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1.
Int J Radiat Oncol Biol Phys ; 106(5): 968-976, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31987977

RESUMO

PURPOSE: This study aimed to report on the institutional outcomes after proton therapy for pelvic rhabdomyosarcoma (RMS). METHODS AND MATERIALS: Thirty-one children (≤21 years old) with group III pelvic RMS were enrolled on a prospective outcome study and treated between 2007 and 2018. Patients with vaginal/cervical RMS were excluded. The median age was 2.6 years. Twenty-four patients had embryonal RMS. At diagnosis, the median tumor volume was 185 cm3 and the median maximum diameter was 9.4 cm. Seven patients had N1 disease. Nineteen and 12 patients received European Pediatric Soft Tissue Sarcoma Study Group- and Children's Oncology Group-based chemotherapy, respectively. Fourteen patients underwent resection of the primary tumor after induction chemotherapy, including 6 patients who had a total cystectomy. The median radiation dose was 50.4 Gy relative biological effectiveness. RESULTS: With a median follow-up of 4.2 years, the 5-year local control, progression-free survival, and overall survival rates were 83%, 80%, and 84%, respectively. Patients <3 years old had better local control (100% vs 68%; P = .02), and patients with embryonal histology had better survival (96% vs 54%; P = .02). No other factors were significantly associated with disease control or survival. Specifically, no statistically significant difference was observed in local control, progression-free survival, or overall survival when comparing patients who underwent biopsy versus gross total resection (75% vs 93%, 68% vs 93%, 75% vs 93%, respectively). Excluding patients who underwent cystectomy, urinary toxicity was limited to 2 patients with nocturnal enuresis. Exploratory surgery to address a persistent mass or thickened bladder wall after radiation was the most common source of serious toxicity. CONCLUSIONS: This cohort of young children with large pelvic tumors treated with proton therapy demonstrates similar local control with less toxicity than historic reports. Functional bladder preservation is possible in most patients. Exploratory biopsy in the 18 months after radiation should be approached with caution.


Assuntos
Neoplasias Pélvicas/radioterapia , Terapia com Prótons , Rabdomiossarcoma/radioterapia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Terapia com Prótons/efeitos adversos , Resultado do Tratamento , Adulto Jovem
2.
BMC Cancer ; 19(1): 945, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31610788

RESUMO

BACKGROUND: Biliary rhabdomyosarcoma (RMS) is the most common biliary tumor in children. The management of affected patients contains unique challenges because of the rarity of this tumor entity and its critical location at the porta hepatis, which can make achievement of a radical resection very difficult. METHODS: In a retrospective chart analysis we analysed children suffering from biliary RMS who were registered in three different CWS trials (CWS-96, CWS-2002P, and SoTiSaR registry). RESULTS: Seventeen patients (12 female, 5 male) with a median age of 4.3 years were assessed. The median follow-up was 42.2 months (10.7-202.5). The 5-year overall (OS) and event free survival (EFS) rates were 58% (45-71) and 47% (34-50), respectively. Patients > 10 years of age and those with alveolar histology had the worst prognosis (OS 0%). Patients with botryoid histology had an excellent survival (OS 100%) compared to those with non-botryoid histology (OS 38%, 22-54, p = 0.047). Microscopic complete tumor resection was achieved in almost all patients who received initial tumor biopsy followed by chemotherapy and delayed surgery. CONCLUSION: Positive predictive factors for survival of children with biliary RMS are age ≤ 10 years and botryoid tumor histology. Primary surgery with intention of tumor resection should be avoided.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Sistema Biliar/tratamento farmacológico , Neoplasias do Sistema Biliar/cirurgia , Rabdomiossarcoma/tratamento farmacológico , Rabdomiossarcoma/cirurgia , Adolescente , Sistema Biliar/patologia , Neoplasias do Sistema Biliar/patologia , Neoplasias do Sistema Biliar/radioterapia , Biópsia , Criança , Pré-Escolar , Terapia Combinada , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Lactente , Estimativa de Kaplan-Meier , Masculino , Complicações Pós-Operatórias , Recidiva , Estudos Retrospectivos , Rabdomiossarcoma/patologia , Rabdomiossarcoma/radioterapia
3.
Int J Radiat Oncol Biol Phys ; 105(5): 1043-1054, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31419513

