Prospective evaluation of multitarget treatment of pediatric patients with helical intensity-modulated radiotherapy

Abstract

Background and purpose Radiotherapy (RT) is persistently gaining significance in the treatment of pediatric tumors. However, individual features of a growing body and multifocal stages complicate this approach. Tomotherapy offers advantages in the treatment of anatomically complex tumors with low risks of side effects. Here we report on toxicity incidence and outcome of tomotherapy with a focus on multitarget RT (mtRT). Materials and methods From 2008 to 2017, 38 children diagnosed with sarcoma were treated with tomotherapy. The median age was 15 years (6-19 years). Toxicity was graded according to the Common Terminology Criteria for Adverse Events v.4.03 and classified into symptoms during RT, acutely (0-6 months) and late (>6 months) after RT, and long-term sideeffects (>24 months). Results The main histologies were Ewing sarcoma (n = 23 [61%]) and alveolar rhabdomyosarcoma (n = 5 [13%]). RT was performed with a median total dose of 54 Gy (40.5-66.0 Gy) and a single dose of 2 Gy (1.80-2.27 Gy). Twenty patients (53%) received mtRT. Median follow-up was 29.7 months (95% confidence interval 15.3-48.2 months) with a 5-year survival of 55.2% (±9.5%). The 5-year survival rate of patients with mtRT (n = 20) was 37.1 ± 13.2%, while patients who received single-target RT (n = 18) had a 5-year survival rate of 75 ± 10.8%. Severe toxicities (grade 3 and 4) emerged in 14 patients (70%) with mtRT and 7 patients (39%) with single-target RT. Two non-hematological grade 4 toxicities occurred during RT: one mucositis and one radiodermatitis. After mtRT 5 patients had grade 3 toxicities acute and after single-target RT 4 patients. One patient had acute non-hematological grade 4 toxicities (gastritis, pericarditis, and pericardial effusion) after mtRT. Severe late effects of RT occurred in 2 patients after mtRT and in none of the single-target RT patients. No severe long-term side effects appeared. Conclusion Our results showed acceptable levels of acute and late toxicities, considering the highly advanced diseases and multimodal treatment. Hence, tomotherapy is a feasible treatment method for young patients with anatomically complex tumors or multiple targets. Especially mtRT is a promising and innovative treatment approach for pediatric sarcomas, delivering unexpectedly high survival rates for patients with multifocal Ewing sarcomas in this study, whereby the limited number of patients should invariably be considered in the interpretation.

Evaluation of treatment-associated eye toxicity after irradiation in childhood and adolescence—results from the Registry of the Evaluation of Side Effects after Radiotherapy in Childhood and Adolescence (RiSK)

“…In radiotherapy, the technical possibilities are constantly being developed with the aim of minimizing acute and late sequelae. Techniques such as IMRT or tomotherapy make it possible to irradiate pathological tissue in a more conformal manner while sparing healthy surrounding tissue [27,28]. It is well known that in addition to the radiation dose used, the volume irradiated has a major impact on organs at risk (OARs) and this is minimized by new radiation methods [29].…”

Pharmazeutische Behandlung der akuten Radiodermatitis in der deutschsprachigen strahlentherapeutischen Gemeinschaft

“…2,3 Sie kann die Lebensqualität der Patienten erheblich beeinträchtigen 4,5 sowie die Compliance und Therapiewirksamkeit potenziell gefährden. 6 Trotz jüngster technischer Verbesserungen, [7][8][9] und hautschonender Technologien 10,11 bleibt die RD eine Herausforderung für Strahlentherapeuten und an der Behandlung beteiligte Kollegen. Dies ist von größter Bedeutung, da der technische Fortschritt mit der Intensivierung begleitender systemischer Therapien und der Erhöhung der RT-Dosis in einer immer älter werdenden Bevölkerung einhergeht.…”

Pharmaceutical management of acute radiation dermatitis in the German speaking radiation oncology community

“…2,3 Its onset can cause significant affection of the patient's quality of life, 4,5 and may potentially threaten the adherence and effectiveness of treatments. 6 Despite recent technical improvements, [7][8][9] and skin-sparing technologies, 10,11 RD remains a challenge for clinicians and RT-related professionals. This is of utmost relevance since technical progress is accompanied by intensification of concomitant systemic therapies and RT dose escalation in a progressively aging population.…”