Whole Abdominopelvic Intensity-Modulated Radiation Therapy for Desmoplastic Small Round Cell Tumor After Surgery

Journal Article · Tue May 01 04:00:00 EDT 2012 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2011.06.1985· OSTI ID:22056351

Pinnix, Chelsea C; Fontanilla, Hiral P ^[1]; Hayes-Jordan, Andrea ^[2]; Subbiah, Vivek ^[3]; Bilton, Stephen D; Chang, Eric L; Grosshans, David R; McAleer, Mary F; Sulman, Eric P; Woo, Shiao Y ^[1]; Anderson, Peter ^[3]; Green, Holly L ^[2]; Mahajan, Anita ^[1]

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1. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States)
2. Department of Pediatric Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States)
3. Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX (United States)

Purpose: Desmoplastic small round cell tumor (DSCRT) is an uncommon pediatric tumor with a poor prognosis. Aggressive multimodality therapy is the current treatment approach; however. treatment toxicity is of concern. We report our results with whole abdominopelvic intensity-modulated radiation therapy (WAP-IMRT) as a component of multimodality therapy for DSCRT at a single institution. Materials/Methods: Medical records of all patients with DSCRT who received WAP-IMRT as part of definitive treatment at MD Anderson (2006-2010) were identified and reviewed. Results: Eight patients with DSRCT received WAP-IMRT with a median follow-up of 15.2 months. All patients received multiple courses of chemotherapy followed by surgical debulking of intra-abdominal disease; seven also had intraoperative hyperthermic cisplatin. WAP-IMRT was delivered to a total dose of 30 Gy postoperatively; four patients received a simultaneous boost (6-10 Gy) to sites of gross residual disease. Seven patients received concurrent chemotherapy during WAP-IMRT. No Radiation Therapy Oncology Group Grade 4 nausea, vomiting, or diarrhea occurred during RT. Red-cell transfusions were given to two patients to maintain hemoglobin levels >10 g/dL. Grade 4 cytopenia requiring growth factor support occurred in only one patient; no other significant cytopenias were noted. WAP-IMRT resulted in 25% lower radiation doses to the lumbosacral vertebral bodies and pelvic bones than conventional RT plans. The median time to local or distant failure after WAP-IMRT was 8.73 months in seven patients. One patient who had completed RT 20 months before the last follow-up remains alive without evidence of disease. Five patients (63%) experienced treatment failure in the abdomen. Distant failure occurred in three patients (37.5%). Conclusions: WAP-IMRT with concurrent radiosensitizing chemotherapy was well tolerated after aggressive surgery for DSCRT. Enhanced bone sparing with IMRT probably accounts for the low hematologic toxicity (vs. conventional WAP-RT). This modality should be considered as an additional local-regional control option for DSRCT.

• OSTI ID: 22056351
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 83; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ABDOMEN
CHEMOTHERAPY
DIARRHEA
FAILURES
GROWTH FACTORS
HEMOGLOBIN
MEDICAL RECORDS
NAUSEA
PATIENTS
PEDIATRICS
RADIATION DOSES
RADIOTHERAPY
SARCOMAS
SKELETON
SURGERY
TOXICITY
TRANSFUSIONS
VOMITING