Interventional radiotherapy (brachytherapy) achieves very good long-term quality of life in children and adolescents with soft-tissue sarcoma.
brachytherapy
childhood
interventional radiotherapy
late effects
sarcoma
Journal
Pediatric blood & cancer
ISSN: 1545-5017
Titre abrégé: Pediatr Blood Cancer
Pays: United States
ID NLM: 101186624
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
16
03
2020
accepted:
16
05
2020
pubmed:
25
7
2020
medline:
5
1
2021
entrez:
25
7
2020
Statut:
ppublish
Résumé
Effective local therapy (surgery, radiation) and systemic multidrug chemotherapy are mandatory for curing childhood sarcoma. The standard radiation therapy for pediatric patients with soft-tissue sarcoma (STS) is external beam radiotherapy (EBRT). Because EBRT may cause long-term side effects with adverse effects on the patients' health and quality of life (QoL), alternative strategies are required. Interventional radiotherapy (IRT; brachytherapy) is established as a standard treatment for several tumors in adulthood. Single-center series have reported low levels of late effects and improved QoL in survivors treated with IRT in childhood. However, IRT is still applied infrequently in pediatric patients. Thirty patients with STS were treated with IRT between 1992 and 2012 at the University Hospital Schleswig Holstein, Germany. Five patients were lost to follow-up, and 25 patients (mean age at time of data collection 24.8 years [range, 10.7-36.1]) could be analyzed focusing on overall survival and QoL (EORTC-C30 questionnaire). For more detailed information regarding general and health-specific questions, a separate questionnaire was developed. Nineteen of 25 patients were alive 13.4 [1.6-25.2] years after first cancer disease, and the three-year overall survival was 76% (SE, 0.09). The score of QoL/global health status (76.2 [16.6-100]) in our patients outvalues the European (66.1) and equals the German (75.9) reference value. IRT is an effective treatment option for pediatric patients with localized STS. Its role among other radiation dose-sparing techniques such as proton beam therapy has to be defined in prospective studies.
Sections du résumé
BACKGROUND
Effective local therapy (surgery, radiation) and systemic multidrug chemotherapy are mandatory for curing childhood sarcoma. The standard radiation therapy for pediatric patients with soft-tissue sarcoma (STS) is external beam radiotherapy (EBRT). Because EBRT may cause long-term side effects with adverse effects on the patients' health and quality of life (QoL), alternative strategies are required. Interventional radiotherapy (IRT; brachytherapy) is established as a standard treatment for several tumors in adulthood. Single-center series have reported low levels of late effects and improved QoL in survivors treated with IRT in childhood. However, IRT is still applied infrequently in pediatric patients.
METHODS
Thirty patients with STS were treated with IRT between 1992 and 2012 at the University Hospital Schleswig Holstein, Germany. Five patients were lost to follow-up, and 25 patients (mean age at time of data collection 24.8 years [range, 10.7-36.1]) could be analyzed focusing on overall survival and QoL (EORTC-C30 questionnaire). For more detailed information regarding general and health-specific questions, a separate questionnaire was developed.
RESULTS
Nineteen of 25 patients were alive 13.4 [1.6-25.2] years after first cancer disease, and the three-year overall survival was 76% (SE, 0.09). The score of QoL/global health status (76.2 [16.6-100]) in our patients outvalues the European (66.1) and equals the German (75.9) reference value.
CONCLUSION
IRT is an effective treatment option for pediatric patients with localized STS. Its role among other radiation dose-sparing techniques such as proton beam therapy has to be defined in prospective studies.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e28464Informations de copyright
© 2020 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.
Références
Kaatsch P, Grabow D, Spix C, Jahresbericht / Annual report 2017 of the German childhood cancer registry. Institut für Medizinische Statistik und Dokumentation, Universität Mainz, Germany; 2018.
Yohe ME, Heske CM, Stewart E, et al. Insights into pediatric rhabdomyosarcoma research: challenges and goals. Pediatr Blood Cancer. 2019;e27869:1-10.
Strege RJ, Kovács G, Lamcke P, et al. Role of perioperative brachytherapy in the treatment of malignancies involving the skull base and orbit. Neurosurgery Quarterly. 2007;17(3):193-207.
Paulino AC, Simon JH, Zhen W, Wen B-C. Long-term effects in children treated with radiotherapy for head and neck rhabdomyosarcoma. Int J Radiat Oncol Biol Phys. 2000;48:1489-1495.
Raney RB, Anderson JR, Kollath J, et al. Late effects of therapy in 94 patients with localized rhabdomyosarcoma of the orbit: report from the Intergroup Rhabdomyosarcoma Study (IRS)-III, 1984-1991. Med Pediatr Oncol. 2000;34(6):413-420.
Mandeville HC. Radiotherapy in the management of childhood rhabdomyosarcoma. Clin Oncol (R Coll Radiol). 2019;31(7):462-470.
Koller M, Neugebauer EAM, Augustin M, et al. [Assessment of quality of life in health services research - conceptual, methodological and structural prerequisites]. Das Gesundheitswesen. 2009;71(12):864-872.
