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Published on: February 6, 2019
Proton radiotherapy for parameningeal rhabdomyosarcoma: clinical outcomes and late effects
Stephanie K Childs1, Kevin R Kozak, Alison M Friedmann
1Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Insights
Proton radiotherapy for pediatric parameningeal rhabdomyosarcoma (PM-RMS) shows survival rates comparable to historical controls. This treatment also demonstrates a favorable late side effect profile compared to photon therapy.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Medical Physics
Background:
- Parameningeal rhabdomyosarcoma (PM-RMS) is a rare and aggressive childhood cancer.
- Effective treatment strategies are crucial for improving outcomes in pediatric patients.
- Proton radiotherapy offers potential advantages in dose distribution for complex tumor sites.
Purpose of the Study:
- To evaluate the clinical outcomes of proton radiotherapy in children with PM-RMS.
- To assess the late side effect profile associated with proton radiotherapy for PM-RMS.
- To compare the efficacy and safety of proton radiotherapy with historical data.
Main Methods:
- A cohort of 17 children with PM-RMS treated with proton radiotherapy between 1996-2005 was reviewed.
- Clinical outcomes and specific late side effects were analyzed.
- Data from referring physicians were incorporated to capture detailed side effect information.
Main Results:
- The 5-year failure-free survival was 59% and overall survival was 64%.
- Late effects observed in recurrence-free patients included growth disturbances, endocrinopathies, facial hypoplasia, dental issues, and chronic congestion.
- Tumor control and survival rates were comparable to historical controls with similar poor prognostic factors.
Conclusions:
- Proton radiotherapy provides comparable tumor control and survival for pediatric PM-RMS patients.
- The late effects profile of proton radiotherapy appears favorable when compared to photon therapy cohorts.
- Proton therapy is a viable treatment option for pediatric PM-RMS, balancing efficacy and reduced toxicity.
Purpose:
To report the clinical outcome and late side effect profile of proton radiotherapy in the treatment of children with parameningeal rhabdomyosarcoma (PM-RMS).
Methods And Materials:
Seventeen consecutive children with PM-RMS were treated with proton radiotherapy at Massachusetts General Hospital between 1996 and 2005. We reviewed the medical records of all patients and asked referring physicians to report specific side effects of interest.
Results:
Median patient age at diagnosis was 3.4 years (range, 0.4-17.6). Embryonal (n = 11), alveolar (n = 4), and undifferentiated (n = 2) histologies were represented. Ten patients (59%) had intracranial extension. Median prescribed dose was 50.4 cobalt gray equivalents (GyRBE) (range, 50.4-56.0 GyRBE) delivered in 1.8-2.0-GyRBE daily fractions. Median follow-up was 5.0 years for survivors. The 5-year failure-free survival estimate was 59% (95% confidence interval, 33-79%), and overall survival estimate was 64% (95% confidence interval, 37-82%). Among the 7 patients who failed, sites of first recurrence were local only (n = 2), regional only (n = 2), distant only (n = 2), and local and distant (n = 1). Late effects related to proton radiotherapy in the 10 recurrence-free patients (median follow-up, 5 years) include failure to maintain height velocity (n = 3), endocrinopathies (n = 2), mild facial hypoplasia (n = 7), failure of permanent tooth eruption (n = 3), dental caries (n = 5), and chronic nasal/sinus congestion (n = 2).
Conclusions:
Proton radiotherapy for patients with PM-RMS yields tumor control and survival comparable to that in historical controls with similar poor prognostic factors. Furthermore, rates of late effects from proton radiotherapy compare favorably to published reports of photon-treated cohorts.