RESUMO

PURPOSE: The standard of care of childhood parameningeal rhabdomyosarcoma (pRMS) is chemotherapy and local radiation therapy. Protons are increasingly being used to decrease late effects. The aim of the present study is to analyze the pattern of relapse and the correlation with dosimetric factors in pRMS treated with proton therapy. METHODS AND MATERIALS: This retrospective evaluation includes children treated in our institution for pRMS. Information on demographics, treatment, tumor characteristics, and toxicities and outcome was prospectively collected within the in-house registry. For patients presenting with local relapse, a fusion of the dosimetry with magnetic resonance imaging displaying site and geometry of recurrence was performed. RESULTS: Median follow-up time was 2.9 years (0.5-4.7). Forty-six patients were identified in our institution between July 2013 and November 2017. Main characteristics of patients were as follows: 56.5% male, median age 5.1 years (1.3-17.5), 39.1% alveolar histology, 26.1%, 52.2%, 8.7%, and 13% patients with subgroup risk classification D, E/F/G, H, or metastatic, respectively, median total prescribed dose 55.8 Gy (50.4-56.4). Estimated 2-year local control, metastasis-free survival, event-free survival, and overall survival were 83.8%, 87.8%, 76.9%, and 88.9%, respectively. No acute or late local toxicity exceeding grade 3 was observed. Risk-group was identified as prognostic factor for metastasis-free survival in univariate analysis but not in multivariate analysis (trend: P = .09). In this cohort, dosimetric factors did not correlate with outcome. Isolated local failure happened in 5 of the 11 relapses. Local relapses were matched with dosimetry for 6 patients: 4 of them occurred in the high dose volume and 2 in the intermediate or low dose volume. CONCLUSIONS: Proton therapy was effective and well feasible even in a critical cohort. Still, local relapse within the target volume of the radiation therapy remains an important issue in pRMS and new treatment strategies are needed.


Assuntos
Neoplasias Meníngeas/radioterapia , Recidiva Local de Neoplasia , Terapia com Prótons , Rabdomiossarcoma/radioterapia , Adolescente , Análise de Variância , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Pré-Escolar , Intervalo Livre de Doença , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Lactente , Imagem por Ressonância Magnética/métodos , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/mortalidade , Neoplasias Meníngeas/cirurgia , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/mortalidade , Prognóstico , Terapia com Prótons/efeitos adversos , Lesões por Radiação/patologia , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Estudos Retrospectivos , Rabdomiossarcoma/diagnóstico por imagem , Rabdomiossarcoma/mortalidade , Rabdomiossarcoma/cirurgia , Rabdomiossarcoma Alveolar/diagnóstico por imagem , Rabdomiossarcoma Alveolar/mortalidade , Rabdomiossarcoma Alveolar/radioterapia , Rabdomiossarcoma Alveolar/cirurgia , Fatores de Tempo , Resultado do Tratamento
4.
Radiat Oncol ; 14(1): 127, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307511

RESUMO

BACKGROUND: The role of local radiotherapy in the treatment of metastatic rhabdomyosarcoma is important. However, with peritoneal dissemination, the application of local therapy is challenging. Although there are few reports addressing the efficacy of the whole abdominopelvic irradiation to peritoneal disseminated rhabdomyosarcoma patients, no precise curse of treatment nor the follow up result is explained in paper nor in the text. CASE PRESENTATION: Six years old rhabdomyosarcoma boy with peritoneal dissemination was treated at our facility under COG D9803 protocol (vincristine, dactinomycin, and cyclophosphamide (VAC)). He underwent tumor resection on the 14th week according to the protocol. During surgery, the 2-cm residual tumor was completely resected, but in the pelvis, numerous nodules that were suspected as peritoneal disseminated tumors were observed. We administered 30 Gy/20fr whole abdominopelvic radiotherapy using volumetric modulated arc therapy (VMAT) technique and a 6 Gy sequential boost to pelvis after the surgery and completed the protocol treatment. During the course of treatment, the patient experienced G4 hematological toxicity and received multiple transfusions, particularly after whole abdominopelvic irradiation. He has achieved complete remission and is alive without evidence of recurrence and severe late adverse effect for 3 years. In terms of growth, his height and weight are within the average values for Japanese boys at the same age. CONCLUSION: By using the VMAT technique, a patient with peritoneal disseminated rhabdomyosarcoma can be treated, and a dose of 30 Gy to the whole abdominopelvis with concurrent chemotherapy may be tolerable.


Assuntos
Abdome/efeitos da radiação , Pelve/efeitos da radiação , Neoplasias Peritoneais/radioterapia , Radioterapia de Intensidade Modulada/métodos , Rabdomiossarcoma/radioterapia , Criança , Seguimentos , Humanos , Masculino , Prognóstico , Dosagem Radioterapêutica
5.
J Appl Clin Med Phys ; 20(7): 48-57, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31237090

RESUMO

To improve the penumbra of low-energy beams used in spot-scanning proton therapy, various collimation systems have been proposed and used in clinics. In this paper, focused on patient-specific brass collimators, the collimator-scattered protons' physical and biological effects were investigated. The Geant4 Monte Carlo code was used to model the collimators mounted on the scanning nozzle of the Hokkaido University Hospital. A systematic survey was performed in water phantom with various-sized rectangular targets; range (5-20 cm), spread-out Bragg peak (SOBP) (5-10 cm), and field size (2 × 2-16 × 16 cm2 ). It revealed that both the range and SOBP dependences of the physical dose increase had similar trends to passive scattering methods, that is, it increased largely with the range and slightly with the SOBP. The physical impact was maximized at the surface (3%-22% for the tested geometries) and decreased with depth. In contrast, the field size (FS) dependence differed from that observed in passive scattering: the increase was high for both small and large FSs. This may be attributed to the different phase-space shapes at the target boundary between the two dose delivery methods. Next, the biological impact was estimated based on the increase in dose-averaged linear energy transfer (LETd ) and relative biological effectiveness (RBE). The LETd of the collimator-scattered protons were several keV/µm higher than that of unscattered ones; however, since this large increase was observed only at the positions receiving a small scattered dose, the overall LETd increase was negligible. As a consequence, the RBE increase did not exceed 0.05. Finally, the effects on patient geometries were estimated by testing two patient plans, and a negligible RBE increase (0.9% at most in the critical organs at surface) was observed in both cases. Therefore, the impact of collimator-scattered protons is almost entirely attributed to the physical dose increase, while the RBE increase is negligible.


