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Title: Intensity Modulated Radiation Therapy With Dose Painting to Treat Rhabdomyosarcoma

Abstract

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 diseasemore » 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.« less

Authors:
;  [1];  [2];  [3];  [4];  [1]
  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)
Publication Date:
OSTI Identifier:
22149595
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 84; Journal Issue: 3; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ADOLESCENTS; CHEMOTHERAPY; CHILDREN; FAILURES; HEALTH HAZARDS; LYMPH NODES; NEOPLASMS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; SURGERY

Citation Formats

Yang, Joanna C., Dharmarajan, Kavita V., Wexler, Leonard H., La Quaglia, Michael P., Happersett, Laura, and Wolden, Suzanne L., E-mail: woldens@mskcc.org. Intensity Modulated Radiation Therapy With Dose Painting to Treat Rhabdomyosarcoma. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2012.04.022.
Yang, Joanna C., Dharmarajan, Kavita V., Wexler, Leonard H., La Quaglia, Michael P., Happersett, Laura, & Wolden, Suzanne L., E-mail: woldens@mskcc.org. Intensity Modulated Radiation Therapy With Dose Painting to Treat Rhabdomyosarcoma. United States. doi:10.1016/J.IJROBP.2012.04.022.
Yang, Joanna C., Dharmarajan, Kavita V., Wexler, Leonard H., La Quaglia, Michael P., Happersett, Laura, and Wolden, Suzanne L., E-mail: woldens@mskcc.org. Thu . "Intensity Modulated Radiation Therapy With Dose Painting to Treat Rhabdomyosarcoma". United States. doi:10.1016/J.IJROBP.2012.04.022.
@article{osti_22149595,
title = {Intensity Modulated Radiation Therapy With Dose Painting to Treat Rhabdomyosarcoma},
author = {Yang, Joanna C. and Dharmarajan, Kavita V. and Wexler, Leonard H. and La Quaglia, Michael P. and Happersett, Laura and Wolden, Suzanne L., E-mail: woldens@mskcc.org},
abstractNote = {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.},
doi = {10.1016/J.IJROBP.2012.04.022},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 3,
volume = 84,
place = {United States},
year = {2012},
month = {11}
}