Punyko JA, Mertens AC, Gurney JG, et al. Long-term medical effects of childhood and adolescent rhabdomyosarcoma: a report from the childhood cancer survivor study. Pediatr Blood Cancer. 2005;44(7):643-653.
Vaarwerk B, Schoot RA, Maurice-Stam H, et al. Psychosocial well-being of long-term survivors of pediatric head-neck rhabdomyosarcoma. Pediatr Blood Cancer. 2019;66(2):1-9.
Esiashvili N, Prabhu R, Kahn S, Paulino AC. Current strategies and challenges in treatment of childhood rhabdomyosarcoma. J Radiat Oncol. 2013;2(2):159-168.
Nag S, Fernandes PS, Martinez-Monge R, Ruymann FB. Use of brachytherapy to preserve function in children with soft-tissue sarcomas. Oncology (Williston Park). 1999;13(3):361-374.
Chen P, Wu W-J, Yi Z-Q, et al. 125 I interstitial brachytherapy in management of pediatric skull base tumors. Pediatr Blood Cancer. 2019;66(5):e27622.
Mazeron R, Oberlin O, Dumas I, et al. Brachytherapy in children with rhabdomyosarcomas of the nasolabial fold. Pediatr Blood Cancer. 2014;61:1162-1167.
Heinzelmann F, Thorwarth D, Lamprecht U, et al. Comparison of different adjuvant radiotherapy approaches in childhood bladder/prostate rhabdomyosarcoma treated with conservative surgery. Strahlenther Onkol. 2011;187(11):715-721.
Habrand J-L, Abdulkarim B, Roberti H. Radiotherapeutical innovations in pediatric solid tumors. Pediatr Blood Cancer. 2004;43(6):622-628.
Healey EA, Shamberger RC, Grier HE, Loeffler JS, Tarbell NJ. A 10-year experience of pediatric brachytherapy. Int J Radiat Oncol Biol Phys. 1995;32(2):451-455.
Nag S, Tippin DB. Brachytherapy for pediatric tumors. Brachytherapy. 2003;2(3):131-138.
Fijuth J. Brachytherapy in paediatric malignancies - review of indications. J Contemp Brachytherapy. 2010;2(2):81-83.
Martinez-Monge R, Cambeiro M, San-Julián M, Sierrasesúmaga L. Use of brachytherapy in children with cancer: the search for an uncomplicated cure. Lancet Oncol. 2006;7(2):157-166.
Chargari C, Haie-Meder C, Guérin F, et al. Brachytherapy combined with surgery for conservative treatment of children with bladder neck and/or prostate rhabdomyosarcoma. Int J Radiat Oncol Biol Phys. 2017;98(2):352-359.
Laskar S, Pilar A, Khanna N, et al. Interstitial brachytherapy for pediatric soft tissue sarcoma: evolving practice over three decades and long-term outcomes. Pediatr Blood Cancer. 2018;e27112:1-8.
Strege RJ, Kovács G, Meyer JE, Holland D, Claviez A, Mehdorn MH. Perioperative intensity-modulated brachytherapy for refractory orbital rhabdomyosarcomas in children. Strahlenther Onkol. 2009;185:789-798.
Martelli H, Borrego P, Guérin F, et al. Quality of life and functional outcome of male patients with bladder prostate rhabdomyosarcoma treated with conservative surgery and brachytherapy during childhood. Brachytherapy. 2016;15(3):306-311.
Schoot RA, Slater O, Ronckers CM, et al. Adverse events of local treatment in long-term head and neck rhabdomyosarcoma survivors after external beam radiotherapy or AMORE treatment. Eur J Cancer. 2015;51(11):1424-1434.
Koscielniak E, Klingbiel T. Weichteilsarkome. In: Niemeyer C, Eggert A, eds. Pädiatrische Hämatologie und Onkologie. 2. Auflage ed. Berlin: Springer; 2018:485-488.
Fayers P, Bottomley A. Quality of life research within the EORTC-the EORTC QLQ-C30. Eur J Cancer. 2002;38:125-133.
Karger C, Schulz-Ertner D, Sterzing F. Strahlentherapie. In: Reiser M, Kuhn FP, Debus J, eds. Radiologie. 4. Auflage ed. Stuttgart: Georg Thieme Verlag; 2017:110-116.
Larrier NA, Czito BG, Kirsch DG. Radiation therapy for soft tissue sarcoma: indications and controversies for neoadjuvant therapy, adjuvant therapy, intraoperative radiation therapy and brachytherapy. Surg Oncol Clin N Am. 2016;25(4):841-860.
Mazeron JJ, Ardiet JM, Haie-Méder C, et al. GEC-ESTRO recommendations for brachytherapy for head and neck squamous cell carcinomas. Radiother Oncol. 2009;91(2):150-156.
