2022] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
AIMS The UK Proton Overseas Programme (POP) was launched in 2008. The Proton Clinical Outcomes Unit (PCOU) warehouses a centralised registry for collection, curation and analysis of all outcomes data for all National Health Service-funded UK patients referred and treated abroad with proton beam therapy (PBT) via the POP. Outcomes are reported and analysed here for patients diagnosed with non-central nervous system tumours treated from 2008 to September 2020 via the POP. MATERIALS AND METHODS All non-central nervous system tumour files for treatments as of 30 September 2020 were interrogated for follow-up information, and type (following CTCAE v4) and time of onset of any late (>90 days post-PBT completion) grade 3-5 toxicities. RESULTS Four hundred and ninety-five patients were analysed. The median follow-up was 2.1 years (0-9.3 years). The median age was 11 years (0-69 years). 70.3% of patients were paediatric (<16 years). Rhabdomyosarcoma (RMS) and Ewing sarcoma were the most common diagnoses (42.6% and 34.1%). 51.3% of treated patients were for head and neck (H&N) tumours. At last known follow-up, 86.1% of all patients were alive, with a 2-year survival rate of 88.3% and 2-year local control of 90.3%. Mortality and local control were worse for adults (≥25 years) than for the younger groups. The grade 3 toxicity rate was 12.6%, with a median onset of 2.3 years. Most were in the H&N region in paediatric patients with RMS. Cataracts (30.5%) were the most common, then musculoskeletal deformity (10.1%) and premature menopause (10.1%). Three paediatric patients (1-3 years at treatment) experienced secondary malignancy. Seven grade 4 toxicities occurred (1.6%), all in the H&N region and most in paediatric patients with RMS. Six related to eyes (cataracts, retinopathy, scleral disorder) or ears (hearing impairment). CONCLUSIONS This study is the largest to date for RMS and Ewing sarcoma, undergoing multimodality therapy including PBT. It demonstrates good local control, survival and acceptable toxicity rates.
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Affiliation(s)
- E Hwang
- The Christie Proton Beam Therapy Centre, The Christie NHS Foundation Trust, Manchester, UK; Department of Radiation Oncology, Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, NSW, Australia; Institute of Medical Physics, School of Physics, University of Sydney, NSW, Australia.
| | - S Gaito
- Proton Clinical Outcomes Unit, The Christie NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - A France
- Proton Clinical Outcomes Unit, The Christie NHS Foundation Trust, Manchester, UK
| | - A M Crellin
- NHS England National Clinical Lead Proton Beam Therapy, UK
| | - D I Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, NSW, Australia; Radiotherapy Research Group, Leeds Institute of Medical Research, St James's Hospital and School of Medicine, Leeds University, Leeds, UK
| | - V Ahern
- Department of Radiation Oncology, Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, NSW, Australia; Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - D Indelicato
- University of Florida Department of Radiation Oncology, Jacksonville, FL, USA
| | - B Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen, West German Cancer Centre, German Cancer Consortium, Essen, Germany
| | - E Smith
- The Christie Proton Beam Therapy Centre, The Christie NHS Foundation Trust, Manchester, UK; Proton Clinical Outcomes Unit, The Christie NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, Manchester, UK
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7
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Foster-Thomas E, Aznar M, Indelicato D, Pan S, Hwang E, Sitch P, Horner K, Smith E, Gaito S. Late Dental Toxicities After Proton Chemoradiation for Rhabdomyosarcoma: A Pediatric Case Report. Int J Part Ther 2022; 9:50-57. [PMID: 36721482 PMCID: PMC9875822 DOI: 10.14338/ijpt-22-00011.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose Radiation therapy is an independent risk factor for adverse sequelae to the oral cavity and dentition in childhood cancer survivors. However, dental toxicities after radiation therapy often are underreported and there are minimal published data on disturbances in tooth development after proton beam therapy (PBT). We present the long-term clinical and radiographic dental findings 8 years after treatment completion for a patient treated with PBT and chemotherapy for rhabdomyosarcoma. Materials and Methods Clinical follow-up data of patients treated with PBT within the Proton Overseas Programme (POP) is stored in a National Database and curated by a dedicated outcomes unit at the Christie NHS PBT center. This case report was identified from the extraction and analysis of data for pediatric head and neck cancer patients in this database for a service evaluation project. Results The permanent dentition in this patient aged 3.5 years at the time of treatment was severely affected with abnormal dental development first observed 3.5 years after treatment completion. PBT delivered mean doses of 30 Gy(RBE = 1.1) to the maxilla and 25.9 Gy(RBE = 1.1) to the mandible. Conclusion Significant dental development abnormalities occurred in this pediatric patient, despite doses in areas being lower than the proposed thresholds in the literature. Improved descriptions of dental toxicities and routine contouring of the maxilla and mandible are needed to correlate dosimetric data. The dose to teeth should be kept as low as reasonably possible in younger patients until the dose thresholds for dental toxicities are known.
