Intensity modulated radiation therapy with dose painting to treat rhabdomyosarcoma Journal Article

  


Authors: Yang, J. C.; Dharmarajan, K. V.; Wexler, L. H.; La Quaglia, M. P.; Happersett, L.; Wolden, S. L.
Article 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 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. © 2012 Elsevier Inc.
Keywords: adolescent; adult; child; clinical article; preschool child; school child; treatment outcome; child, preschool; treatment failure; retrospective studies; young adult; intensity modulated radiation therapy; radiation dose; chemotherapy; follow up; follow-up studies; radiotherapy dosage; radiotherapy; patient monitoring; infant; physical therapy; radiotherapy, intensity-modulated; lymph node; body fluids; local control; rhabdomyosarcoma; disease control; patterns of failure; intra-operative; target volumes; local failure; second-look surgery; dose escalation; dose painting; young children
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 84
Issue: 3
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2012-11-01
Start Page: e371
End Page: e377
Language: English
DOI: 10.1016/j.ijrobp.2012.04.022
PROVIDER: scopus
PUBMED: 22658517
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-84866742616&partnerID=40&md5=405f63dbf8f0568d000d1868862edbff
Notes: --- - "Export Date: 2 November 2012" - "CODEN: IOBPD" - "Source: Scopus"
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MSK Authors
  1. Michael P La Quaglia
    411 La Quaglia
  2. Suzanne L Wolden
    560 Wolden
  3. Leonard H Wexler
    191 Wexler
  4. Laura Happersett
    89 Happersett
  5. Kavita Vyas Dharmarajan
    12 Dharmarajan
  6. Joanna C Yang
    41 Yang
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