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BMC Cancer  2007 

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

DOI: 10.1186/1471-2407-7-177

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Abstract:

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 × 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).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.IMRT and FSRT lead to excellent outcome in children with head-and-neck RMS with a low incidence of treatment-related side effects.Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma entity in children [1]. The most common sites of RMS in children are the head and neck region (35%), the genitourinary tract (35%) and the extremities (17%) [2]. The orbit is the primary site in about 10% of these tumors, the most common localization in the head and neck area is parameningeal, including the nasopharynx, the paranasal sinuses, the middle ear and mastoid and the infratemporal fossa/pterygopalatine space [2-8]. Most children are younger than 10 years of age (72%) [9].Modern therapy protocols comprise of surgical resection, chemotherapy and radiotherapy (RT). However, RT in children is commonly applied cautiously with respect to early and late side effects [10-14].With modern RT techniques such as Intensity Modulated Radiotherapy (IMRT) and Fractionated Stereotactic Radiotherapy (FSRT)

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