Assuntos
Algoritmos , Melanoma/radioterapia , Terapia com Prótons/instrumentação , Terapia com Prótons/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Rabdomiossarcoma/radioterapia , Neoplasias Uveais/radioterapia , Criança , Simulação por Computador , Relação Dose-Resposta à Radiação , Humanos , Método de Monte Carlo , Órgãos em Risco/efeitos da radiação , Eficiência Biológica Relativa , Espalhamento de Radiação
6.
J Appl Clin Med Phys ; 20(6): 194-198, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31055870

RESUMO

The case of a 50-year-old man affected by a rhabdomiosarcoma metastatic lesion in the left flank Is reported. The patient was addressed to 50.4 Gy radiotherapy with concomitant chemotherapy in order to locally control the lesion. A Tri-60-Co magnetic resonance hybrid radiotherapy unit was used for treatment delivery and a respiratory gating protocol was applied for the different breathing phases (Free Breathing, Deep Inspiration Breath Hold and Final Expiration Breath Hold). Three intensity modulated radiation therapy (IMRT) plans were calculated and Final Expiration Breath Hold plan was finally selected due to the absence of PTV coverage differences and better organs at risk sparing (i.e. kidneys). This case report suggests that organs at risk avoidance with MRI-guided respiratory-gated Radiotherapy is feasible and particularly advantageous whenever sparing the organs at risk is of utmost dosimetric or clinical importance.


Assuntos
Imagem por Ressonância Magnética/métodos , Órgãos em Risco/efeitos da radiação , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/métodos , Técnicas de Imagem de Sincronização Respiratória/métodos , Rabdomiossarcoma/radioterapia , Neoplasias Torácicas/radioterapia , Suspensão da Respiração , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos , Rabdomiossarcoma/patologia , Neoplasias Torácicas/secundário
7.
Med Oncol ; 36(7): 59, 2019 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-31104202

RESUMO

Rhabdomyosarcoma (RMS) is rare in adults and it is generally characterized by poor outcome. In a previous retrospective study, we demonstrated a better prognosis in adults treated with multimodality approach resembling pediatric protocols. Thereafter, we developed specific recommendations based on the principles adopted in pediatric oncology. The present analysis reports the results in a subsequent prospective series. The study included 95 consecutive patients (age 18-77 years) treated from 2002 to 2015 for embryonal and alveolar RMS. As in the previous series, patients were stratified by the appropriateness of their treatment according to therapeutic guidelines for childhood RMS. The 5-year event-free survival (EFS) and overall survival (OS) rates were 33.6% and 40.3%, respectively. The 5-year EFS was 40.8% for patients with the highest treatment score, and 15% for those with lower score, while OS was 44.4% and 24.5%, respectively. The developing of specific recommendations enabled an increase in the number of patients treated with intensive multimodal treatment resembling pediatric strategy (69.7% vs. 39.1% in the retrospective series). This study reinforced the idea that adherence to the principles of pediatric protocols, improves adult RMS outcomes. However, treating adults with pediatric-type strategy is not enough to achieve the results obtained in children. Issues in compliance and a more aggressive biology of adult RMS might have a role in the different outcome according to age. Improving the collaboration between pediatric and adult oncologists in promoting specific clinical and biological research is crucial to improve the outcome for this patient population.


Assuntos
Rabdomiossarcoma/terapia , Adulto , Fatores Etários , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada , Dactinomicina/administração & dosagem , Intervalo Livre de Doença , Doxorrubicina/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Humanos , Ifosfamida/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Rabdomiossarcoma/tratamento farmacológico , Rabdomiossarcoma/radioterapia , Rabdomiossarcoma/cirurgia , Taxa de Sobrevida , Vincristina/administração & dosagem , Adulto Jovem
8.
Clin Oncol (R Coll Radiol) ; 31(7): 462-470, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30992168

RESUMO

Rhabdomyosarcoma is the most common soft-tissue sarcoma of childhood, comprising over 50% of cases. It is considered to be an embryonal tumour of skeletal muscle cell origin, frequently occurring at genitourinary and head and neck sites, although it can arise throughout the body and at sites where there is no skeletal muscle. For most cases, multimodality therapy is required to achieve the best results, incorporating induction ifosfamide, vincristine and actinomycin D-based chemotherapy and local therapy (radiotherapy and/or surgery). Recent reports from the European Paediatric Soft Tissue Sarcoma Group (EpSSG) RMS 2005 study have shown significant improvements in outcomes; high-risk rhabdomyosarcoma having a 3-year event-free survival and overall survival of about 68% and 80%, respectively. The more routine use of radiotherapy is considered to be a contributing factor to these improved results, but does also often result in significant long-term sequelae for survivors. Despite an increasing number of rhabdomyosarcoma treated with advanced radiotherapy techniques, including protons, brachytherapy and rotational intensity-modulated radiotherapy, in an effort to reduce the frequency of late complications, there remain a number of unanswered questions. Future planned collaborative group studies, such as the EpSSG Frontline and Relapsed Rhabdomyosarcoma (FaR-RMS) study, are looking to address these questions, investigating the potential benefits of preoperative radiotherapy, dose escalation and the irradiation of metastatic sites.


