Le Reun Eymeric, Espenel Sophie, Garcia Max-Adrien, Girbovan Anamaria Hermina, Terlizzi Mario, Minard-Colin Véronique, Lasseau Théo, Guérin Florent, Chargari Cyrus
Department of Radiation Oncology, Gustave Roussy Cancer Campus, Cancer Center, Villejuif, France; Inserm, U1296 Unit, "Radiation: Defense, Health and Environment", Centre Léon-Bérard, Lyon, France.
Department of Radiation Oncology, Gustave Roussy Cancer Campus, Cancer Center, Villejuif, France.
Int J Radiat Oncol Biol Phys. 2025 Mar 1;121(3):658-666. doi: 10.1016/j.ijrobp.2024.09.037. Epub 2024 Sep 20.
Rhabdomyosarcoma (RMS) is the most common soft tissue cancer in children. Around 15% of RMS involve the bladder and/or prostate (BP). Overall survival is around 85%. After chemotherapy, patients receive local treatment based on surgery and/or radiation therapy. In recent decades, image guidance and pulsed-dose rate (PDR) brachytherapy have made it possible to personalize treatment and reduce radiation-related toxicity while maintaining good tumor control. We report one of the largest series of image guided brachytherapy for pediatric RMS BP.
The clinical and dosimetric parameters of children treated with brachytherapy for BP RMS between July 2014 and September 2020 were retrospectively reviewed. Patients were treated with a multimodal conservative approach, combining partial conservative surgery (preservation of the bladder neck and urethra), followed by an interstitial brachytherapy procedure. Iridium-192 PDR treatment was administered on the basis of computed tomography and magnetic resonance imaging planning. Toxicities were reported according to version 4.0 of the Common Terminology Criteria for Adverse Events.
A total of 75 patients were identified, with a median age of 29 months (range, 2-84) at diagnosis. The median brachytherapy dose was 60.06 Gy (143 pulses, 0.42 Gy/pulse). With a median follow-up of 44.1 months (range, 0.7-90), the 5-year overall survival and progression-free survival rates were 97.3% and 92%, respectively. Median D for the bladder and D for the rectum were 38.6 Gy and 49 Gy, respectively. The 5-year probability of survival without severe late urinary toxicity (grade 3 or higher) was estimated at 78.8% (95% CI, 68.1-91.1). A total of 9.3% of children experienced grade 2 or 3 late rectal toxicity.
Image guided PDR brachytherapy offers personalized treatment for pediatric BP RMS, with a favorable therapeutic index. No prognostic factors for urinary toxicity have been identified. Multicenter studies with larger numbers of patients are needed to clarify these data.
横纹肌肉瘤（RMS）是儿童最常见的软组织癌。约15%的RMS累及膀胱和/或前列腺（BP）。总体生存率约为85%。化疗后，患者接受基于手术和/或放射治疗的局部治疗。近几十年来，图像引导和脉冲剂量率（PDR）近距离放射治疗使个性化治疗成为可能，并在保持良好肿瘤控制的同时降低了辐射相关毒性。我们报告了最大系列的儿童BP RMS图像引导近距离放射治疗之一。
回顾性分析2014年7月至2020年9月期间接受BP RMS近距离放射治疗的儿童的临床和剂量学参数。患者采用多模式保守方法治疗，包括部分保守手术（保留膀胱颈和尿道），随后进行间质近距离放射治疗。基于计算机断层扫描和磁共振成像规划给予铱-192 PDR治疗。根据不良事件通用术语标准第4.0版报告毒性。
共确定75例患者，诊断时中位年龄为29个月（范围2-84个月）。近距离放射治疗的中位剂量为60.06 Gy（143脉冲，0.42 Gy/脉冲）。中位随访44.1个月（范围0.7-90个月），5年总生存率和无进展生存率分别为97.3%和92%。膀胱的中位D值和直肠的D值分别为38.6 Gy和49 Gy。无严重晚期泌尿系统毒性（3级或更高）的5年生存概率估计为78.8%（95%CI，68.1-91.1）。共有9.3%的儿童出现2级或3级晚期直肠毒性。
图像引导PDR近距离放射治疗为儿童BP RMS提供了个性化治疗，具有良好的治疗指数。尚未确定泌尿系统毒性的预后因素。需要更多患者的多中心研究来阐明这些数据。
