Intensity Modulated Radiotherapy (IMRT) and Fractionated Stereotactic Radiotherapy (FSRT) for children with head-and-neck-rhabdomyosarcoma

Abstract

Background: The present study evaluates the outcome of 19 children with rhabdomyosarcoma of the head-and-neck region treated with Intensity Modulated Radiotherapy (IMRT) or Fractionated Stereotactic Radiotherapy (FSRT) between August 1995 and November 2005.

Methods: We treated 19 children with head-and-neck rhabdomyosarcoma with FSRT (n = 14) or IMRT (n = 5) as a part of multimodal therapy. Median age at the time of radiation therapy was 5 years (range 2-15 years). All children received systemic chemotherapy according to the German Soft Tissue Sarcoma Study protocols. Median size of treatment volume for RT was 93,4 ml. We applied a median total dose of 45 Gy (range 32 Gy - 54 Gy) using a median fractionation of 5 x 1,8 Gy/week (range 1,6 Gy - 1,8 Gy). The median time interval between primary diagnosis and radiation therapy was 5 months (range 3-9 months).

Results: After RT, the 3- and 5-year survival rate was 94%. The 3- and 5-year actuarial local control rate after RT was 89%. The actuarial freedom of distant metastases rate at 3- and 5-years was 89% for all patients. Radiotherapy was well tolerated in all children and could be completed without interruptions > 4 days. No toxicities >CTC grade 2 were observed. The median follow-up time after RT was 17 months.

Conclusion: IMRT and FSRT lead to excellent outcome in children with head-and-neck RMS with a low incidence of treatment-related side effects.

Figure 1

Typical 3D treatment plan of Intensity modulated Radiotherapy (IMRT) for a child with head-and-neck RMS. Thick red line = target volume; orange area 90–100% of the total dose; yellow area 70–90% of the total dose; green area 50–70% of the total dose; blue areas 10–50% of the total dose.

Figure 2

Overall survival in 19 children with head-and-neck RMS treated with FSRT or IMRT.

Figure 3

Local Control rates were 89% after 3- and 5-years (A). For RMS of the orbit only, local control was 100% after 5 years, and 81% for parameningeal RMS and other RMS of the head and neck (B). The rate of distant metastases-free survival was 89% at 5 years (C). Distant-metastases free survival rates were 100% for orbital RMS, and 81% for parameningeal and other head-and-neck RMS (D).