Assuntos
Rabdomiossarcoma/radioterapia , Adolescente , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Rabdomiossarcoma/mortalidade
9.
Radiother Oncol ; 134: 143-150, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31005208

RESUMO

PURPOSE: Pediatric patients with rhabdomyosarcoma (RMS) of the head and neck (H&N) are treated with multimodal therapy, often with radiotherapy (RT) as definitive local therapy. We report on the patterns of failure following proton beam therapy (PBT) for H&N RMS. METHODS: Forty-six H&N RMS patients were enrolled on a prospective registry protocol between 2006 and 2015. All were treated with a combination of chemotherapy (ChT) and PBT. Most patients (25 patients, 54%) had parameningeal tumors, of which 11 (24%) had intracranial extension (ICE). Thirteen patients (28%) had primary tumors greater than 5 cm. Median total cyclophosphamide (CPM) equivalent dose was 13.2 g/m2 (range 0-16.8 g/m2). Median RT dose was 50.4 Gy(RBE) (range 36 Gy[RBE]-50.8 Gy[RBE]). RESULTS: With median follow-up of 3.9 years, five-year overall survival was 76%, and five-year progression-free survival was 57%. Seventeen patients (37%) experienced relapse, including 7 with local failure (LF). Five-year local control (LC) was 84%. Tumor size greater than 5 cm predicted increased risk of LF (hazard ratio [HR] 6.49, p = 0.03), as did the presence of ICE at diagnosis (HR 5.21, p = 0.03). Six relapses occurred in patients with ICE; all included a component of central nervous system relapse, with leptomeningeal disease and/or LF with an intracranial component. Delayed RT delivery after week 4 of ChT predicted increased risk of relapse for ICE patients (HR 10.49, p = 0.006). CONCLUSIONS: PBT confers excellent LC, and a favorable late toxicity profile as compared with prior photon RT data. Our observations support ongoing trial efforts to dose-escalate RT for patients with larger tumors. However, these data raise concerns regarding excess failures among patients with ICE.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Terapia com Prótons/métodos , Rabdomiossarcoma/radioterapia , Adolescente , Criança , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Lactente , Masculino , Dosagem Radioterapêutica , Falha de Tratamento
10.
J Craniofac Surg ; 30(4): 1275-1279, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31033757

RESUMO

Radiotherapy is essential for achieving and maintaining local control in head and neck rhabdomyosarcoma patients. However, radiotherapy may cause outgrowth disturbances of facial bone and soft tissue, resulting in facial asymmetry.Several studies have shown that the management of irradiated bones still remains challenging. The possibility of obtaining functional and aesthetic results when managing facial deformities due to radiation therapy with distraction osteogenesis combined with free flaps reconstruction is not common and not well documented in recent literature.In this report, we present the long-term results of distraction osteogenesis and soft tissue reconstruction via microvascular free flap to correct the facial hypoplasia of a young patient who underwent radiation therapy for rhabdomyosarcoma.This is the first presentation of 26 years long-term results in a patient who also underwent free flaps reconstruction as ancillary surgery for esthetic good results.


Assuntos
Ossos Faciais/efeitos da radiação , Neoplasias Faciais/radioterapia , Retalhos de Tecido Biológico , Osteogênese por Distração/métodos , Rabdomiossarcoma/radioterapia , Adolescente , Face/efeitos da radiação , Feminino , Humanos , Masculino , Lesões por Radiação/etiologia , Lesões por Radiação/cirurgia , Radioterapia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos
11.
Pediatr Blood Cancer ; 66(7): e27725, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30920113

RESUMO

OBJECTIVES: To evaluate the impact of local therapies on the outcome of patients with liver-bile duct rhabdomyosarcoma (LBDRMS). METHODS: Data of 30 patients included in the EpSSG-RMS 2005 study were analyzed. RESULTS: The median age at diagnosis was 3 years (11 months-8 years). All patients had non-alveolar histology. Fifteen patients had a tumor > 5 cm and six had enlarged regional lymph nodes on imaging. Eight patients (27%) had primary surgery (1 R0). Six of them received external beam radiotherapy (EBRT). All are in first complete remission (CR1) except one (R1, EBRT+ , local relapse, death). Six patients (20%) received EBRT without surgery: one had local relapse and died. Sixteen patients (53%) underwent delayed surgery, with 12 achieving R0 margins, which were higher than those in the primary surgery group (P = 0.003). Three patients with R0 margins received EBRT; one had a metastatic relapse and died. Nine patients with R0 resection did not receive EBRT, three relapsed locally (two deaths). Four R1 patients received additional EBRT without relapses. Local relapse occurred in two among 19 patients with EBRT and three among 11 without EBRT (P = 0.326). At a median follow-up of 61 months (48-84 months), five patients died; all had a tumor size > 5 cm (P = 0.01). The five-year overall survival was 85% (95% CI, 65-94), and event-free survival was 76% (95% CI, 54-89). CONCLUSION: This analysis did not show any significant difference in outcome between irradiated and nonirradiated patients. Local relapse in LBDRMS is related to initial tumor size and is often fatal.


