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Dávila Fajardo R, Scarzello G, Gaze MN, Boterberg T, Cameron A, Fuchs J, Guérin F, Hoskin P, Krasin MJ, Kroon P, Magelssen H, Mercke C, Merks JHM, Paulsen F, Pommier P, Ramos M, Rees H, Rogers T, Schmid M, Seitz G, Slater O, Smeulders N, Stenman J, Terwisscha S, Chargari C, Mandeville HC. Brachytherapy for rhabdomyosarcoma: Survey of international clinical practice and development of guidelines. Radiother Oncol 2024; 195:110273. [PMID: 38588921 DOI: 10.1016/j.radonc.2024.110273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/07/2024] [Accepted: 04/04/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to address the lack of published data on the use of brachytherapy in pediatric rhabdomyosarcoma by describing current practice as starting point to develop consensus guidelines. MATERIALS AND METHODS An international expert panel on the treatment of pediatric rhabdomyosarcoma comprising 24 (pediatric) radiation oncologists, brachytherapists and pediatric surgeons met for a Brachytherapy Workshop hosted by the European paediatric Soft tissue Sarcoma Study Group (EpSSG). The panel's clinical experience, the results of a previously distributed questionnaire, and a review of the literature were presented. RESULTS The survey indicated the most common use of brachytherapy to be in combination with tumor resection, followed by brachytherapy as sole local therapy modality. HDR was increasingly deployed in pediatric practice, especially for genitourinary sites. Brachytherapy planning was mostly by 3D imaging based on CT. Recommendations for patient selection, treatment requirements, implant technique, delineation, dose prescription, dose reporting and clinical management were defined. CONCLUSIONS Consensus guidelines for the use of brachytherapy in pediatric rhabdomyosarcoma have been developed through multicenter collaboration establishing the basis for future work. These have been adopted for the open EpSSG overarching study for children and adults with Frontline and Relapsed RhabdoMyoSarcoma (FaR-RMS).
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Affiliation(s)
- Raquel Dávila Fajardo
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Division Imaging and Oncology, University Medical Center, Utrecht, the Netherlands.
| | | | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
| | - Alison Cameron
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.
| | - Joerg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Childreńs Hospital, Tuebingen, Germany
| | - Florent Guérin
- Department of Paediatric Surgery, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Paris, France
| | - Peter Hoskin
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Matthew J Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, USA
| | - Petra Kroon
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands; Division Imaging and Oncology, University Medical Center, Utrecht, the Netherlands.
| | | | - Claes Mercke
- Department of Oncology-Pathology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
| | - Johannes H M Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Division Imaging and Oncology, University Medical Center, Utrecht, the Netherlands.
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital, Tuebingen, Germany.
| | - Pascal Pommier
- Department of Radiation Oncology, Centre Leon Berard, Lyon, France.
| | - Monica Ramos
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Helen Rees
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.
| | - Tim Rogers
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Maximilian Schmid
- Medical University of Vienna, Department of Radiation Oncology, Comprehensive Cancer Center, Vienna, Austria.
| | - Guido Seitz
- Department of Pediatric Surgery and Urology, University Hospital Giessen-Marburg, Campus Marburg, Marburg, Germany.
| | - Olga Slater
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
| | - Naima Smeulders
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
| | - Jakob Stenman
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
| | - Sheila Terwisscha
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France.
| | - Henry C Mandeville
- The Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
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Yang N, Kong D, Wang X, Liu Y. Perianal rhabdomyosarcoma in an adult: A case report and review of the literature. Medicine (Baltimore) 2023; 102:e36276. [PMID: 38050209 PMCID: PMC10695526 DOI: 10.1097/md.0000000000036276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023] Open
Abstract
Perianal/perineal rhabdomyosarcomas (PRMS) is rare, and the outcome is poor. A 29-year-old female presented with perineal rhabdomyosarcomas revealed metastases to inguinal lymph nodes on the bilateral side. Disease progression was discovered when the patient got adjuvant epirubicin, ifosfamide, and bevacizumab for 2 cycles. After 3 cycles of nivolumab, dacarbazine, cisplatin, and vinblastine therapy, a partial response was identified in the patient. The surgical resection was performed. The patient received neoadjuvant chemotherapy before surgery and was weak after surgery, so he did not receive chemoradiotherapy. The patient succumbed after 11 months postoperatively due to widespread intraabdominal metastasis.
