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Schoot RA, Saeed P, Freling NJ, Blank LECM, Pieters BR, van der Grient JNB, Strackee SD, Bras J, Caron HN, Merks JHM. Local Resection and Brachytherapy for Primary Orbital Rhabdomyosarcoma: Outcome and Failure Pattern Analysis. Ophthalmic Plast Reconstr Surg 2017; 32:354-60. [PMID: 26398242 DOI: 10.1097/iop.0000000000000562] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Survival in patients with orbital rhabdomyosarcoma (RMS) is excellent. Therefore, new local treatment modalities, such as brachytherapy, have been developed to minimize adverse events. Since 1990, patients with orbital RMS and a residual tumor after induction chemotherapy were eligible for resection and brachytherapy. Otherwise patients received external beam radiotherapy. In this study, the authors describe the outcome for 20 patients with primary orbital RMS. The aim was to assess risk factors for treatment failure in this single center cohort. METHODS In this retrospective cohort study, the authors reviewed imaging studies, surgery reports, histology reports, and radiotherapy plans in a multidisciplinary setting. The authors included 20 consecutive patients with orbital RMS, treated between 1990 and 2007, (median age: 7.4 years, range: 0.7-16.1; median follow up: 11.5 years). RESULTS After induction chemotherapy, 12 patients were treated with surgery and brachytherapy, 2 with external beam radiotherapy, and in 5 patients who achieved complete remission, local treatment was withheld. In 1 patient, brachytherapy was incorrectly withheld after delayed surgery. Seven patients relapsed (no local treatment, N = 2; surgery and brachytherapy, N = 2; external beam radiotherapy, N = 2; surgery only, N = 1). The authors found no patient, tumor, or treatment characteristics that predisposed for treatment failure. Ten-year-overall survival and event-free survival were 89% and 65%, respectively. CONCLUSIONS Overall survival in this cohort of orbital RMS patients was good, including surgery and brachytherapy as treatment modality for orbital RMS resulted in an effective local treatment approach with fewer adverse events than external beam radiotherapy. The authors could not identify factors predisposing for treatment failure.
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Affiliation(s)
- Reineke A Schoot
- *Department of Pediatric oncology, Emma Children's Hospital-Academic Medical Center (EKZ-AMC), Amsterdam; †Department of Ophthalmology, Orbital Center, ‡Department of Radiology, §Department of Radiation Oncology, ‖Department of Plastic, Reconstructive and Hand Surgery, and ¶Department of Pathology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
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Koning CCE, Blank LECM, Koedooder C, van Os RM, van de Kar M, Jansen E, Battermann JJ, Beijert M, Gernaat C, van Herpen KAM, Hoekstra C, Horenblas S, Jobsen JJ, Krol ADG, Lybeert MLM, van Onna IEW, Pelger RCM, Poortmans P, Pos FJ, van der Steen-Banasik E, Slot A, Visser A, Pieters BR. Brachytherapy after external beam radiotherapy and limited surgery preserves bladders for patients with solitary pT1-pT3 bladder tumors. Ann Oncol 2012; 23:2948-2953. [PMID: 22718135 DOI: 10.1093/annonc/mds126] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Several French, Belgian and Dutch radiation oncologists have reported good results with the combination of limited surgery after external beam radiotherapy (EBRT) followed by brachytherapy in early-stage muscle-invasive bladder cancer. PATIENTS AND METHODS Data from 12 of 13 departments which are using this approach have been collected retrospectively, in a multicenter database, resulting in 1040 patients: 811 males and 229 females with a median age of 66 years, range 28-92 years. Results were analyzed according to tumor stage and diameter, histology grade, age and brachytherapy technique, continuous low-dose rate (CLDR) and pulsed dose rate (PDR). RESULTS At 1, 3 and 5 years, the local recurrence-free probability was 91%, 80% and 75%, metastasis-free probability was 91%, 80% and 74%, disease-free probability was 85%, 68% and 61% and overall survival probability was 91%, 74% and 62%, respectively. The differences in the outcome between the contributing departments were small. After multivariate analysis, the only factor influencing the local control rate was the brachytherapy technique. Toxicity consisted mainly of 24 fistula, 144 ulcers/necroses and 93 other types. CONCLUSIONS EBRT followed by brachytherapy, combined with limited surgery, offers excellent results in terms of bladder sparing for selected groups of patients suffering from bladder cancer.
