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. 2016 Sep;63(9):1608-14.
doi: 10.1002/pbc.26061. Epub 2016 May 16.

Late Toxicities of Intensity-Modulated Radiation Therapy for Head and Neck Rhabdomyosarcoma

Natalie A Lockney  1 , Danielle Novetsky Friedman  2 , Leonard H Wexler  2 , Charles A Sklar  2 , Dana L Casey  1 , Suzanne L Wolden  1
Affiliations

Late Toxicities of Intensity-Modulated Radiation Therapy for Head and Neck Rhabdomyosarcoma

Natalie A Lockney et al. Pediatr Blood Cancer. 2016 Sep.

Abstract

Purpose/objectives: To examine the late effects of intensity-modulated radiation therapy (IMRT) in pediatric patients with rhabdomyosarcoma of the head and neck.

Materials/methods: All 1-year survivors of pediatric head and neck rhabdomyosarcoma treated with IMRT at a single institution from 1999 to 2014 were assessed for long-term complications. Late toxicities were graded according to CTCAE version 4.03.

Results: Among 30 patients, median age at IMRT was 7.4 (1.5-20.8) years, median follow-up was 7.7 (1.2-14.4) years, and median IMRT dose was 50.4 (36-50.4) Gy. Tumor subsites included parameningeal (80%), orbit (13%), and other (7%). Common late toxicities were facial disfigurement (n = 23, 77%), growth hormone deficiency (n = 11, 37%), cataract (n = 10, 34%), and dental problems (n = 10, 33%). Twenty-two patients (73%) had ≥2 late toxicities and 14 patients (47%) had ≥3 late toxicities. Seventeen patients (57%) experienced grade 2 toxicity and 10 patients (33%) had grade 3 toxicity. Grade 3 toxicities included visual disturbance, cataract, facial disfigurement, chronic sinusitis/otitis, and hearing loss. Severe facial deformity was noted in nine patients (30%), and three patients underwent cosmetic surgery. Patients with severe facial deformity were treated at younger ages (median 6.0 years vs. 8.1 years for patients with no/nonsevere facial deformity) and more likely to have infratemporal fossa tumors. There were no secondary solid malignancies.

Conclusions: Late radiation toxicities are common in survivors of pediatric head and neck rhabdomyosarcoma treated with IMRT. While the majority of late effects are mild-moderate, they can significantly impact quality of life, particularly facial disfigurement.

Keywords: intensity-modulated radiation therapy; late radiation effects; pediatric rhabdomyosarcoma.

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Figures

Figure 1
Figure 1
Cumulative incidence curve for the development of late toxicities following intensity modulated radiation therapy (IMRT) for head and neck rhabdomyosarcoma in pediatric patients.
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