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Brachytherapy Combined With Surgery for Conservative Treatment of Children With Bladder Neck and/or Prostate Rhabdomyosarcoma. | LitMetric

Brachytherapy Combined With Surgery for Conservative Treatment of Children With Bladder Neck and/or Prostate Rhabdomyosarcoma.

Int J Radiat Oncol Biol Phys

Department of Pediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France; Faculté de Médecine Paris Sud, Université Paris Sud, Université Paris Saclay, Paris, France.

Published: June 2017

AI Article Synopsis

  • This study explores a conservative treatment strategy combining partial surgery and brachytherapy for children with bladder-prostate rhabdomyosarcoma (BP RMS) over a 24-year period.
  • A total of 100 patients were treated, with high survival rates: 84% disease-free and 91% overall at five years, while most survivors experienced mild to moderate urinary issues.
  • The findings suggest that brachytherapy is an effective option with lower long-term side effects compared to traditional external beam radiation, though further research is needed for more extended follow-up on functional outcomes.

Article Abstract

Purpose: To report the results of a conservative strategy based on partial surgery combined with brachytherapy in a prospective cohort of children with bladder-prostate rhabdomyosarcoma (BP RMS).

Methods And Materials: We prospectively documented the outcome of children treated in our department between 1991 and 2015 for BP RMS and undergoing a multimodal approach combining conservative surgery (partial cystectomy and/or partial prostatectomy) and perioperative interstitial low-dose-rate or pulse-dose-rate brachytherapy. Before brachytherapy, children had received chemotherapy with modalities depending on their risk group of treatment.

Results: A total of 100 patients were identified, with a median age of 28 months (range, 5.6 months-14 years). According to the Intergroup Rhabdomyosarcoma Study (IRS) group, 84 were IRS-III, and 12 were IRS-IV tumors. Four patients were treated at relapse. The median number of chemotherapy cycles before local therapy was 6 (range, 4-13). After surgery, 63 patients had a macroscopic tumor residuum. Five patients underwent a brachytherapy boost before pelvic external beam radiation therapy because of nodal involvement, and 95 had exclusive brachytherapy. Median follow-up was 64 months (range, 6 months-24.5 years). Five-year disease-free and overall survival rates were 84% (95% confidence interval 80%-88%) and 91% (95% confidence interval 87%-95%), respectively. At last follow-up most survivors presented with only mild to moderate genitourinary sequelae and a normal diurnal urinary continence. Five patients required a secondary total cystectomy: 3 for a nonfunctional bladder and 2 for relapse.

Conclusion: Brachytherapy is effective as part of a conservative strategy for BP RMS, with a relatively low delayed toxicity as compared with previously published studies using external beam radiation therapy. Longer follow-up is required to ensure that the functional results are maintained over time.

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Source
http://dx.doi.org/10.1016/j.ijrobp.2017.02.026DOI Listing

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