Late Toxicities of Intensity‐Modulated Radiation Therapy for Head and Neck Rhabdomyosarcoma

Abstract

Purpose/Objectives To examine the late effects of intensity modulated radiation therapy (IMRT) in pediatric patients with rhabdomyosarcoma of the head and neck. Materials/Methods All one-year survivors of pediatric head and neck rhabdomyosarcoma treated with IMRT at a single institution from 1999-2014 were assessed for long term complications. Late toxicities were graded according to CTCAE version 4.03. Results Among 30 patients, median age at IMRT was 7.4 (1.5-20.8) years, median follow-up was 7.7 (1.2-14.4) years, and median IMRT dose was 50.4 (36-50.4) Gy. Tumor subsites included parameningeal (80%), orbit (13%), and other (7%). Common late toxicities were facial disfigurement (n=23, 77%), growth hormone deficiency (n=11, 37%), cataract (n=10, 34%), and dental problems (n=10, 33%). Twenty-two patients (73%) had ≥ 2 late toxicities and fourteen patients (47%) had ≥ 3 late toxicities. Seventeen patients (57%) experienced grade 2 toxicity and ten patients (33%) had grade 3 toxicity. Grade 3 toxicities included visual disturbance, cataract, facial disfigurement, chronic sinusitis/otitis, and hearing loss. Severe facial deformity was noted in nine patients (30%), and three patients underwent cosmetic surgery. Patients with severe facial deformity were treated at younger ages (median 6.0 years versus 8.1 years for patients with no/non-severe facial deformity) and more likely to have infratemporal fossa tumors. There were no secondary solid malignancies. Conclusions Late radiation toxicities are common in survivors of pediatric head and neck rhabdomyosarcoma treated with IMRT. While the majority of late effects are mild-moderate, they can significantly impact quality of life, particularly facial disfigurement.

Proton therapy for pediatric head and neck malignancies

“…76.7% of patients had facial disfigurement, 36.7% of patients demonstrated growth hormone deficiency, 33.3% demonstrated dental problems, 20% had hearing loss, 20% had visual disturbance, and 6.7% had a secondary malignancy. 5 These rates appear to be reduced in studies of RMS patients using PBT, with 0-30% rates of decreased growth velocity, 20-70% facial hypoplasia, 0-8% visual complications, 3-30% dentition issues, 0-3% auditory complications, and no reported secondary malignancies. 11,13 If late toxicities are reduced, PBT may allow for dose escalation in refractory histologies.…”

“…Late toxicities include dental anomalies, xerostomia, craniofacial abnormalities, trismus, endocrine abnormalities, cataracts, and osteoradionecrosis. [3][4][5] In addition, areas exposed to radiation are at risk for secondary malignancies that may manifest decades after primary radiation therapy. 6 Proton beam therapy (PBT), using double scattering proton therapy (DS-PT) or pencil beam scanning proton therapy (PBS-PT) techniques, has been shown in dosimetric studies of adult head and neck malignancies to reduce the amount of normal tissue exposed to radiation compared to modern photon plans.…”

Psychosocial well‐being of long‐term survivors of pediatric head–neck rhabdomyosarcoma

“…[4][5][6] Furthermore, other adverse events, such as growth hormone deficiency and cataract, are frequently reported. [4][5][6][7] The impact of these adverse events on psychosocial well-being is unclear. Multiple studies showed that, in general, health-related quality of life (HRQoL) in survivors of childhood cancer is comparable with normative values of healthy individuals; however, specific subgroups are at risk for impaired psychosocial wellbeing.…”

Rhabdomyosarcoma of the Head and Neck: A Multimodal Approach

“…Lockney et al described late toxicities after IMRT for 30 patients with HNRMS treated at Memorial Sloan Kettering. 38 With a median follow-up of 7.7 years, the most common late toxicity observed was facial disfigurement, seen in 77% of patients. Children treated at younger ages (median 6.0 years) and those with infratemporal fossa tumors were more likely to develop severe facial deformity.…”