Intensity-Modulated Radiation Therapy With Dose-Painting for Pediatric Sarcomas With Pulmonary Metastases.
Pediatr Blood Cancer. 2013 Jun 13;
Authors: Yang JC, Wexler LH, Meyers PA, Happersett L, La Quaglia MP, Wolden SL
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;9999:XX-XX. © 2013 Wiley Periodicals, Inc.
PMID: 23765910 [PubMed – as supplied by publisher]