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

Lockney, Natalie A.; Friedman, Danielle Novetsky; Wexler, Leonard H.; Sklar, Charles A.; Casey, Dana L.; Wolden, Suzanne L.

doi:10.1016/j.ijrobp.2015.07.1844

Cited by 4 publications

(6 citation statements)

References 14 publications

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“…Therefore, the reduced risk of mortality associated with surgery that was observed in this cohort is likely skewed by the fact that most patients undergoing surgery have less extensive disease to begin with. Successful complete resection of the HNRMS may obviate the need for adjuvant radiotherapy in some cases, reducing the long‐term risks associated with radiation exposure 2,31–36 . Currently, omission of radiotherapy is only recommended for patients embryonal histology who are able to undergo a CG I resection, but radiation dose may be reduced for patients undergoing DPE or resection to CG II 37 .…”

Section: Discussionmentioning

confidence: 99%

Role of Surgery in Rhabdomyosarcoma of the Head and Neck in Children

et al. 2020

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Objectives Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. The goal of this research is to analyze the role of surgery in the management of pediatric parameningeal (PM) and non‐PM head and neck RMS (HNRMS). Study Design Retrospective review. Methods Retrospective chart review of patients <20 years of age treated for HNRMS between 1970 and 2015. Clinical presentation, tumor characteristics, treatment, recurrence, follow‐up, and outcome data were collected. Results Of 97 patients with HNRMS, 56% were male. Overall median (IQR: interquartile range) age at diagnosis was 5.8 (3.3–9.8) years. Sixty‐five patients (67%) had PM tumors. Of 75 patients with histologic subtype identified, 51 (53%) had embryonal and 20 (21%) alveolar RMS. Almost all patients received chemotherapy (99%) and radiotherapy (95%). Forty‐four patients (45%) underwent surgery. Surgery was more likely to be conducted in patients with lesions of a non‐PM site. Median follow‐up time was 3.4 years (IQR: 1.1–10.8). In 5 years of follow‐up, 20% (17 of 85) died and 29% (20 of 70) had recurrence. The estimated 5‐year survival rate was 72% (95% CI, 57.8, 81.5%). Surgery was associated with a reduced risk of mortality after accounting for TNM stage 4 and tumor site (adjusted HR 0.24; 95% CI, 0.07, 0.79; P = .02). The association between surgery and risk of mortality was similar in PM and non‐PM tumors. Conclusion A multimodal protocol for treatment including chemotherapy, surgery, and radiotherapy is the mainstay for management of children with HNRMS. While surgery is more commonly used to treat non‐PM HNRMS, patients who are able to undergo surgery have significantly higher 5‐year survival. Level of Evidence 4 Laryngoscope, 131:E984–E992, 2021

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Section: Discussionmentioning

confidence: 99%

Role of Surgery in Rhabdomyosarcoma of the Head and Neck in Children

et al. 2020

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“…PBT may significantly reduce late toxicities in this patient population. At a median of 7.7 years after IMRT for RMS of the head and neck, 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 . 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 .…”

Section: Discussionmentioning

confidence: 99%

“…Patients may experience mucositis and dermatitis during treatment that may necessitate feeding tube placement, narcotic administration for pain control, hospitalization for symptom management, or treatment breaks. Late toxicities include dental anomalies, xerostomia, craniofacial abnormalities, trismus, endocrine abnormalities, cataracts, and osteoradionecrosis . In addition, areas exposed to radiation are at risk for secondary malignancies that may manifest decades after primary radiation therapy …”

Section: Introductionmentioning

confidence: 99%

Proton therapy for pediatric head and neck malignancies

Vogel

Both

Kirk

et al. 2017

Pediatric Blood & Cancer

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“…RMS generally occurs in young children, and radiotherapy at young age leads to abnormal growth and function of musculoskeletal tissues; therefore, many HNRMS survivors suffer from facial disfigurements (incidence rate, 35–77%) . Furthermore, other adverse events, such as growth hormone deficiency and cataract, are frequently reported . The impact of these adverse events on psychosocial well‐being is unclear.…”

Section: Introductionmentioning

confidence: 99%

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

Vaarwerk

Schoot

Maurice‐Stam

et al. 2018

Pediatric Blood & Cancer

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Background Head and neck rhabdomyosarcoma (HNRMS) survivors are at risk to develop adverse events (AEs). The impact of these AEs on psychosocial well‐being is unclear. We aimed to assess psychosocial well‐being of HNRMS survivors and examine whether psychosocial outcomes were associated with burden of therapy. Procedure Sixty‐five HNRMS survivors (median follow‐up: 11.5 years), treated in the Netherlands and the United Kingdom between 1990 and 2010 and alive ≥2 years after treatment visited the outpatient multidisciplinary follow‐up clinic once, in which AEs were scored based on a predefined list according to the Common Terminology Criteria for Adverse Events. Survivors were asked to complete questionnaires on health‐related quality of life (HRQoL; PedsQL and YQOL‐FD), self‐perception (KIDSCREEN), and satisfaction with appearances (SWA). HRQoL and self‐perception scores were compared with reference values, and the correlation between physician‐assessed AEs and psychosocial well‐being was assessed. Results HNRMS survivors showed significantly lower scores on PedsQL school/work domain (P ≤ 0.01, P = 0.02, respectively), YQOL‐FD domains negative self‐image and positive consequences (P ≤ 0.01, P = 0.04, respectively) compared with norm data; scores on negative consequences domain were significantly higher (P = 0.03). Over 50% of survivors negatively rated their appearances on three or more items. Burden of AEs was not associated with generic HRQoL and self‐perception scores, but was associated with disease‐specific QoL (YQOL‐FD). Conclusion In general, HRQoL in HNRMS survivors was comparable to reference groups; however, survivors did report disease‐specific consequences. We therefore recommend including specific questionnaires related to difficulties with facial appearance in a systematic monitoring program to determine the necessity for tailored care.

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

Cited by 4 publications

References 14 publications

Role of Surgery in Rhabdomyosarcoma of the Head and Neck in Children

Role of Surgery in Rhabdomyosarcoma of the Head and Neck in Children

Proton therapy for pediatric head and neck malignancies

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

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