Assuntos
Neoplasias dos Ductos Biliares , Recidiva Local de Neoplasia , Rabdomiossarcoma , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/mortalidade , Neoplasias dos Ductos Biliares/radioterapia , Neoplasias dos Ductos Biliares/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Metástase Neoplásica , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/radioterapia , Recidiva Local de Neoplasia/cirurgia , Rabdomiossarcoma/diagnóstico por imagem , Rabdomiossarcoma/mortalidade , Rabdomiossarcoma/radioterapia , Rabdomiossarcoma/cirurgia
12.
J Appl Clin Med Phys ; 20(3): 56-70, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30791198

RESUMO

PURPOSE: This study investigates the difference in whole-body dose equivalent between 6 and 15 MV image-guided radiotherapy (IGRT) for the treatment of a rhabdomyosarcoma in the prostate. METHODS: A previously developed model for stray radiation of the primary beam was improved and used to calculate the photon dose and photon energy in the out-of-field region for a radiotherapy patient. The dose calculated by the treatment planning system was fused with the model-calculated out-of-field dose, resulting in a whole-body photon dose distribution. The peripheral neutron dose equivalent was calculated using an analytical model from the literature. A daily cone beam CT dose was added to the neutron and photon dose equivalents. The calculated 3D dose distributions were compared to independent measurements conducted with thermoluminescence dosimeters and an anthropomorphic phantom. The dose contributions from the IGRT treatments of three different techniques applied with two nominal X-ray energies were compared using dose equivalent volume histograms (DEVHs). RESULTS: The calculated and measured out-of-field whole-body dose equivalents for the IGRT treatments agreed within (9 ± 10) % (mean and type A SD). The neutron dose equivalent was a minor contribution to the total out-of-field dose up to 50 cm from the isocenter. Further from the isocenter, head leakage was dominating inside the patient body, whereas the neutron dose equivalent contribution was important close to the surface. There were small differences between the whole-body DEVHs of the 6 and 15 MV treatments applied with the same technique, although the single scatter contributions showed large differences. Independent of the beam energy, the out-of-field dose of the volumetric-modulated arc therapy (VMAT) treatment was significantly lower than the dynamic intensity-modulated radiation therapy (IMRT) treatment. CONCLUSION: The calculated whole-body dose helped to understand the importance of the dose contributions in different areas of the patient. Regarding radiation protection of the patient for IGRT treatments, the choice of beam energy is not important, whereas the treatment technique has a large influence on the out-of-field dose. If the patient is treated with intensity-modulated beams, VMAT should be used instead of dynamic IMRT in terms of radiation protection of the patient. In general, the developed models for photon and neutron dose equivalent calculation can be used for any patient geometry, tumor location, and linear accelerator.


Assuntos
Nêutrons , Imagens de Fantasmas , Neoplasias da Próstata/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Conformacional/métodos , Radioterapia de Intensidade Modulada/métodos , Rabdomiossarcoma/radioterapia , Adolescente , Humanos , Masculino , Aceleradores de Partículas , Fótons , Radiometria , Dosagem Radioterapêutica , Irradiação Corporal Total
13.
Radiother Oncol ; 131: 21-26, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30773183

RESUMO

BACKGROUND AND PURPOSE: Survival after relapse of head and neck rhabdomyosarcoma (HNRMS) after prior external beam radiotherapy (EBRT) is poor, since options for adequate local treatment are often lacking. In this study we describe our experience with salvage AMORE in patients with relapsed HNRMS after prior EBRT. MATERIALS AND METHODS: Patients with relapsed HNRMS after prior EBRT in which salvage AMORE treatment was considered feasible were analysed; this includes patients with parameningeal, head and neck non-parameningeal and orbital localization. AMORE treatment consisted of Ablative surgery, MOuld technique brachytherapy and surgical REconstruction. RESULTS: In total 18 patients received salvage AMORE treatment; nine patients had relapsed parameningeal (PM) RMS, two patients had relapsed head and neck non-parameningeal RMS (HN-nonPM) and seven patients had relapsed orbital RMS. Local control rate was 67% and 5-year overall survival was 54% (95% confidence interval: 31-78%); 3/9 patients with PM RMS, 0/2 patients with HN-nonPM RMS and 6/7 patients with orbital RMS were alive after a median follow-up of 8.6 years. One patient with PM RMS survived more than 5 years after which he died from a secondary cancer. Six patients developed a local relapse (of which one patient also developed a distant metastasis) and two patients developed distant metastases. CONCLUSIONS: Salvage AMORE treatment is a feasible and effective local therapy approach even after prior EBRT. Since salvage AMORE treatment is sometimes the only curative option in patient with relapsed HNRMS, we encourage physicians to consider salvage AMORE treatment for patients with relapsed HNRMS after prior EBRT.


