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Favorable outcomes after whole abdominopelvic radiation therapy for pediatric and young adult sarcoma
Author(s) -
Casey Dana L.,
Wexler Leonard H.,
LaQuaglia Michael P.,
Meyers Paul A.,
Wolden Suzanne L.
Publication year - 2014
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.25088
Subject(s) - medicine , sarcoma , rhabdomyosarcoma , radiation therapy , abdomen , pelvis , pancytopenia , ascites , surgery , pathology , bone marrow
Background Current Children's Oncology Group (COG) guidelines recommend 24 Gy whole abdominopelvic radiation therapy (WAP‐RT) for pediatric patients with sarcoma with peritoneal dissemination and/or malignant ascites. However, WAP‐RT has never been described for pediatric sarcoma excluding desmoplastic small round‐cell tumor (DSRCT). The objective of this study was to evaluate feasibility, outcomes, and toxicity of WAP‐RT in children with sarcoma and peritoneal dissemination. Procedure Detailed records of all 10 pediatric patients with sarcoma (excluding DSRCT) treated with WAP‐RT from 2001 to 2013 were reviewed. Results Median age was 9.9 years (range, 1.7–33.8). Seven patients had rhabdomyosarcoma, 2 embryonal undifferentiated sarcoma of the liver, and 1 Ewing sarcoma. Patients received a median dose of 24 Gy with intensity‐modulated radiation therapy (IMRT) to the whole abdomen and pelvis. Two patients did not complete treatment, one due to transfusion‐resistant pancytopenia and one due to moderate acute gastrointestinal toxicity. At a median follow‐up of 4.0 years, both relapse‐free survival and overall survival were 100%. Acute hematologic toxicities were common, with 40% of patients developing a grade 4 hematologic toxicity. Most acute gastrointestinal toxicities were grade 1 and managed appropriately with anti‐diarrheals and anti‐emetics. Late effects varied, and half of patients are without long‐term sequelae. Conclusions All patients remain free of disease, both locally and distantly. Although WAP‐RT was associated with acute and late toxicity, treatment was feasible with supportive care. Given the excellent rates of tumor control, we recommend that all providers give WAP‐RT with IMRT to patients with pediatric sarcoma and peritoneal dissemination and/or malignant ascites. Pediatr Blood Cancer 2014;61:1565–1569. © 2014 Wiley Periodicals, Inc.