Brachytherapy combined with surgery for conservative treatment of children with bladder neck and/or prostate rhabdomyosarcoma

Publication date: Available online 21 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Cyrus Chargari, Christine Haie-Meder, Florent Guérin, Véronique Minard-Colin, Guénolée de Lambert, Renaud Mazeron, Alexandre Escande, Fanny Marsolat, Isabelle Dumas, Eric Deutsch, Dominique Valteau-Couanet, Georges Audry, Odile Oberlin, Hélène Martelli
PurposeTo 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).Patients and MethodsWe prospectively documented the outcome of children treated in our department between 1991 and 2015 for a BP RMS and undergoing a multimodal approach combining a conservative surgery (partial cystectomy and/or partial prostatectomy) and a perioperative interstitial low-dose rate or pulse-dose rate brachytherapy. Prior to brachytherapy, children had received chemotherapy with modalities depending on their risk group of treatment.Results100 patients were identified, median age of 28 months (5.6 months-14 years). According to the Intergroup Rhabdomyosarcoma Study (IRS) Group group, 84 were IRS-III and 12 were IRS-IV tumors. Four patients were treated at relapse. Median number of chemotherapy cycles before local therapy was 6 (4–13). After surgery, 63 patients had a macroscopical tumor residuum. Five patients underwent a brachytherapy boost before pelvic external beam radiotherapy (EBRT) because of nodal involvement and 95 had exclusive brachytherapy. Median follow-up was 64 months (6 months-24.5 years). Five year disease-free and overall survival rates were 84% (95%CI: 80–88%) and 91% (95%CI: 87–95%), respectively. At last follow-up, most survivors presented with only mild to moderate genito-urinary sequelae and a normal diurnal urinary continence. Five patients required a secondary total cystectomy: 3 for a nonfunctional bladder and 2 for relapse.ConclusionBrachytherapy is effective as part of a conservative strategy on BP RMS, with a relatively low delayed toxicity as compared with previously published studies using EBRT. Longer follow-up is required to ensure that the functional results are maintained over time.

Teaser

We report the outcome of 100 consecutive children with bladder/prostate rhabdomyosarcoma treated in our center according to a multimodal treatment based on chemotherapy, conservative surgery and brachytherapy. With median follow-up of 64 months (6 months-24.5 years), 5-year disease-free and overall survival rates were 84% (95%CI: 80–88%) and 91% (95%CI: 87–95%), respectively. Most survivors presented with mild to moderate genito-urinary sequelae, suggesting that this strategy is effective and associated with acceptable delayed toxicity.


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