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Intensity‐modulated radiation therapy with dose‐painting for pediatric sarcomas with pulmonary metastases
Author(s) -
Yang Joanna C.,
Wexler Leonard H.,
Meyers Paul A.,
Happersett Laura,
La Quaglia Michael P.,
Wolden Suzanne L.
Publication year - 2013
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.24502
Subject(s) - medicine , radiation therapy , intensity (physics) , radiology , sarcoma , oncology , pathology , physics , quantum mechanics
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 1.8 Gy fractions to the primary tumor (n = 3) or post‐operative tumor bed (n = 6). Two patients ≤4 years received 12 Gy intraoperative radiation therapy and 30.6–36 Gy IMRT postoperatively to the tumor bed. All patients received 14–16.8 Gy in 0.54–0.88 Gy 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.