MODERN RADIOTHERAPY FOR PEDIATRIC RHABDOMYOSARCOMA
Abstract
Rhabdomyosarcoma is the most common soft tissue sarcoma among children and represents half of all soft tissue sarcomas. Tumor is derived from primitive mesenchymal stem cells which develop into striated muscle and common sites of occurrence are the head and neck region, genitourinary tract and extremities.
Treatment is multimodal and includes surgery, radiotherapy and chemotherapy. Application of combined treatment led to significant improvement in treatment outcome. Due to long-term survival, great importance is given to the expected treatment complications. Therapy for pediatric rhabdomyosarcoma requires a delicate balance between the need to intensify therapy for certain group of patients and the desire to reduce potentially toxic therapy and risk for secondary malignancies for patients with good prognosis. Radiotherapy plays an important role in local control of disease and is performed in nearly all patients. Since it is applied to organs and tissues that are in growth and development phase, radiotherapy in childhood has its own specificity and represents greater challenge in relation to the treatment of adult patients.
The use of modern radiotherapy techniques ensures excellent local control of disease with better sparing of normal surrounding tissues which reduces radiotherapy toxicity and preserves quality of life of treated children.
References
Dasgupta R, Rodeberg DA. Update on rhabdomyosarcoma. Semin Pediatr Surg. 2012 Feb;21(1):68–78.
Paulino AC, Okcu MF. Rhabdomyosarcoma. Curr Probl Cancer. 2008 Feb;32(1):7–34.
Shouman T, El-Kest I, Zaza K, Ezzat M, William H, Ezzat I. Rhabdomyosarcoma in childhood: A retrospective analysis od 190 patients treated at a singe institution, Journal of the Egyptian Nat. Cancer Inst. 2005 Jul; 17(2):67-75.
Malempati S, Hawkins DS, Rhabdomyosarcoma: review of the Children's Oncology Group (COG) Soft-Tissue Sarcoma Committee experience and rationale for current COG studies, Pediatr Blood Cancer. 2012 Jul; 59 (1):5-10.
Meza JL, Anderson J, Pappo AS, Meyer WH, Children’s Oncology Group Analysis of prognostic factors in patients with nonmetastatic rhabdomyosarcoma treated on intergroup rhabdomyosarcoma studies III and IV: the Children’s Oncology Group. J Clin Oncol. 2006 Aug;24(24):3844–3851.
Crist W, Gehan EA, Ragab AH, et al. The third Intergroup Rhabdomyosarcoma Study. J Clin Oncol. 1995 Mar; 13:610– 630.
Halperin EC, Constine LS, Tarbell N, Kun N, Pediatric Radiation Oncology, 5th edition, Lippincott Williams and Wilkins; 2010.
A.J. Olch, Pediatric Radiotherapy, Planning and Treatment, CRC Press Taylor and Francis Group, 2013.
Haie-Meder C, Mazeron R, Martelli H, Oberlin O, Brachytherapy role in pediatric rhabdomyosarcomas, Cancer Radiother. 2013 Apr; 17(2):155-8.
Guerin, S, C.Guibout, A.Shamsaldin, et al. Concomitant chemo-radiotherapy and local dose of radiation as risk factors for second malignant neoplasms after solid cancer in childhood: A case-control study. International Journal of Cancer. 2007 Sep;120 (1):96–102.
Beyzadeoglu M, Ozyigit G, Ebruli C, Basic radiation oncology,Berlin Heidelberg: Springer Verlag; 2010.
Barett A., Dobbs J., Morris S, Practical radiotherapy planning, forth edition, London, UK:Hodder Arnold; 2009.
Berthelsen A, Dobbs J, Kjellen E, Landberg T, Moller T, Nilsson P et al. What’s new in target volume definitionfor radiologists in ICRU report 71? How can the ICRU volume definitions be integrated in clinical practice?, Cancer Imaging. 2007 Jun; 7(1):104-116.
Taylor A, Powell M, Intensity-modulated radiotherapy-what is it?, Cancer Imaging. 2004 Mar; 4(2):68-73.
Teoh M, Clark C, Wood K, Whitaker S, Nisbet A, Volumetric modulated arc therapy: a review of current literature and clinical use in practice, Br J Radiol. 2011 Nov; 84(1007):967-996.
Hall EJ, Intensity-modulated radiation therapy, protons, and the risk of second cancers, Int J Radiat Oncol Biol Phys. 2006 May; 65(1):1-7.
Cotter S, Herrup D, Friedmann A, Macdonald S, Pieretti R, Robinson G et al, Proton radiotherapy for pediatric bladder/prostate rhabdomyosarcoma: clinical outcomes and dosimetry compared to intensity-modulated radiation therapy, Int J Radiat Oncol Biol Phys. 2011 Dec;81(5):1367-73.
Merchant TE, Conklin HM, Wu S, et al. Late effects of conformal radiation therapy for pediatric patients with low-grade glioma: prospective evaluation ofcognitive, endocrine, and hearing deficits. J Clin Oncol. 2009 Aug;27:3691–3697.
Barnett G, West C, Dunning A, Elliott R, Coles C, Pharoah P et al, Normal tissue reactions to radiotherapy, Nat Rev Canc.2009 Feb; 9 (2):134-142.
Constine LS, Tarbell NJ, Halperin EC. Pediatric radiation oncology. 6th ed. Wolters Kluwer; 2016.
Chemaitilly W, Cohen L, Endocrine late-effects of childhood cancer and its treatments, European Journal of Endocrinology. 2017 Apr; 176 (4): 183–203.
Brodin P, Rosenschold P, Aznar M, Vogelius i, Kill A, Brojk T et al, Radiobiological risk estimates of adverse events and secondary cancer for proton and photon radiation therapy of pediatric medulloblastoma, Acta Oncologica. 2011 Aug; 50 (6):806-816.
Merchant TE, Kortmann RD. Pediatric Radiation Oncology. 1st ed. Springer International Publishing Switzerland; 2018.