Dominic Leiser1, Gabriele Calaminus2, Robert Malyapa3, Beat Bojaxhiu1, Francesca Albertini3, Ulrike Kliebsch3, Lorentzos Mikroutsikos3, Petra Morach3, Alessandra Bolsi3, Marc Walser3, Beate Timmermann4, Tony Lomax5, Ralf Schneider3, Damien C Weber6. 1. Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Center for Proton Therapy, Paul Scherrer Institute, Switzerland. 2. Department of Pediatric Hematology and Oncology, University Hospital Münster, Germany. 3. Center for Proton Therapy, Paul Scherrer Institute, Switzerland. 4. Clinic for Particle Therapy, University Hospital Essen, West German Proton Therapy Center Essen (WPE), Germany. 5. Department of Pediatric Hematology and Oncology, University Hospital Münster, Germany; ETH Zürich, Switzerland. 6. Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Center for Proton Therapy, Paul Scherrer Institute, Switzerland; University of Bern, Switzerland; University of Zürich, Switzerland. Electronic address: damien.weber@psi.ch.
Abstract
PURPOSE: To assess clinical outcomes in children with rhabdomyosarcoma (RMS) treated with pencil beam scanning (PBS) proton therapy (PT). METHODS AND MATERIALS: Eighty-three RMS (embryonal, n=74; 89%) patients treated between January 2000 and December 2014 were included. The median age was 4.5years (range, 0.8-15.5). All patients received systemic chemotherapy according to prospective protocols. Patients had low-, intermediate-, and high-risk disease in 24%, 63%, and 13% of cases, respectively. The median total dose delivered was 54Gy(RBE) (range, 41.4-64.8). RESULTS: After a median follow-up time of 55.5 months (range, 0.9-126.3), local failure occurred in 16 patients. The 5-year local-control survival rate was 78.5% [95% confidence interval (CI), 69.5-88.5%]. Significant predictors for local failure were group/stage, tumour location, and size. Fourteen patients (16%) died, all from tumour progression. The 5-year overall survival was 80.6% (95%CI, 71.8-90.0%). The 5-year incidence of grade 3 non-ocular late toxicity was 3.6% (95%CI, 1-12%). No grade 4-5 late toxicities were observed. One radiation-induced malignancy was observed (1.2%). The Quality of Life (QoL) scores increased significantly after PT compared to baseline values. CONCLUSIONS: PBS PT led to excellent outcome in children with RMS. Late non-ocular toxicity was minimal and QoL good.
PURPOSE: To assess clinical outcomes in children with rhabdomyosarcoma (RMS) treated with pencil beam scanning (PBS) proton therapy (PT). METHODS AND MATERIALS: Eighty-three RMS (embryonal, n=74; 89%) patients treated between January 2000 and December 2014 were included. The median age was 4.5years (range, 0.8-15.5). All patients received systemic chemotherapy according to prospective protocols. Patients had low-, intermediate-, and high-risk disease in 24%, 63%, and 13% of cases, respectively. The median total dose delivered was 54Gy(RBE) (range, 41.4-64.8). RESULTS: After a median follow-up time of 55.5 months (range, 0.9-126.3), local failure occurred in 16 patients. The 5-year local-control survival rate was 78.5% [95% confidence interval (CI), 69.5-88.5%]. Significant predictors for local failure were group/stage, tumour location, and size. Fourteen patients (16%) died, all from tumour progression. The 5-year overall survival was 80.6% (95%CI, 71.8-90.0%). The 5-year incidence of grade 3 non-ocular late toxicity was 3.6% (95%CI, 1-12%). No grade 4-5 late toxicities were observed. One radiation-induced malignancy was observed (1.2%). The Quality of Life (QoL) scores increased significantly after PT compared to baseline values. CONCLUSIONS:PBS PT led to excellent outcome in children with RMS. Late non-ocular toxicity was minimal and QoL good.
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