Brachytherapy Combined With Surgery for Conservative Treatment of Children With Bladder Neck and/or Prostate Rhabdomyosarcoma

Journal Article · Thu Jun 01 04:00:00 EDT 2017 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2017.02.026· OSTI ID:22649932

Chargari, Cyrus ^[1]; Haie-Meder, Christine ^[1]; Guérin, Florent ^[2]; Minard-Colin, Véronique ^[3]; Lambert, Guénolée de ^[2]; Mazeron, Renaud; Escande, Alexandre; Marsolat, Fanny; Dumas, Isabelle ^[1]; Deutsch, Eric ^[1]; Valteau-Couanet, Dominique ^[3]; others, and

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1. Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif (France)
2. Department of Pediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre (France)
3. Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif (France)

Purpose: To report the results of a conservative strategy based on partial surgery combined with brachytherapy in a prospective cohort of children with bladder–prostate rhabdomyosarcoma (BP RMS). Methods and Materials: We prospectively documented the outcome of children treated in our department between 1991 and 2015 for BP RMS and undergoing a multimodal approach combining conservative surgery (partial cystectomy and/or partial prostatectomy) and perioperative interstitial low-dose-rate or pulse-dose-rate brachytherapy. Before brachytherapy, children had received chemotherapy with modalities depending on their risk group of treatment. Results: A total of 100 patients were identified, with a median age of 28 months (range, 5.6 months-14 years). According to the Intergroup Rhabdomyosarcoma Study (IRS) group, 84 were IRS-III, and 12 were IRS-IV tumors. Four patients were treated at relapse. The median number of chemotherapy cycles before local therapy was 6 (range, 4-13). After surgery, 63 patients had a macroscopic tumor residuum. Five patients underwent a brachytherapy boost before pelvic external beam radiation therapy because of nodal involvement, and 95 had exclusive brachytherapy. Median follow-up was 64 months (range, 6 months-24.5 years). Five-year disease-free and overall survival rates were 84% (95% confidence interval 80%-88%) and 91% (95% confidence interval 87%-95%), respectively. At last follow-up most survivors presented with only mild to moderate genitourinary sequelae and a normal diurnal urinary continence. Five patients required a secondary total cystectomy: 3 for a nonfunctional bladder and 2 for relapse. Conclusion: Brachytherapy is effective as part of a conservative strategy for BP RMS, with a relatively low delayed toxicity as compared with previously published studies using external beam radiation therapy. Longer follow-up is required to ensure that the functional results are maintained over time.

• OSTI ID: 22649932
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 2 Vol. 98; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BLADDER
BRACHYTHERAPY
CHEMOTHERAPY
CHILDREN
CONNECTIVE TISSUE
EXTERNAL BEAM RADIATION THERAPY
PATIENTS
RADIATION HAZARDS
RHABDOMYOSARCOMAS
SURGERY