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Affiliation(s)
- C C E Koning
- Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam.
| | - L E C M Blank
- Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam
| | - C Koedooder
- Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam
| | - R M van Os
- Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam
| | - M van de Kar
- Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam
| | - E Jansen
- Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam
| | - J J Battermann
- Departments of Radiation Oncology and Urology, University Medical Centre Utrecht, Utrecht
| | - M Beijert
- Department of Radiation Oncology, University Medical Centre Groningen, Groningen
| | - C Gernaat
- Department of Radiation Oncology, Medisch Spectrum Twente, Enschede
| | | | - C Hoekstra
- Radiotherapeutic Institute RISO, Department of Radiation Oncology, Deventer
| | - S Horenblas
- The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Departments of Urology and Radiation Oncology, Amsterdam
| | - J J Jobsen
- Department of Radiation Oncology, Medisch Spectrum Twente, Enschede
| | - A D G Krol
- Department of Radiation Oncology, University Medical Centre Leiden, Leiden
| | - M L M Lybeert
- Department of Radiation Oncology, Catharina Hospital Eindhoven
| | | | - R C M Pelger
- Department of Urology, University Medical Centre Leiden, Leiden
| | - P Poortmans
- Institute Verbeeten, Department of Radiation Oncology, Tilburg
| | - F J Pos
- The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Departments of Urology and Radiation Oncology, Amsterdam
| | | | - A Slot
- Radiotherapeutic Institute Friesland (RIF), Leeuwarden, The Netherlands
| | - A Visser
- Arnhem Radiotherapeutic Institute (ARTI), Arnhem
| | - B R Pieters
- Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam
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Baldeschi L, MacAndie K, Koetsier E, Blank LECM, Wiersinga WM. The influence of previous orbital irradiation on the outcome of rehabilitative decompression surgery in graves orbitopathy. Am J Ophthalmol 2008; 145:534-540. [PMID: 18191092 DOI: 10.1016/j.ajo.2007.10.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 10/15/2007] [Accepted: 10/19/2007] [Indexed: 11/15/2022]
Abstract
PURPOSE To investigate whether orbital irradiation influences the outcome of decompression surgery in Graves orbitopathy. DESIGN Retrospective, comparative case series. METHODS The medical records of all the patients with Graves orbitopathy treated with a three-wall orbital decompression through a coronal approach at our institution between January 1, 1990 and December 31, 2000 were reviewed. Only patients who underwent bilateral surgery for aesthetic rehabilitation, without preoperative diplopia, and who, in the active phase of the disease, had received orbital radiotherapy alone (20 Grays (Gy) in 10 daily fractions of two Gy over a period of two weeks; group R), systemic glucocorticoids alone (daily administration for more than three months independently from the dosage; group G), or both radiotherapy and glucocorticoids (group RG) were selected. Groups were compared for demographics, smoking habits, preoperative characteristics, and surgical outcome (mean reduction of exophthalmos, reduction of lid retraction, persistence of periorbital swelling requiring cosmetic eyelid surgery, onset of diplopia within 20 degrees of the central position of gaze, and variations in the peripheral field of diplopia). RESULTS Sixty-one of 376 patients were selected for this study. There were no differences between group R (n=29), group G (n=15), and group RG (n=17) with respect to demographics or predecompression characteristics, whereas the number of smokers was significantly greater in group RG (P=.019). We could not find differences in surgical outcome by comparing the three groups. CONCLUSIONS The total radiation dose, fraction size, and irradiated volume commonly used to treat active Graves orbitopathy do not adversely interfere with the outcome of rehabilitative decompression surgery.
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Affiliation(s)
- Lelio Baldeschi
- Orbital Center, Department of Ophthalmology, University of Amsterdam, Amsterdam, The Netherlands.
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Blank LECM, Koedooder K, van Os R, van de Kar M, van der Veen JH, Koning CCE. Results of bladder-conserving treatment, consisting of brachytherapy combined with limited surgery and external beam radiotherapy, for patients with solitary T1-T3 bladder tumors less than 5 cm in diameter. Int J Radiat Oncol Biol Phys 2007; 69:454-8. [PMID: 17560734 DOI: 10.1016/j.ijrobp.2007.03.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Revised: 03/13/2007] [Accepted: 03/14/2007] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the long-term, local relapse-free, distant metastasis-free, and overall survival rates in patients with a solitary bladder tumor <5 cm in diameter who were treated with external beam radiotherapy, limited surgery, and brachytherapy. METHODS AND MATERIALS The results of 122 patients after bladder-saving treatment were analyzed. After EBRT, the patients underwent cystotomy, and catheters were implanted. Of the 122 patients, 99 were treated with a continuous low-dose-rate technique and 23 patients with a pulsed-dose-rate technique. The median follow-up period was 5 years. RESULTS The 5-year local and distant relapse-free survival rate was 76% and 83%, respectively. The 5 and 10-year relapse-free survival rate was 69% and 66%, respectively. For overall survival, the corresponding rates were 73% and 49%. Toxicity was low. No differences were found between the continuous low-dose-rate and pulsed-dose-rate groups. CONCLUSION The results of our study have shown that external beam radiotherapy followed by brachytherapy as a bladder-saving treatment for a selected group of patients with bladder cancer yields excellent local tumor control and low toxicity.