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Affiliation(s)
- Emma Foster-Thomas
- Restorative Dentistry, University Dental Hospital of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Marianne Aznar
- Adaptive Radiotherapy, University of Manchester Division of Clinical Cancer Science, School of Medical Sciences, Manchester, UK
| | - Daniel Indelicato
- Department of Radiation Oncology, University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
| | - Shermaine Pan
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Eunji Hwang
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia
| | - Peter Sitch
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Keith Horner
- Dental and Maxillofacial Radiology, University Dental Hospital of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ed Smith
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Simona Gaito
- The Christie Proton Clinical Outcomes Unit/The University of Manchester Division of Clinical Cancer Science, School of Medical Sciences, Manchester, UK
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Mohindra S, Tripathi M, Batish A, Kapoor A, Patil NR, Mahendru S, Ahuja C, Chatterjee D. Primary Calvarial Ewing Sarcoma: A Case Series. Skull Base Surg 2022; 83:e181-e190. [DOI: 10.1055/s-0041-1722900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Abstract
Background Calvarial Ewing tumor is a relatively rare differential among bony neoplasms. We present our experience of managing primary calvarial Ewing sarcoma (EWS), highlighting their clinical and radiological findings.
Method In a retrospective analysis, we evaluated our 12-year database for pathologically proven EWS. A literature search was conducted for the comparative presentation and update on the management and outcome.
Result From January 2008 to December 2020, we managed eight patients (male:female = 5:3; age range 6 months to 19 years, mean 11.5 years) harboring primary calvarial EWS. All cases underwent wide local excision; two patients required intradural tumor resection, while one required rotation flap for scalp reconstruction. Mean hospital stay was 8 days. All patients received adjuvant chemo- and radiotherapy. Three patients remained asymptomatic at 5 years of follow-up, while two patients died.
Conclusion Primary calvarial EWS is a rare entity. It usually affects patients in the first two decades of life. These tumors can be purely intracranial, causing raised intracranial pressure symptoms, which may exhibit rapidly enlarging subgaleal tumors with only cosmetic deformities or symptoms of both. Radical excision followed by adjuvant therapy may offer a favorable long-term outcome.
