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

Abstract

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 onlymore » 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.« less

Authors:
 [1];  [2];  [2];  [1];  [3];  [4];  [3]; ; ; ;  [1];  [1];  [2];  [4];
  1. Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif (France)
  2. (France)
  3. Department of Pediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre (France)
  4. Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif (France)
Publication Date:
OSTI Identifier:
22649932
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 98; Journal Issue: 2; Other Information: Copyright (c) 2017 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BLADDER; BRACHYTHERAPY; CHEMOTHERAPY; CHILDREN; CONNECTIVE TISSUE; EXTERNAL BEAM RADIATION THERAPY; PATIENTS; RADIATION HAZARDS; RHABDOMYOSARCOMAS; SURGERY

Citation Formats

Chargari, Cyrus, E-mail: cyrus.chargari@gustaveroussy.fr, Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, Haie-Meder, Christine, Guérin, Florent, Minard-Colin, Véronique, Lambert, Guénolée de, Mazeron, Renaud, Escande, Alexandre, Marsolat, Fanny, Dumas, Isabelle, Deutsch, Eric, Faculté de Médecine Paris Sud, Université Paris Sud, Université Paris Saclay, Paris, Valteau-Couanet, Dominique, and and others. Brachytherapy Combined With Surgery for Conservative Treatment of Children With Bladder Neck and/or Prostate Rhabdomyosarcoma. United States: N. p., 2017. Web. doi:10.1016/J.IJROBP.2017.02.026.
Chargari, Cyrus, E-mail: cyrus.chargari@gustaveroussy.fr, Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, Haie-Meder, Christine, Guérin, Florent, Minard-Colin, Véronique, Lambert, Guénolée de, Mazeron, Renaud, Escande, Alexandre, Marsolat, Fanny, Dumas, Isabelle, Deutsch, Eric, Faculté de Médecine Paris Sud, Université Paris Sud, Université Paris Saclay, Paris, Valteau-Couanet, Dominique, & and others. Brachytherapy Combined With Surgery for Conservative Treatment of Children With Bladder Neck and/or Prostate Rhabdomyosarcoma. United States. doi:10.1016/J.IJROBP.2017.02.026.
Chargari, Cyrus, E-mail: cyrus.chargari@gustaveroussy.fr, Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, Haie-Meder, Christine, Guérin, Florent, Minard-Colin, Véronique, Lambert, Guénolée de, Mazeron, Renaud, Escande, Alexandre, Marsolat, Fanny, Dumas, Isabelle, Deutsch, Eric, Faculté de Médecine Paris Sud, Université Paris Sud, Université Paris Saclay, Paris, Valteau-Couanet, Dominique, and and others. Thu . "Brachytherapy Combined With Surgery for Conservative Treatment of Children With Bladder Neck and/or Prostate Rhabdomyosarcoma". United States. doi:10.1016/J.IJROBP.2017.02.026.
@article{osti_22649932,
title = {Brachytherapy Combined With Surgery for Conservative Treatment of Children With Bladder Neck and/or Prostate Rhabdomyosarcoma},
author = {Chargari, Cyrus, E-mail: cyrus.chargari@gustaveroussy.fr and Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge and French Military Health Service Academy, Ecole du Val-de-Grâce, Paris and Haie-Meder, Christine and Guérin, Florent and Minard-Colin, Véronique and Lambert, Guénolée de and Mazeron, Renaud and Escande, Alexandre and Marsolat, Fanny and Dumas, Isabelle and Deutsch, Eric and Faculté de Médecine Paris Sud, Université Paris Sud, Université Paris Saclay, Paris and Valteau-Couanet, Dominique and and others},
abstractNote = {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.},
doi = {10.1016/J.IJROBP.2017.02.026},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 2,
volume = 98,
place = {United States},
year = {Thu Jun 01 00:00:00 EDT 2017},
month = {Thu Jun 01 00:00:00 EDT 2017}
}
  • Purpose: To evaluate the long-term, local relapse-free, distant metastasis-free, and overall survival rates in patients with a solitary bladder tumor <5 cm in diameter who were treated with external beam radiotherapy, limited surgery, and brachytherapy. Methods and Materials: The results of 122 patients after bladder-saving treatment were analyzed. After EBRT, the patients underwent cystotomy, and catheters were implanted. Of the 122 patients, 99 were treated with a continuous low-dose-rate technique and 23 patients with a pulsed-dose-rate technique. The median follow-up period was 5 years. Results: The 5-year local and distant relapse-free survival rate was 76% and 83%, respectively. The 5more » and 10-year relapse-free survival rate was 69% and 66%, respectively. For overall survival, the corresponding rates were 73% and 49%. Toxicity was low. No differences were found between the continuous low-dose-rate and pulsed-dose-rate groups. Conclusion: The results of our study have shown that external beam radiotherapy followed by brachytherapy as a bladder-saving treatment for a selected group of patients with bladder cancer yields excellent local tumor control and low toxicity.« less
  • Purpose: To identify an anatomic structure predictive for acute (AUT) and late (LUT) urinary toxicity in patients with prostate cancer treated with low-dose-rate brachytherapy (LDR) with or without external beam radiation therapy (EBRT). Methods and Materials: From July 2002 to January 2013, 927 patients with prostate cancer (median age, 66 years) underwent LDR brachytherapy with Iodine 125 (n=753) or Palladium 103 (n=174) as definitive treatment (n=478) and as a boost (n=449) followed by supplemental EBRT (median dose, 50.4 Gy). Structures contoured on the computed tomographic (CT) scan on day 0 after implantation included prostate, urethra, bladder, and the bladder neck, defined asmore » 5 mm around the urethra between the catheter balloon and the prostatic urethra. AUT and LUT were assessed with the Common Terminology Criteria for Adverse Events, version4. Clinical and dosimetric factors associated with AUT and LUT were analyzed with Cox regression and receiver operating characteristic analysis to calculate area under the receiver operator curve (ROC) (AUC). Results: Grade ≥2 AUT and grade ≥2 LUT occurred in 520 patients (56%) and 154 patients (20%), respectively. No grade 4 toxicities were observed. Bladder neck D2cc retained a significant association with AUT (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.03-1.04; P<.0001) and LUT (HR, 1.01; 95% CI, 1.00-1.03; P=.014) on multivariable analysis. In a comparison of bladder neck with the standard dosimetric variables by use of ROC analysis (prostate V100 >90%, D90 >100%, V150 >60%, urethra D20 >130%), bladder neck D2cc >50% was shown to have the strongest prognostic power for AUT (AUC, 0.697; P<.0001) and LUT (AUC, 0.620; P<.001). Conclusions: Bladder neck D2cc >50% was the strongest predictor for grade ≥2 AUT and LUT in patients treated with LDR brachytherapy. These data support inclusion of bladder neck constraints into brachytherapy planning to decrease urinary toxicity.« less
  • One hundred and forty-one patients with embryonal rhabdomyosarcoma (RMS) of the head and neck are reviewed. 57/141 had lesions of para-meningeal sites. 20/57 (35%) developed evidence of direct meningeal extension. 18/20 (90%) died of this complication. Radiation portals and doses were limited in 42% and 32%, respectively. All patients had chemotherapy for 6 weeks prior to radiation. The significance of the adequacy of radiation factors and the timing of chemotherapy are reviewed. Recommendations for managing these patients include earlier use of radiation and increased coverage of adjacent meninges by radiation including total craniospinal axis radiation when brain meningeal involvement exists.