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Affiliation(s)
- Leo E C M Blank
- Department of Radiotherapy, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Pieters BR, van der Grient JNB, Blank LECM, Koedooder K, Hulshof MCCM, de Reijke TM. Minimal displacement of novel self-anchoring catheters suitable for temporary prostate implants. Radiother Oncol 2006; 80:69-72. [PMID: 16870287 DOI: 10.1016/j.radonc.2006.06.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Revised: 06/12/2006] [Accepted: 06/26/2006] [Indexed: 11/24/2022]
Abstract
Catheters were developed that can be fixed in the prostate gland by self-expanding parts for use in PDR brachytherapy. Daily CT-scans were made to investigate the magnitude of catheter displacement. The mean absolute displacement during the 3 day treatment was 1.2 mm. The resulting minor alterations in dose-volume parameters were of no clinical importance.
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Affiliation(s)
- Bradley R Pieters
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, The Netherlands.
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Buwalda J, Freling NJ, Blank LECM, Balm AJM, Bras J, Voûte PA, Caron HN, Schouwenburg PF, Merks JHM. Amore protocol in pediatric head and neck rhabdomyosarcoma: Descriptive analysis of failure patterns. Head Neck 2005; 27:390-6. [PMID: 15825203 DOI: 10.1002/hed.20164] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The AMORE protocol is a local treatment for patients with nonorbital pediatric head and neck rhabdomyosarcoma (HNRMS). The objectives of this study were: (1) to assess the adequacy of the concept, and (2) to identify factors associated with relapse. METHODS We performed a retrospective multidisciplinary review of 22 children primarily treated according to the AMORE protocol, excluding two children with inadequate imaging data. RESULTS Seven patients had a local relapse, six within and one outside the residual tumor area. Five of the six patients with relapse in the residual area had gross total or debulking (incomplete) surgery, suboptimal position of the mold for brachytherapy, or both. In the 15 nonrecurrent cases, four patients had either incomplete surgery or suboptimal mold position. Both surgical and brachytherapeutic factors seem to be associated with relapse. CONCLUSIONS AMORE is an adequate concept. More rigid preoperative imaging and intraoperative verification of the brachytherapy mold position might lead to a reduction in the number of local failures.
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Affiliation(s)
- Joeri Buwalda
- Department of Otorhinolaryngology and Head and Neck Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22700, 1100 DE Amsterdam, The Netherlands. J.Buwalda @kmb.azu.nl
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Buwalda J, Blank LECM, Schouwenburg PF, Copper MP, Strackee SD, Voûte PA, Merks JHM, Caron HN. The AMORE protocol as salvage treatment for non-orbital head and neck rhabdomyosarcoma in children. Eur J Surg Oncol 2005; 30:884-92. [PMID: 15336736 DOI: 10.1016/j.ejso.2004.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2004] [Indexed: 10/01/2022] Open
Abstract
AIM To investigate the feasibility and outcome of the AMORE protocol as salvage treatment in paediatric head and neck rhabdomyosarcoma (HNRMS). METHODS The AMORE protocol is a local treatment regimen, consisting of Ablative surgery, Moulage technique brachytherapy and surgical Reconstruction, scheduled in 1 week. Patients with recurrent or residual non-orbital HNRMS were eligible for AMORE salvage treatment. RESULTS The procedure was feasible in nine out of 11 eligible patients. Five patients were treated for recurrent or residual parameningeal RMS after prior chemoradiation. Local complete remission was achieved in all five patients and maintained in four. Three patients are without evidence of RMS with a follow-up duration of 4-10 years. Two patients developed a distant relapse, together with a local recurrence in one. Both patients died of their disease. Four patients were included for recurrent non-parameningeal HNRMS. Long-term local control at the site of recurrence was obtained in all four patients (follow-up 5-10 years). CONCLUSIONS The AMORE protocol is a feasible salvage strategy for non-orbital HNRMS even after external beam radiotherapy. The local salvage rate in this series is promising.