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Affiliation(s)
- Sandeep Mohindra
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Batish
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Kapoor
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ninad Ramesh Patil
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shaurya Mahendru
- Medical Undergraduate, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Chirag Ahuja
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Indelicato DJ, Vega RBM, Viviers E, Morris CG, Bradfield SM, Ranalli NJ, Bradley JA. Modern Therapy for Spinal and Paraspinal Ewing Sarcoma: An Update of the XXX Experience. Int J Radiat Oncol Biol Phys 2022; 113:161-165. [PMID: 35033584 DOI: 10.1016/j.ijrobp.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE In 2010, we published a comprehensive review of our institutional outcomes treating children with spinal and paraspinal Ewing sarcoma using photon therapy. Multimodality therapy was associated with fair disease control but also with serious toxicity, including a 37% rate of Grade ≥3 toxicity. We therefore sought to assess our more recent experience treating children with more modern technology and treatment regimens. METHODS AND MATERIALS Between 2010 and 2021, 32 pediatric patients with nonmetastatic spinal and paraspinal Ewing sarcoma were treated at XXX and enrolled in a retrospective outcome study. Median age at diagnosis was 9.8 (range, 2.1-21.8) years old. Three, 22, and 7 tumors arose within the cervical, thoracic, and lumbar spine regions, respectively. Median maximum tumor diameter was 5 (range, 3-19) cm. At diagnosis, 28/32 patients had motor, bowel, or bladder deficits. Chemotherapy was delivered per contemporary North American and European interval-compressed regimens. Before radiotherapy, 14 patients underwent gross total resection while 18 underwent a biopsy or subtotal resection with cord decompression. All patients were treated with proton therapy; 6 with hardware stabilization also received a component of intensity-modulated photon therapy. Median prescription dose was 50.4 (range, 45-54) GyRBE. Median maximum dose to the spinal cord was 50.2 (range, 0-54.9) GyRBE. RESULTS With a median follow-up of 4.1 (range, 0.7 - 9.4) years, the 5-year local control, progression-free survival, and overall survival rates were 92%, 79%, and 85%, respectively. Ten of 30 living patients have residual motor, bowel, or bladder deficits. Overall, 22% of patients experienced CTCAE grade 3 late toxicity related to multimodality treatment: kyphosis (n=4), esophagitis (n=2) and chronic kidney disease (n=1). No patients developed grade ≥4 toxicity, new neurologic deficits, or second malignancy. CONCLUSION Modern treatment advances may offer an improved therapeutic ratio for pediatric spinal and paraspinal Ewing sarcoma. With appropriate management, most patients can be cured with recovery of long-term neurologic function and modest side-effects.
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Affiliation(s)
- Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL.
| | - Raymond B Mailhot Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - Emma Viviers
- University of Florida Health Proton Therapy Institute, Jacksonville, FL
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - Scott M Bradfield
- Department of Pediatrics, Nemours Children's Specialty Care, Jacksonville, FL
| | - Nathan J Ranalli
- Department of Neurosurgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
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10
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Gigliotti MJ, Mau C, Specht CS, Lawson C, McNutt S, Natarajan S, Rizk EB, Iantosca M. Malignant spindle cell tumors of the posterior fossa in children: case series and review of management. J Neurosurg Pediatr 2021; 28:609-619. [PMID: 34416730 DOI: 10.3171/2021.3.peds2148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/25/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The WHO Classification of Tumours of the Central Nervous System (2016) classifies nonmeningothelial malignant spindle cell tumors involving the extraaxial tissues of the posterior fossa as melanocytic tumors and malignant mesenchymal tumors (sarcomas). The objective of this study was to conduct a review of the literature pertaining to the management strategies of posterior fossa malignant spindle cell tumors in the pediatric population. METHODS The authors performed an institutional search of their pathology database for patients younger than 18 years of age who presented with posterior fossa malignant spindle cell tumors. A literature review was also performed using the PubMed database, with "posterior fossa" or "spindle cell tumors" or "Ewing sarcoma" or "high-grade" or "spindle cell sarcoma" or "leptomeningeal melanocytoma" as keywords. The database search was restricted to pediatric patients (age ≤ 18 years). Parameters reported from the literature review included patient age, tumor location, presenting symptoms, treatment modalities (resection, chemotherapy, and/or radiotherapy), leptomeningeal spread at or after the time of treatment, and follow-up length and resulting outcome. RESULTS The authors report 3 rare cases of posterior fossa malignant spindle cell tumors, including Ewing sarcoma in a 13-year-old male; high-grade spindle cell sarcoma, not otherwise specified in a 10-year-old male; and primary leptomeningeal melanocytoma in a 16-year-old female. All 3 patients underwent resection and radiotherapy and either chemotherapy or targeted immunotherapy. At the last follow-up, all patients were alive with either resolution or stable disease. CONCLUSIONS A review of these 3 cases and the existing literature support managing patients with intracranial malignant spindle cell tumors with multimodal therapy that can include a combination of resection, radiotherapy, and chemotherapy or immunotherapy to prolong progression-free and overall survival.
