Conservative surgery with combined high dose rate brachytherapy for patients suffering from genitourinary and perianal rhabdomyosarcoma

Fuchs, Jörg; Paulsen, Frank; Bleif, Martin; Lamprecht, Ulf; Weidner, N.; Zips, Daniel; Neunhoeffer, Felix; Seitz, Guido

doi:10.1016/j.radonc.2016.10.010

Cited by 38 publications

(50 citation statements)

References 14 publications

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“…Anus saving surgery was considered in all patients. Brachytherapy was considered but abandoned because all three still had a substantial infiltrating residual tumor and because experience from brachytherapy in PRMS in children was sparse [6,7]. The decision for abdominoperineal excision and permanent colostomy was eventually made in agreement with all three patients and their caregivers as it was felt that anus saving surgery would carry also a high risk of tumor recurrence and anal incontinence.…”

Section: Resultsmentioning

confidence: 99%

“…Conservative surgery with brachytherapy or with proton beam radiation has also been used in perineal and PRMS but due to the rarity of the disease the number of reported cases is low. Fuchs et al (2016) [6] reported two patients and Demoor-Goldschmidt et al (2015) [7] one patient with PRMS treated with combined surgery and brachytherapy. The experience with the proton beam therapy is also limited to a few patients [16,17].…”

Section: Discussionmentioning

confidence: 98%

“…Treatment options have included chemotherapy, conservative or radical excision of the tumor and local radiotherapy. In selected patients a combination of brachytherapy in the treatment protocol may improve the chances for non-mutilating surgery [6][7][8][9].…”

mentioning

confidence: 99%

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Combined management of perianal rhabdomyosarcoma with chemotherapy, radical surgery, and irradiation: A series of three consecutive children

Koivusalo

Rintala

Pakarinen

2019

Journal of Pediatric Surgery

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Background and aim: We describe a series of three successive patients with perianal rhabdomyosarcoma (PRMS) from 2014 to 2017 managed with combined chemotherapy, radical surgery, and radiotherapy. Methods: Ethical consent was obtained. Data including tumor presentation, treatment, and survival was collected from hospital reports. Results: Two girls aged 15 and 16 years (patient #1 and #2) and one boy aged five years (patient #3) were referred because of a suspected perianal abscess. MRI showed large perianal tumors from 7 to 12 cm in diameter that surrounded or infiltrated the anal sphincters and were inconsistent with abscess. Tumor biopsies showed RMS of alveolar (#1 and #2) and embryonal (#3) types. Patient #1 had lymph node and bone metastases, patient #2 lymph node metastases, and patient #3 no metastases. Pretreatment staging, IRS Clinical Group, and Risk Groups were: Stage 4, II, high; Stage 3, GII, intermediate; and Stage 3, I, low, respectively. All underwent colostomy before neoadjuvant chemotherapy (CWS-RMS 2009 program). Neoadjuvant chemotherapy failed to clear the tumors from anal sphincters preventing anus-saving surgery, and all patients underwent abdominoperineal excision. All removed specimens had free margins with negative lymph nodes. After adjuvant chemotherapy and local radiation, the patients were tumor free after 48, 13, and 18 months. Conclusion: In PRMS local surgical control required abdominoperineal excision. Confusion between PRMS and abscess may cause unnecessary delay in management. Level of Evidence: IV (Treatment Study, Case Series with no Comparison Group).

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

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Combined management of perianal rhabdomyosarcoma with chemotherapy, radical surgery, and irradiation: A series of three consecutive children

Koivusalo

Rintala

Pakarinen

2019

Journal of Pediatric Surgery

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“…11,17 HDR may be understood as the gold-standard technique for IRT, and recent studies have shown that HDR-IRT provides very good local tumor control with tolerable side effects, whether performed intraoperatively or postoperatively. [47][48][49][50] Another dose-sparing radiation technology is PBT. 51 Results of a phase II trial have recently suggested PBT to be an effective and safe treatment option with reduced acute and late toxicities in childhood RMS.…”

Section: Discussionmentioning

confidence: 99%

“…These techniques take only a few minutes and reduce both prolonged hospital stays and radiation exposure to families and healthcare professionals, thereby facilitating treatment of even very young children 11,17 . HDR may be understood as the gold‐standard technique for IRT, and recent studies have shown that HDR‐IRT provides very good local tumor control with tolerable side effects, whether performed intraoperatively or postoperatively 47‐50 …”

Section: Discussionmentioning

confidence: 99%

Interventional radiotherapy (brachytherapy) achieves very good long‐term quality of life in children and adolescents with soft‐tissue sarcoma

Sütterlin

Demmert

Kovács

et al. 2020

Pediatric Blood & Cancer

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Background Effective local therapy (surgery, radiation) and systemic multidrug chemotherapy are mandatory for curing childhood sarcoma. The standard radiation therapy for pediatric patients with soft‐tissue sarcoma (STS) is external beam radiotherapy (EBRT). Because EBRT may cause long‐term side effects with adverse effects on the patients’ health and quality of life (QoL), alternative strategies are required. Interventional radiotherapy (IRT; brachytherapy) is established as a standard treatment for several tumors in adulthood. Single‐center series have reported low levels of late effects and improved QoL in survivors treated with IRT in childhood. However, IRT is still applied infrequently in pediatric patients. Methods Thirty patients with STS were treated with IRT between 1992 and 2012 at the University Hospital Schleswig Holstein, Germany. Five patients were lost to follow‐up, and 25 patients (mean age at time of data collection 24.8 years [range, 10.7‐36.1]) could be analyzed focusing on overall survival and QoL (EORTC‐C30 questionnaire). For more detailed information regarding general and health‐specific questions, a separate questionnaire was developed. Results Nineteen of 25 patients were alive 13.4 [1.6‐25.2] years after first cancer disease, and the three‐year overall survival was 76% (SE, 0.09). The score of QoL/global health status (76.2 [16.6‐100]) in our patients outvalues the European (66.1) and equals the German (75.9) reference value. Conclusion IRT is an effective treatment option for pediatric patients with localized STS. Its role among other radiation dose‐sparing techniques such as proton beam therapy has to be defined in prospective studies.

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Rhabdomyosarcoma

Yechieli

Mandeville

Hiniker

et al. 2021

Pediatric Blood & Cancer

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Rhabdomyosarcoma is a heterogeneous disease both in presentation and histology. Improvements in a multimodality therapy resulted in the improved overall survival for patients with a low‐risk and intermediate‐risk disease but not for patients with a metastatic disease. We reviewed and contrasted the North American and European practice patterns, though ultimately the principles of staging, surgery, radiation therapy, and chemotherapy are similar in both Children's Oncology Group and International Society of Paediatric Oncology treatment approaches. Efforts are underway to investigate improved local control rates in higher risk patients using radiation dose escalation strategies, and delayed primary excision in select cases. The prognostic significance of imaging‐based chemotherapy response, proton therapy, novel biomarkers, and targeted drugs will be determined in upcoming clinical trials.

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Conservative surgery with combined high dose rate brachytherapy for patients suffering from genitourinary and perianal rhabdomyosarcoma

Cited by 38 publications

References 14 publications

Combined management of perianal rhabdomyosarcoma with chemotherapy, radical surgery, and irradiation: A series of three consecutive children

Combined management of perianal rhabdomyosarcoma with chemotherapy, radical surgery, and irradiation: A series of three consecutive children

Interventional radiotherapy (brachytherapy) achieves very good long‐term quality of life in children and adolescents with soft‐tissue sarcoma

Rhabdomyosarcoma

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