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Pencil Beam Scanning Proton Therapy for Pediatric Parameningeal Rhabdomyosarcomas: Clinical Outcome of Patients Treated at the Paul Scherrer Institute
Author(s) -
Weber Damien C.,
Ares Carmen,
Albertini Francesca,
FreiWelte Martina,
Niggli Felix K.,
Schneider Ralf,
Lomax Antony J
Publication year - 2016
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.25864
Subject(s) - medicine , pencil beam scanning , proton therapy , rhabdomyosarcoma , toxicity , univariate analysis , radiation therapy , chemotherapy , concomitant , nuclear medicine , surgery , sarcoma , multivariate analysis , pathology
Background Parameningeal rhabdomyosarcomas (PM‐RMSs) represent approximately 25% of all rhabdomyosarcoma (RMS) cases. These tumors are associated with early recurrence and poor prognosis. This study assessed the clinical outcome and late toxicity of pencil beam scanning (PBS) proton therapy (PT) in the treatment of children with PM‐RMS. Procedures Thirty‐nine children with PM‐RMS received neoadjuvant chemotherapy followed by PBS‐PT at the Paul Scherrer Institute, with concomitant chemotherapy. The median age was 5.8 years (range, 1.2–16.1). Due to young age, 25 patients (64%) required general anesthesia during PT. The median time from the start of chemotherapy to PT was 13 weeks (range, 3–23 weeks). Median prescription dose was 54 Gy (relative biologic effectiveness, RBE). Results With a mean follow‐up of 41 months (range, 9–106 months), 10 patients failed. The actuarial 5‐year progression‐free survival (PFS) was 72% (95% CI, 67–94%) and the 5‐year overall survival was 73% (95% CI, 69–96%). On univariate analysis, a delay in the initiation of PT (>13 weeks) was a significant detrimental factor for PFS. Three (8%) patients presented with grade 3 radiation‐induced toxicity. The estimated actuarial 5‐year toxicity ≥grade 3 free survival was 95% (95% CI, 94–96%). Conclusions Our data contribute to the growing body of evidence demonstrating the safety and effectiveness of PT for pediatric patients with PM‐RMS. These preliminary results are encouraging and in line with other combined proton–photon and photons series; observed toxicity was acceptable.