Assuntos
Neoplasias de Cabeça e Pescoço/terapia , Rabdomiossarcoma/terapia , Terapia de Salvação/métodos , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Braquiterapia/efeitos adversos , Braquiterapia/métodos , Criança , Pré-Escolar , Terapia Combinada , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Rabdomiossarcoma/diagnóstico por imagem , Rabdomiossarcoma/radioterapia , Rabdomiossarcoma/cirurgia , Resultado do Tratamento , Adulto Jovem
14.
Urol Int ; 102(1): 118-121, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-28427078

RESUMO

A 32-year-old man visited our hospital due to urinary retention. Prostate-specific antigen was 13.7 ng/mL. Imaging examinations showed a large prostatic tumor and lung and internal iliac lymph node metastases. Transrectal biopsy confirmed embryonal rhabdomyosarcoma of the prostate classified as cT2bN1M1 (stage IV) by the International Rhabdomyosarcoma Study (IRS) Group staging system. Systemic chemotherapy was started according to the IRS III regimen 36, which consisted of 16 weeks of induction chemotherapy with radiation. After 20 weeks, magnetic resonance imaging showed the disappearance of metastases, and the prostate tumor shrunk markedly. Moreover, prostatic re-biopsy showed no viable tumor cells. Maintenance chemotherapy, excluding vincristine because of severe peripheral nerve disorder, was performed for 2 years. There has been no recurrence for 49 months after the termination of maintenance chemotherapy. To the best of our knowledge, this is the longest surviving case of adult-onset metastatic rhabdomyosarcoma of the prostate reported in the literature.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Rabdomiossarcoma/tratamento farmacológico , Rabdomiossarcoma/radioterapia , Adulto , Terapia Combinada , Ciclofosfamida/administração & dosagem , Dactinomicina/administração & dosagem , Doxorrubicina/administração & dosagem , Humanos , Masculino , Recidiva Local de Neoplasia/tratamento farmacológico , Próstata/patologia , Neoplasias da Próstata/patologia , Rabdomiossarcoma/patologia , Vincristina/administração & dosagem
15.
Int J Radiat Oncol Biol Phys ; 103(1): 19-27, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30138647

RESUMO

PURPOSE: For infants with localized rhabdomyosarcoma who were enrolled on Children's Oncology Group ARST0331 and ARST0531, local therapy guidelines were provided, but adherence was not mandated because of toxicity concerns. We examined adherence to protocol for local therapy guidelines, treatment variations, and outcomes for these patients. METHODS: Children aged ≤24 months who were enrolled on ARST0331 and ARST0531 were evaluated. Data were verified through radiologic, surgical, pathologic, and clinical records. Local therapy was assessed for adherence to protocol guidelines, with variations termed "individualized local therapy." The subdistribution hazards model assessed local failure, the Kaplan-Meier product limit method assessed event-free survival (EFS) and overall survival, and the log-rank test was used to evaluate prognostic impact. RESULTS: The median age of the patients was 14 months, and 124 patients were eligible. Common primary sites were genitourinary (40%), parameningeal (14%), and the extremities (11%). Most patients had unresected disease (group 3, 64%) and embryonal histology (73%). Fifty-eight percent of patients received radiation therapy at a median of week 12 (weeks 1-45). The median radiation dose was 48.6 Gy (30.6-54 Gy). Forty-three percent of patients received individualized local therapy (outside protocol guidelines), typically omission or delay of radiation therapy. Delayed primary excision was performed in 28% at a median of week 14 (weeks 7-34). With a median follow-up of 5.6 years, the 5-year local failure, EFS, and overall survival rates were 24%, 68%, and 82%, respectively. Local failure was significantly higher (35%) in patients receiving individualized local therapy than in patients who received protocol-specified local therapy (16%; P = .02). The site of failure was local in 64% of patients, local and distant in 5%, and distant only in 23%. EFS was significantly higher among patients who were aged 12 to 24 months, had tumors ≤5 cm, had group 1/2 disease, and underwent protocol-specified therapy. CONCLUSIONS: Local recurrence was the predominant pattern of failure and was more common in those receiving individualized local therapy. De-escalation of effective therapies because of concerns about treatment toxicity should be considered cautiously.


Assuntos
Rabdomiossarcoma/radioterapia , Feminino , Fidelidade a Diretrizes , Humanos , Lactente , Recém-Nascido , Masculino , Dosagem Radioterapêutica , Rabdomiossarcoma/mortalidade , Rabdomiossarcoma/patologia , Rabdomiossarcoma/cirurgia
16.
Radiother Oncol ; 129(3): 513-519, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30017104

