Proton beam therapy with concurrent chemotherapy is feasible in children with newly diagnosed rhabdomyosarcoma.
Proton beam therapy with concurrent chemotherapy is feasible in children with newly diagnosed rhabdomyosarcoma.
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DOI：
10.5603/rpor.a2021.0082
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Takada H
中科院分区：
文献类型：
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作者：
Suzuki R;Fukushima H;Okuwaki H;Inaba M;Hosaka S;Yamaki Y;Fukushima T;Masumoto K;Mizumoto M;Sakurai H;Takada H
横纹肌肉瘤（RMS）的最佳治疗需要化疗、手术和放疗等多学科治疗。手术和放射治疗是RMS局部控制（LC）的组成部分。然而，术后和放射治疗相关的并发症可能会根据局部治疗和肿瘤部位而发生。在这项研究中，我们进行了一项单中心分析的结果和毒性的多学科治疗使用质子束治疗（PBT）的儿童RMS。本研究入组了2009年至2019年期间在筑波大学医院（UTH）接受PBT的年龄小于20岁的RMS新诊断患者。采用回顾性病历分析的方法收集患者的临床资料。纳入48例患者。所有患者的3年无进展生存率（PFS）和总生存率（OS）分别为68.8%和94.2%。根治性切除、保守性切除和仅活检的3年PFS率分别为65.3%、83.3%和67.6%（p = 0.721）。根治性切除、保守性切除和仅活检的3年LC率分别为90.9%、83.3%和72.9%（p = 0.548）。14例患者发生3级或3级以上粘膜炎/皮炎。虽然PBT化疗期间因粘膜炎/皮炎而使用阿片类药物的天数长于无PBT化疗期间的天数[分别为6.1和1.6（平均值），p = 0.001]，但发热和C反应蛋白升高的频率相同。包含PBT的多学科治疗是可行的，并且提供了相对公平的3年PFS，即使在新诊断的RMS儿童中也没有严重毒性。
The optimal treatment for rhabdomyosarcoma (RMS) requires multidisciplinary treatment with chemotherapy, surgery, and radiotherapy. Surgery and radiotherapy are integral to the local control (LC) of RMS. However, postsurgical and radiotherapy-related complications could develop according to the local therapy and tumor location. In this study, we conducted a single-center analysis of the outcomes and toxicity of multidisciplinary treatment using proton beam therapy (PBT) for pediatric RMS. RMS patients aged younger than 20 years whose RMS was newly diagnosed and who underwent PBT at University of Tsukuba Hospital (UTH) during the period from 2009 to 2019 were enrolled in this study. The patients’ clinical information was collected by retrospective medical record review. Forty-eight patients were included. The 3-year progression-free survival (PFS) and overall survival (OS) rates of all the patients were 68.8% and 94.2%, respectively. The 3-year PFS rates achieved with radical resection, conservative resection, and biopsy only were 65.3%, 83.3%, and 67.6%, respectively (p = 0.721). The 3-year LC rates achieved with radical resection, conservative resection, and biopsy only were 90.9%, 83.3%, and 72.9%, respectively (p = 0.548). Grade 3 or higher mucositis/dermatitis occurred in 14 patients. Although the days of opioid use due to mucositis/dermatitis during the chemotherapy with PBT were longer than those during the chemotherapy without PBT [6.1 and 1.6 (mean), respectively, p = 0.001], the frequencies of fever and elevation of C-reactive protein were equivalent. Multidisciplinary therapy containing PBT was feasible and provided a relatively fair 3-year PFS, even in children with newly diagnosed RMS without severe toxicity.