Proton Radiotherapy for Parameningeal Rhabdomyosarcoma: Clinical Outcomes and Late Effects

Journal Article · Wed Feb 01 04:00:00 EST 2012 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2010.11.048· OSTI ID:22056005

Childs, Stephanie K ^[1]; Kozak, Kevin R ^[2]; Friedmann, Alison M ^[3]; Yeap, Beow Y ^[4]; Adams, Judith; MacDonald, Shannon M; Liebsch, Norbert J; Tarbell, Nancy J ^[1]

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1. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)
2. Department of Radiation Oncology, University of Wisconsin Cancer Center Johnson Creek, Madison, WI (United States)
3. Department of Pediatric Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)
4. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)

Purpose: To report the clinical outcome and late side effect profile of proton radiotherapy in the treatment of children with parameningeal rhabdomyosarcoma (PM-RMS). Methods and Materials: Seventeen consecutive children with PM-RMS were treated with proton radiotherapy at Massachusetts General Hospital between 1996 and 2005. We reviewed the medical records of all patients and asked referring physicians to report specific side effects of interest. Results: Median patient age at diagnosis was 3.4 years (range, 0.4-17.6). Embryonal (n = 11), alveolar (n = 4), and undifferentiated (n = 2) histologies were represented. Ten patients (59%) had intracranial extension. Median prescribed dose was 50.4 cobalt gray equivalents (GyRBE) (range, 50.4-56.0 GyRBE) delivered in 1.8-2.0-GyRBE daily fractions. Median follow-up was 5.0 years for survivors. The 5-year failure-free survival estimate was 59% (95% confidence interval, 33-79%), and overall survival estimate was 64% (95% confidence interval, 37-82%). Among the 7 patients who failed, sites of first recurrence were local only (n = 2), regional only (n = 2), distant only (n = 2), and local and distant (n = 1). Late effects related to proton radiotherapy in the 10 recurrence-free patients (median follow-up, 5 years) include failure to maintain height velocity (n = 3), endocrinopathies (n = 2), mild facial hypoplasia (n = 7), failure of permanent tooth eruption (n = 3), dental caries (n = 5), and chronic nasal/sinus congestion (n = 2). Conclusions: Proton radiotherapy for patients with PM-RMS yields tumor control and survival comparable to that in historical controls with similar poor prognostic factors. Furthermore, rates of late effects from proton radiotherapy compare favorably to published reports of photon-treated cohorts.

• OSTI ID: 22056005
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 2 Vol. 82; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CARIES
CHILDREN
COBALT
CONTROL
DIAGNOSIS
FAILURES
HISTOLOGY
MEDICAL RECORDS
NEOPLASMS
NOSE
PATIENTS
PEDIATRICS
PHOTONS
PROTONS
RADIATION DOSE UNITS
RADIATION DOSES
RADIOTHERAPY
SIDE EFFECTS
SINUSES
TEETH