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Affiliation(s)
- Ning Yang
- Department of General Surgery, The First Affiliated Hospital, Hebei Medical University, Shijiazhuang, China
| | - Dexian Kong
- Department of Endocrinology, The Fourth Affiliated Hospital, Hebei Medical University, Shijiazhuang, China
| | - Xv Wang
- Department of Pathology, The Fourth Affiliated Hospital, Hebei Medical University, Shijiazhuang, China
| | - Yabin Liu
- Department of General Surgery, The Fourth Affiliated Hospital, Hebei Medical University, Shijiazhuang, China
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Polites SF, Rhee DS, Routh JC, Lautz TB, Rodeberg DA, Dasgupta R. Critical elements of pediatric rhabdomyosarcoma surgery. Semin Pediatr Surg 2023; 32:151341. [PMID: 38042091 DOI: 10.1016/j.sempedsurg.2023.151341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
Rhabdomyosarcoma (RMS), the most common soft tissue sarcoma in children, requires multimodal therapy which is determined by risk group stratification. Local control may be achieved by surgical resection, radiation, or both. Resection may occur upfront or following induction chemotherapy as a delayed primary excision. An R1 resection may allow a reduction in radiation exposure; however, debulking is not indicated nor is excision of residual masses at the end of therapy. Regional lymph node assessment is an important component of surgical care, as positive nodal basins require radiation. Depending on the tumor site and biology, sentinel lymph node biopsy vs biopsy of clinically or radiographically concerning nodes is indicated. Therapeutic lymph node dissection is never indicated. Familiarity with site-specific oncologic principles for RMS and participation in a multidisciplinary team including Pediatric Oncology and Radiation Oncology are necessary components of surgical care to ensure optimal outcomes.
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Affiliation(s)
- Stephanie F Polites
- Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Daniel S Rhee
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan C Routh
- Department of Urology, Duke University School of Medicine, Durham, NC, USA
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - David A Rodeberg
- Department of Surgery, Department of Pediatric Surgery, University of Kentucky, Lexington, KY, USA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA.
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Schmidt A, Roder C, Eckert F, Baumann D, Niyazi M, Fideler F, Ernemann U, Tatagiba M, Schäfer J, Urla C, Scherer S, Fuchs J, Paulsen F, Bender B. Increasing Patient Safety and Treatment Quality by Using Intraoperative MRI for Organ-Preserving Tumor Resection and High-Dose Rate Brachytherapy in Children with Bladder/Prostate and Perianal Rhabdomyosarcoma. Cancers (Basel) 2023; 15:3505. [PMID: 37444615 DOI: 10.3390/cancers15133505] [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: 06/16/2023] [Revised: 07/01/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
In children with bladder/prostate (BP) and perianal rhabdomyosarcoma (RMS), we use a hybrid treatment concept for those suitable, combining organ-preserving tumor resection and high-dose rate brachytherapy (HDR-BT). This treatment concept has been shown to improve outcomes. However, it is associated with specific challenges for the clinicians. The exact position of the tubes for BT is a prerequisite for precise radiotherapy. It can finally be determined only with an MRI or CT scan. We evaluated the use of an intraoperative MRI (iMRI) to control the position of the BT tubes and for radiotherapy planning in all patients with BP and perianal RMS who received the above-mentioned combination therapy in our department since January 2021. iMRI was used in 12 children. All tubes were clearly localized. No adverse events occurred. In all 12 children, radiotherapy could be started on time. In a historical cohort without iMRI, this was not possible in 3 out of 20 children. The use of iMRI in children with BP and perianal RMS improved patient safety and treatment quality. This technology has proven to be successful for the patient population we have defined and has become a standard procedure in our institution.
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Affiliation(s)
- Andreas Schmidt
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Constantin Roder
- Department of Neurosurgery, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital, Eberhard Karls University Tuebingen, 72070 Tuebingen, Germany
| | - Franziska Eckert
- Department of Radiation Oncology, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
- Department of Radiation Oncology, AKH, Comprehensive Cancer Center Vienna, Medical University Vienna, 1090 Vienna, Austria
| | - David Baumann
- Department of Radiation Oncology, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Frank Fideler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Ulrike Ernemann
- Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital, Eberhard Karls University Tuebingen, 72070 Tuebingen, Germany
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital, Eberhard Karls University Tuebingen, 72070 Tuebingen, Germany
| | - Jürgen Schäfer
- Department of Pediatric Radiology, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Cristian Urla
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Simon Scherer
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
- Center for Pediatric Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital, Eberhard Karls University Tuebingen, 72070 Tuebingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Benjamin Bender
- Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital, Eberhard Karls University Tuebingen, 72070 Tuebingen, Germany
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
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Developments in the Surgical Approach to Staging and Resection of Rhabdomyosarcoma. Cancers (Basel) 2023; 15:cancers15020449. [PMID: 36672397 PMCID: PMC9857078 DOI: 10.3390/cancers15020449] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
Although survival after rhabdosarcoma treatment has improved over the years, one third of patients still develop locoregional relapse. This review aims to highlight developments pertaining to staging and local treatment of specific RMS tumor sites, including head and neck, chest/trunk, bladder-prostate, female genito-urinary, perianal, and extremity sites.
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