RESUMO

BACKGROUND AND PURPOSE: Limited data exist detailing the role of salvage reirradiation following local-regional recurrence (LR) in previously irradiated pediatric patients with rhabdomyosarcoma (RMS). MATERIALS AND METHODS: We evaluated outcomes and prognostic factors in a multi-institutional cohort of 23 patients with LR-only (N = 19) or LR with distant failure (N = 4) RMS managed with (N = 12) or without (N = 11) re-irradiation who were treated from 1996 to 2012. RESULTS: At a median follow-up of 4.6 years from LR, 7 (30%) patients were alive and 5 (22%) had no evidence of disease. Median OS and PFS from LR were 19.3 and 16.9 months, respectively. LFFS and DFFS at 3 years from relapse were 54% and 56%, respectively. Salvage re-irradiation occurred in 12 (52%) patients, with 9 (75%) receiving resection before re-irradiation. Patients classified as low-risk at diagnosis with favorable primary tumor location had improved 3-year PFS 80% (95% CI 51.6-100%) vs. 47.1% (95% CI 27.3-81.2%), p = 0.066], and OS 80% [(95% CI 22.4-100%) vs. 47.1% (95% CI 27.3-81.3%), p = 0.051] following LR. Median LFFS and OS in unirradiated vs. re-irradiated patients was 12.4 vs. 19.6 (p = 0.1) and 18.8 vs. 26.1 months (p = 0.46). No patients experienced ≥grade 4 acute toxicity from re-irradiation. LR failure was a component of cancer-related death in 60% vs. 40% of the unirradiated and re-irradiated group (p = 0.02). CONCLUSION: Salvage re-irradiation appears tolerable with acceptable morbidity and may reduce the risk of subsequent LR as a component of death in patients with LR RMS.


Assuntos
Recidiva Local de Neoplasia/radioterapia , Reirradiação , Rabdomiossarcoma/radioterapia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Recidiva Local de Neoplasia/mortalidade , Terapia de Salvação , Adulto Jovem
17.
J Pediatr Surg ; 53(7): 1428-1431, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29753523

RESUMO

BACKGROUND/PURPOSE: Fertility preservation is a major goal in treatment of children with cancer. We describe a new technique of testicular transposition (TT) in patients treated with pulse-dose-rate (PDR) brachytherapy as part of the multimodal conservative treatment of bladder neck and/or prostate rhabdomyosarcoma (BP RMS). METHODS: Medical records of consecutive patients treated between September 2016 and August 2017 were studied. These patients underwent a TT performed during BP RMS surgery by the same suprapubic incision. The external oblique aponeurosis was not incised. The spermatic cord was mobilized up to the external inguinal ring, and the gubernaculum attachments were severed from the scrotum. The testis was then flipped over with care taken to avoid injury of the vessels or the vas, wrapped in a silicone material and sutured under the abdominal skin with a transfixing stitch facing the anterior superior iliac spine. At the end of brachytherapy, the testis was relocated in the scrotum and during the same general anesthesia, plastic tubes and stents were removed. Surgical outcome and dosimetric parameters were examined. RESULTS: Eight patients were identified. Median age was 24 months (range 11-80 months). All had embryonal BP RMS and received chemotherapy according to RMS 2005 protocol prior to local treatment. All patients underwent conservative surgery followed by brachytherapy (60 Gy) and had testicular transposition of one testis. None had surgical complications. After converting doses to biologically equivalent doses in 2-Gy fractions (EQD2), the dose delivered to 75% of the transposed testis was 1.5 GyEQD2 (1-3 GyEQD2), versus 5.4 GyEQD2 (3.9-9.4 Gy EQD2) for the untransposed testis (p < 0.001). CONCLUSION: Testicular transposition is feasible in order to potentially preserve fertility and future quality of life in children undergoing brachytherapy for BP RMS. TYPE OF STUDY: Level IV Treatment Study: Case Study with no Comparison Group.


Assuntos
Braquiterapia/métodos , Tratamento Conservador , Neoplasias da Próstata/radioterapia , Rabdomiossarcoma/radioterapia , Neoplasias da Bexiga Urinária/radioterapia , Pré-Escolar , Humanos , Lactente , Masculino , Planejamento da Radioterapia Assistida por Computador/métodos , Rabdomiossarcoma/cirurgia , Testículo/cirurgia
18.
Cancer Med ; 7(5): 1870-1874, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29605967

RESUMO

To evaluate preliminary results of proton radiotherapy (PRT) for pediatric patients with rhabdomyosarcoma (RMS). From 1987 to 2014, PRT was conducted as initial radiotherapy in 55 patients (35 males, 20 females, median age 5 years, range 0-19) with RMS at four institutes in Japan. Thirty-one, 18, and six patients had embryonal, alveolar, and other RMS, respectively. One, 11, 37, and six patients were in IRSG groups I, II, III, and IV, respectively, and the COG risk group was low, intermediate, and high for nine, 39, and seven patients, respectively. The irradiation dose was 36-60 GyE (median: 50.4 GyE). The median follow-up period was 24.5 months (range: 1.5-320.3). The 1- and 2-year overall survival rates were 91.9% (95% CI: 84.3-99.5%) and 84.8% (95% CI 75.2-94.3%), respectively, and these rates were 100% and 100%, 97.1% and 90.1%, and 57.1% and 42.9% for COG low-, intermediate-, and high-risk groups, respectively. There were 153 adverse events of Grade ≥3, including 141 hematologic toxicities in 48 patients (87%) and 12 radiation-induced toxicities in nine patients (16%). Proton-specific toxicity was not observed. PRT has the same treatment effect as photon radiotherapy with tolerable acute radiation-induced toxicity.