Nolte S, Liegl G, Petersen MA, et al. General population normative data for the EORTC QLQ-C30 health-related quality of life questionnaire based on 15,386 persons across 13 European countries, Canada and the Unites States. Eur J Cancer. 2019;107:153-163.
Hinz A, Singer S, Brähler E. European reference values for the quality of life questionnaire EORTC QLQ-C30: results of a German investigation and a summarizing analysis of six European general population normative studies. Acta Oncol. 2014;53(7):958-965.
Hawkins DS, Gupta AA, Rudzinski ER. What is new in the biology and treatment of pediatric rhabdomyosarcoma. Curr Opin Pediatr. 2014;26(1):50-56.
Jairam V, Roberts KB, Yu JB. Historical trends in the use of radiation therapy for pediatric cancers: 1973-2008. Int J Radiat Oncol Biol Phys. 2013;85(3):151-155.
Koscielniak E, Klingbiel T, Weichteilsarkome. In. Evidenzbasierte Leitlinie (S1) im Auftrag der Deutschen Gesellschaft für Kinderheilkunde und Jugendmedizin (DGKJ) durch die Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH): AWMF Leitlinie Nr. 025/007; 2017:1-10.
Nag S, Martinez-Monge R, Ruymann FB, Bauer CJ. Feasibility of intraoperative high-dose rate brachytherapy to boost low dose external beam radiation therapy to treat pediatric soft tissue sarcomas. Med Pediatr Oncol. 1998;31(2):79-85.
Nag S, Olson T, Ruymann F, Teich S, Pieters R. High-dose-rate brachytherapy in childhood sarcomas: a local control strategy preserving bone growth and function. Med Pediatr Oncol. 1995;25(6):463-469.
Saltzman AF, Cost NG. Current treatment of pediatric bladder and prostate rhabdomyosarcoma. Curr Urol Rep. 2018;19(1):1-9.
Allen AM, Pawlicki T, Dong L, et al. An evidence based review of proton beam therapy: the report of ASTRO's emerging technology committee. Radiother Oncol. 2012;103(1):8-11.
Journy N, Indelicato DJ, Withrow DR, et al. Patterns of proton therapy use in pediatric cancer management in 2016: an international survey. Radiother Oncol. 2019;132:155-161.
Affinita MC, Ferrari A, Milano GM, et al. Long-term results in children with head and neck rhabdomyosarcoma: a report from the Italian Soft Tissue Sarcoma Committee. Pediatr Blood Cancer. 2018;65(3):6-11.
Blank LE, Koedooder K, Pieters BR, et al. The AMORE protocol for advanced-stage and recurrent nonorbital rhabdomyosarcoma in the head-and-neck region of children: a radiation oncology view. Int J Radiat Oncol Biol Phys. 2009;74(5):1555-1562.
Schwarz R, Hinz A. Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. Eur J Cancer. 2001;37(11):1345-1351.
Holloway CL, DeLaney TF, Alektiar KM, Devlin PM, O'Farrell DA, Demanes DJ. American Brachytherapy Society (ABS) consensus statement for sarcoma brachytherapy. Brachytherapy. 2013;12(3):179-190.
Pötter R, Knocke TH, Kovács G, et al. Brachytherapy in the combined modality treatment of pediatric malignancies: principles and preliminary experience with treatment of soft tissue sarcoma (recurrence) and Ewing's sarcoma. Klin Padiatr. 1995;207(4):164-173.
Laskar S, Bahl G, Muckaden MA, et al. Interstitial brachytherapy for childhood soft tissue sarcoma. Pediatr Blood Cancer. 2007;49(5):649-655.
Nag S, Grecula J, Ruymann FB. Aggressive chemotherapy, organ preserving surgery and high dose rate remote brachytherapy in the treatment of rhabdmyosarcoma in infants and young children. Cancer. 1993;72(9):2769-2776.
Folkert MR, Tong WY, Laquaglia MP, et al. 20-year experience with intraoperative high-dose-rate brachytherapy for pediatric sarcoma: outcomes, toxicity, and practice recommendations. Int J Radiat Oncol Biol Phys. 2014;90(2):362-368.
Fuchs J, Paulsen F, Bleif M, et al. Conservative surgery with combined high dose rate brachytherapy for patients suffering from genitourinary and perianal rhabdomyosarcoma. Radiother Oncol. 2016;121(2):262-267.
Nag S, Tippin D, Ruymann FB. Long-term morbidity in children treated with fractionated high-dose-rate brachytherapy for soft tissue sarcomas. J Pediatr Hematol Oncol. 2003;25(6):448-452.
Viani GA, Novaes PE, Jacinto AA, et al. High-dose-rate brachytherapy for soft tissue sarcoma in children: a single institution experience. Radiat Oncol. 2008;3:9.
Thomas H, Timmermann B. Paediatric proton therapy. Br J Radiol. 2019;92:20190601.
Ladra MM, Szymonifka JD, Mahajan A, et al. Preliminary results of a phase II trial of proton radiotherapy for pediatric rhabdomyosarcoma. J Clin Oncol. 2014;32(33):3762-3770.