Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Int J Radiat Oncol Biol Phys. 2010 Aug 1;77(5):1463-9. doi: 10.1016/j.ijrobp.2009.06.015. Epub 2009 Oct 26.
Rhabdomyosarcomas in the orbit form a major challenge in terms of cure without severe side effects in childhood cancer. Our specifically developed approach consists of applying brachytherapy to the tumor area using a mold. Analysis of its results for 20 patients was performed.
Thirteen patients were referred for brachytherapy if complete remission was not reached after chemotherapy (Group I) and 7 in case of relapse (Group II). In total, 20 patients were treated between 1991 and 2007. Four were female and 16 male; their ages varied from 1.1 to 16.5 years, with an average of 8.5 years. After macroscopically radical tumor resection, molds with holes drilled to hold flexible catheters were placed into the orbit. The dose to the clinical target volume was 40-50 Gy.
Three patients of Group I and 1 patient of Group II developed local recurrence and underwent exenteration. The progression-free survival in Group I is 71.9% (95% CI 0.44-1.0), in Group II 85.7% (95% CI 0.60-1.0), the overall 5-year survival rate of the entire group is 92% (95% CI 0.76-1.0). During treatment, no serious side effects were observed. The late complications encountered in this series were cataract in 2 patients, 1 of whom also developed mild retinopathy. Two patients with ptosis needed surgical correction. No facial asymmetries or bone growth anomalies were observed.
This entire procedure of brachytherapy with a mold offers a tailor-made treatment for orbital rhabdomyosarcomas with only few signs of late toxicity.
眼眶横纹肌肉瘤在儿童癌症中，要实现无严重副作用的治愈是一个重大挑战。我们专门开发的方法包括使用模具对肿瘤区域进行近距离放射治疗。对 20 名患者的结果进行了分析。
如果化疗后未达到完全缓解（I 组）或复发（II 组），则将 13 名患者转介接受近距离放射治疗。总共在 1991 年至 2007 年间治疗了 20 名患者。其中 4 名为女性，16 名为男性；年龄从 1.1 岁到 16.5 岁不等，平均年龄为 8.5 岁。在进行了宏观上的根治性肿瘤切除后，将带有钻孔以容纳柔性导管的模具放置在眼眶中。临床靶体积的剂量为 40-50Gy。
I 组的 3 名患者和 II 组的 1 名患者发生局部复发并接受了眼眶内容物切除术。I 组的无进展生存率为 71.9%（95%CI 0.44-1.0），II 组为 85.7%（95%CI 0.60-1.0），整个组的 5 年总生存率为 92%（95%CI 0.76-1.0）。在治疗过程中，未观察到严重的副作用。本系列中遇到的晚期并发症包括 2 例白内障，其中 1 例还出现轻度视网膜病变。2 例上睑下垂的患者需要手术矫正。未观察到面部不对称或骨骼生长异常。
这种使用模具的近距离放射治疗整个过程为眼眶横纹肌肉瘤提供了一种定制化的治疗方法，只有很少的晚期毒性迹象。