Assuntos
Terapia com Prótons/efeitos adversos , Rabdomiossarcoma/radioterapia , Adolescente , Criança , Pré-Escolar , Fracionamento da Dose de Radiação , Feminino , Humanos , Lactente , Recém-Nascido , Japão , Masculino , Terapia com Prótons/métodos , Dosagem Radioterapêutica , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
19.
Pediatr Blood Cancer ; 65(1)2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28696016

RESUMO

PURPOSE: The optimal management of central nervous system (CNS) relapse of rhabdomyosarcoma (RMS) is unclear. We examined diagnosis, management, and outcomes of patients with RMS developing CNS relapse. METHODS: Records of 23 patients diagnosed with CNS relapse between 1999 and 2016 were reviewed. Median age at presentation of CNS relapse was 15 years (range, 1-34 years). High-risk features at initial presentation were as follows: 16 alveolar patients, 13 Stage IV, and 13 with primary tumor in parameningeal locations. RESULTS: CNS relapse occurred at a median 12 months (range, 1-23 months) from diagnosis and most common presenting symptoms were headache (n = 9), nausea/vomiting (n = 8), visual difficulty (n = 5), and none (n = 5). Leptomeningeal metastases were detected in 21 patients while only 2 developed parenchymal metastases without leptomeningeal involvement. Fifteen patients received CNS-directed radiation therapy (RT), including craniospinal irradiation to a median 36 Gy (range, 18-36 Gy) and/or whole brain radiotherapy to a median 30 Gy (range, 6-41.4 Gy). Three patients received concurrent chemotherapy. Follow-up magnetic resonance imaging was conducted in 13 patients after RT initiation with 8 demonstrating improvement, 2 with stable disease, and 3 with progression. Twelve patients were tested for reactivity to I-131-labeled monoclonal antibody 8H9, and three tested positive and received at least one intra-Ommaya dose; all three lived >12 months post-CNS relapse. Twenty­two patients died of CNS disease and one of treatment complications, with metastatic disease at other sites. Median survival post-CNS relapse was 5 months (range, 0.1-49 months). CONCLUSIONS: The prognosis for patients with RMS developing CNS relapse remains poor. Treatment including CNS-directed RT should be considered and investigation into preventative therapies is warranted.


Assuntos
Neoplasias Meníngeas , Rabdomiossarcoma , Adolescente , Adulto , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Humanos , Lactente , Masculino , Neoplasias Meníngeas/mortalidade , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/fisiopatologia , Neoplasias Meníngeas/radioterapia , Recidiva Local de Neoplasia , Estudos Retrospectivos , Rabdomiossarcoma/mortalidade , Rabdomiossarcoma/patologia , Rabdomiossarcoma/fisiopatologia , Rabdomiossarcoma/radioterapia , Taxa de Sobrevida
20.
Pediatr Blood Cancer ; 65(2)2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29058370

RESUMO

PURPOSE: Pediatric head and neck malignancies are managed with intensive multimodality therapy. Proton beam therapy (PBT) may reduce toxicity by limiting exposure of normal tissue to radiation. In this study, we report acute toxicities and early outcomes following PBT for pediatric head and neck malignancies. MATERIALS AND METHODS: Between 2010 and 2016, pediatric patients with nonhematologic malignancies of the head and neck were treated with PBT. Clinical and dosimetric data were abstracted from the medical record and treatment planning system with institutional review board approval. RESULTS: Sixty-nine consecutive pediatric patients were treated with proton-based radiotherapy for head and neck malignancies. Thirty-five were treated for rhabdomyosarcoma to a median dose of 50.4 Gy relative biological effectiveness [RBE]. Ten patients were treated for Ewing sarcoma to a median dose of 55.8 Gy[RBE]. Twenty-four patients were treated for other histologies to a median dose of 63.0 Gy[RBE]. Grade 3 oral mucositis, anorexia, and dysphagia were reported to be 4, 22, and 7%, respectively. Actuarial 1-year freedom from local recurrence was 92% (95% CI 80-97). Actuarial 1-year overall survival was 93% (95% CI 79-98) in the entire cohort. Oral cavity mucositis was significantly correlated with oral cavity dose (D80 and D50 [P < 0.05], where D80 and D50 are dose to 50% of the volume and dose to 80% of the volume, respectively). CONCLUSIONS: In this study, we report low rates of acute toxicity in a cohort of pediatric patients with head and neck malignancies. PBT appears safe for this patient population, with local control rates similar to historical reports. Longer follow-up will be required to evaluate late toxicity and long-term disease control.


Assuntos
Neoplasias de Cabeça e Pescoço , Terapia com Prótons , Rabdomiossarcoma , Sarcoma de Ewing , Adolescente , Adulto , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Lactente , Masculino , Rabdomiossarcoma/mortalidade , Rabdomiossarcoma/radioterapia , Sarcoma de Ewing/mortalidade , Sarcoma de Ewing/radioterapia , Taxa de Sobrevida
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