Intensity-modulated radiation therapy with dose-painting for pediatric sarcomas with pulmonary metastases Journal Article

Authors: Yang, J. C.; Wexler, L. H.; Meyers, P. A.; Happersett, L.; La Quaglia, M. P.; Wolden, S. L.
Article Title: Intensity-modulated radiation therapy with dose-painting for pediatric sarcomas with pulmonary metastases
Abstract: Background: We examined patterns of failure in pediatric patients with thoracic sarcoma and pulmonary metastases treated with intensity-modulated radiation therapy with dose-painting (DP-IMRT). Procedure: Eleven pediatric patients, five with Ewing sarcoma family tumors (ESFT) and six with rhabdomyosarcoma (RMS), with primary thoracic tumors and pulmonary metastases underwent DP-IMRT with chemotherapy for definitive treatment. Eight patients also underwent surgery. Median time to RT was 21 (15-31) weeks. Nine patients received 45-50.4-Gy in 1.8Gy fractions to the primary tumor (n=3) or post-operative tumor bed (n=6). Two patients ≤4 years received 12Gy intraoperative radiation therapy and 30.6-36Gy IMRT postoperatively to the tumor bed. All patients received 14-16.8Gy in 0.54-0.88Gy fractions to the whole lungs (n=6) or hemithorax (n=5) using dose-painting technique. A representative case was re-planned with IMRT plus standard AP/PA whole lung irradiation (WLI) for dosimetric comparison. Results: With 27-month median follow-up, 3-year pulmonary relapse-free survival in all patients was 61%: 80% for RMS and 40% for ESFT. Five patients (4 ESFT and 1 RMS) experienced pulmonary relapse at median 16 (9-41) months. There were no local failures. Our representative case demonstrated more homogeneous target volume coverage of the whole lungs and decreased mean dose to esophagus (15%), heart (31%), spinal cord (15%), and liver (19%) with DP-IMRT. Conclusions: The treatment of children with a primary thoracic tumor and pulmonary metastases poses a significant challenge. DP-IMRT is one solution to this technical problem. Initial data from this small series suggest DP-IMRT is feasible and produces superior sparing of critical normal tissues. Pediatr Blood Cancer 2013;60:1616-1620. © 2013 Wiley Periodicals, Inc.
Keywords: adolescent; adult; cancer chemotherapy; child; clinical article; preschool child; school child; child, preschool; disease-free survival; primary tumor; survival rate; retrospective studies; intensity modulated radiation therapy; radiation dose; follow up; follow-up studies; lung neoplasms; childhood cancer; ewing sarcoma; sarcoma; thoracic neoplasms; lung metastasis; liver; radiotherapy, intensity-modulated; spinal cord; lung; neoplasm metastasis; rhabdomyosarcoma; thorax tumor; heart; esophagus; intraoperative radiotherapy; recurrence free survival; pulmonary metastases; sarcoma, ewing; ewing sarcoma family tumors; intensity-modulated radiotherapy with dose-painting; pediatric sarcomas
Journal Title: Pediatric Blood and Cancer
Volume: 60
Issue: 10
ISSN: 1545-5009
Publisher: Wiley Periodicals, Inc  
Date Published: 2013-10-01
Start Page: 1616
End Page: 1620
Language: English
DOI: 10.1002/pbc.24502
PROVIDER: scopus
PUBMED: 23765910
Notes: --- - "Export Date: 4 September 2013" - "CODEN: PBCEA" - "Source: Scopus"
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MSK Authors
  1. Suzanne L Wolden
    419 Wolden
  2. Leonard H Wexler
    130 Wexler
  3. Paul Meyers
    243 Meyers
  4. Joanna C Yang
    31 Yang