Intensity Modulated Radiation Therapy With Dose Painting to Treat Rhabdomyosarcoma

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

DOI:https://doi.org/10.1016/J.IJROBP.2012.04.022· OSTI ID:22149595

Yang, Joanna C.; Dharmarajan, Kavita V. ^[1]; Wexler, Leonard H. ^[2]; La Quaglia, Michael P. ^[3]; Happersett, Laura ^[4]

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1. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
2. Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
3. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
4. Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

Purpose: To examine local control and patterns of failure in rhabdomyosarcoma patients treated with intensity modulated radiation therapy (RT) with dose painting (DP-IMRT). Patients and Methods: A total of 41 patients underwent DP-IMRT with chemotherapy for definitive treatment. Nineteen also underwent surgery with or without intraoperative RT. Fifty-six percent had alveolar histologic features. The median interval from beginning chemotherapy to RT was 17 weeks (range, 4-25). Very young children who underwent second-look procedures with or without intraoperative RT received reduced doses of 24-36 Gy in 1.4-1.8-Gy fractions. Young adults received 50.4 Gy to the primary tumor and lower doses of 36 Gy in 1.8-Gy fractions to at-risk lymph node chains. Results: With 22 months of median follow-up, the actuarial local control rate was 90%. Patients aged {<=}7 years who received reduced overall and fractional doses had 100% local control, and young adults had 79% (P=.07) local control. Three local failures were identified in young adults whose primary target volumes had received 50.4 Gy in 1.8-Gy fractions. Conclusions: DP-IMRT with lower fractional and cumulative doses is feasible for very young children after second-look procedures with or without intraoperative RT. DP-IMRT is also feasible in adolescents and young adults with aggressive disease who would benefit from prophylactic RT to high-risk lymph node chains, although dose escalation might be warranted for improved local control. With limited follow-up, it appears that DP-IMRT produces local control rates comparable to those of sequential IMRT in patients with rhabdomyosarcoma.

• OSTI ID: 22149595
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 3 Vol. 84; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ADOLESCENTS
CHEMOTHERAPY
CHILDREN
FAILURES
HEALTH HAZARDS
LYMPH NODES
NEOPLASMS
PATIENTS
RADIATION DOSES
RADIOTHERAPY
SURGERY