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Affiliation(s)
- J Buwalda
- Department of Otorhinolaryngology and Head and Neck Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
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Wakelkamp IMMJ, Tan H, Saeed P, Schlingemann RO, Verbraak FD, Blank LECM, Prummel MF, Wiersinga WM. Orbital irradiation for Graves' ophthalmopathy: Is it safe? A long-term follow-up study. Ophthalmology 2004; 111:1557-62. [PMID: 15288988 DOI: 10.1016/j.ophtha.2003.12.054] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2003] [Accepted: 12/12/2003] [Indexed: 11/30/2022] Open
Abstract
PURPOSE We evaluated the frequency of long-term complications of orbital irradiation (radiation-induced tumors, cataract, and retinopathy) in comparison with glucocorticoids. DESIGN We conducted a follow-up study in a cohort of 245 Graves' ophthalmopathy patients who had been treated with retrobulbar irradiation (20 Gy in 2 weeks) and/or oral glucocorticoids between 1982 and 1993 in our institution. Irradiated patients were compared with nonirradiated patients. METHODS Data on mortality and cause of death were obtained. Living patients were invited to participate in a follow-up study. Possible retinopathy was assessed in a masked fashion and defined as the presence of > or =1 hemorrhages and/or microaneurysms on red-free retina photographs. If >5 lesions were present, patients were categorized as suffering from definite retinopathy. Cataract was assessed using the Lens Opacity Classification System II score. MAIN OUTCOME MEASURES Mortality, prevalence of retinopathy, prevalence of cataract, and type of cataract. RESULTS Thirty-seven of the 245 patients had died, none of them from an intracranial tumor. Mortality was similar in the irradiated (27/159 [17%]) and nonirradiated patients (10/86 [12%]; P = 0.264). One hundred fifty-seven of the 208 living patients (75%) consented to participate in a follow-up ophthalmologic investigation; the mean follow-up time (+/- standard deviation) was 11+/-3 years. Possible retinopathy was present in 15% of patients, 22 of the irradiated and 1 of the nonirradiated patients (P = 0.002). In 5 patients (all had been irradiated), definite retinopathy (i.e., >5 retinal lesions) was present. Of these, 3 had diabetes mellitus, and 1 had hypertension. Diabetes was associated with both possible (P = 0.029) and definite (P = 0.005) retinopathy, with a relative risk of 21 (95% confidence interval, 3-179). The prevalence and severity of cataract were similar in the radiotherapy group (29%) and the glucocorticoid group (34%); it should be noted that 88 of 104 of the irradiated patients were also treated with oral glucocorticoids. CONCLUSION The data suggest that orbital irradiation for Graves' ophthalmopathy is a safe treatment modality, except possibly for diabetic patients.
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Affiliation(s)
- Iris M M J Wakelkamp
- Department of Endocrinology & Metabolism, Academic Medical Center, University of Amsterdam, The Netherlands.
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Buwalda J, Schouwenburg PF, Blank LECM, Merks JHM, Copper MP, Strackee SD, Voûte PA, Caron HN. A novel local treatment strategy for advanced stage head and neck rhabdomyosarcomas in children: results of the AMORE protocol. Eur J Cancer 2003; 39:1594-602. [PMID: 12855267 DOI: 10.1016/s0959-8049(03)00363-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The AMORE protocol is a local treatment regimen for head and neck rhabdomyosarcomas (HNRMS), consisting of Ablative surgery, Moulage technique brachytherapy and surgical Reconstruction. The aim of AMORE is to intensify local treatment for children with HNRMS and to avoid external beam radiation therapy (EBRT) and its long-term sequelae. All children with primary irresectable, non-orbital HNRMS in whom EBRT was indicated, were evaluated for the feasibility of AMORE. In 20 children, AMORE was performed (15 with parameningeal disease and five with non-parameningeal disease). Complete remission was achieved in all 20 patients. Local complications were limited. 5 patients experienced a local relapse and 1 patient developed distant metastases. Estimated 5-year OS and EFS were 67.5 and 64.1% for the entire group, and 64.2 and 60.0% for the parameningeal subgroup. We conclude that the AMORE protocol is a feasible strategy, with a good local control rate. Long-term sequelae of EBRT might be avoided although, to date, the follow-up is too short for definitive conclusions regarding these sequelae.
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Affiliation(s)
- J Buwalda
- Department of Otolaryngology and Head and Neck Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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