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Affiliation(s)
- Michael J Gigliotti
- 1Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey
| | - Christine Mau
- 1Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey
| | - Charles S Specht
- 1Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey
- 2Department of Pathology, Penn State Health Milton S. Hershey Medical Center, Hershey; and
| | - Cynthia Lawson
- 2Department of Pathology, Penn State Health Milton S. Hershey Medical Center, Hershey; and
| | - Sarah McNutt
- 3College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Shreela Natarajan
- 3College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Elias B Rizk
- 1Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey
| | - Mark Iantosca
- 1Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey
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11
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Meazza C, Luksch R, Luzzati A. Managing axial bone sarcomas in childhood. Expert Rev Anticancer Ther 2021; 21:747-764. [PMID: 33593222 DOI: 10.1080/14737140.2021.1891886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Axial osteosarcoma and Ewing sarcoma are rare, aggressive neoplasms with a worse prognosis than with tumors involving the extremities because they are more likely to be associated with larger tumor volumes, older age, primary metastases, and a poor histological response to chemotherapy. The 5-year OS rates are reportedly in the range of 18-41% for axial osteosarcoma, and 46-64% for Ewing sarcoma.Area covered: The treatment of axial bone tumors is the same as for extremity bone tumors, and includes chemotherapy, surgery and/or radiotherapy.Expert opinion: Local treatment of axial tumors is particularly difficult due to their proximity to neurological and vascular structures, which often makes extensive and en bloc resections impossible without causing significant morbidity. The incidence of local relapse is consequently high, and this is the main issue in the treatment of these tumors. Radiotherapy is an option in the case of surgical resections with close or positive margins, as well as for inoperable tumors. Delivering high doses of RT to the spinal cord can be dangerous. Given the complexity and rarity of these tumors, it is essential for this subset of patients to be treated at selected reference institutions with specific expertise and multidisciplinary skills.
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Affiliation(s)
- Cristina Meazza
- Pediatric Oncology Unit, Medical Oncology and Emathology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Medical Oncology and Emathology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Alessandro Luzzati
- Orthopedic Oncology and Spinal Reconstruction Surgery, Orthopedic Oncology Department, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
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Bouaoud J, Temam S, Galmiche L, Cozic N, Bolle S, Belhous K, Kolb F, Qassemyar Q, Bidault F, Couloigner V, Picard A, Le Deley MC, Mahier-Ait Oukhatar C, Gaspar N, Kadlub N. Head and neck Ewing sarcoma: French surgical practice analysis pleads for surgery centralization. J Craniomaxillofac Surg 2021; 50:439-448. [DOI: 10.1016/j.jcms.2021.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 11/07/2020] [Accepted: 01/31/2021] [Indexed: 12/26/2022] Open
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13
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Palmer JD, Gamez ME, Ranta K, Ruiz-Garcia H, Peterson JL, Blakaj DM, Prevedello D, Carrau R, Mahajan A, Chaichana KL, Trifiletti DM. Radiation therapy strategies for skull-base malignancies. J Neurooncol 2020; 150:445-462. [PMID: 32785868 DOI: 10.1007/s11060-020-03569-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The management of skull base malignancies continues to evolve with improvements in surgical technique, advances in radiation delivery and novel systemic agents. METHODS In this review, we aim to discuss in detail the management of common skull base pathologies which typically require multimodality therapy, focusing on the radiotherapeutic aspects of care. RESULTS Technological advances in the administration of radiation therapy have led to a wide variety of different treatment strategies for the treatment of skull base malignances, with outcomes summarized herein. CONCLUSION Radiation treatment plays a key and critical role in the management of patients with skull base tumors. Recent advancements continue to improve the risk/benefit ratio for radiotherapy in this setting.
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Affiliation(s)
- J D Palmer
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - M E Gamez
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - K Ranta
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - H Ruiz-Garcia
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - J L Peterson
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA.,Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - D M Blakaj
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - D Prevedello
- Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Otolaryngology - Head and Neck Surgery at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - R Carrau
- Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Otolaryngology - Head and Neck Surgery at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - A Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - K L Chaichana
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - D M Trifiletti
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA. .,Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA.
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