Late Toxicities of Intensity-Modulated Radiation Therapy for Head and Neck Rhabdomyosarcoma.
Late Toxicities of Intensity-Modulated Radiation Therapy for Head and Neck Rhabdomyosarcoma.
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DOI：
10.1002/pbc.26061
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发表时间：
2016-09
影响因子：
3.2
通讯作者：
Wolden SL
中科院分区：
文献类型：
--
作者：
Lockney NA;Friedman DN;Wexler LH;Sklar CA;Casey DL;Wolden SL
目的探讨调强放射治疗(IMRT)治疗儿童头颈部横纹肌肉瘤的远期疗效。所有1999-2014年间在一家机构接受调强放射治疗的儿童头颈部横纹肌肉瘤一年的幸存者都接受了长期并发症评估。晚期毒性按CTCAE版本4.03进行分级。30例患者中，中位年龄7.4(1.5~20.8)岁，中位随访期7.7(1.2~14.4)年，中位剂量50.4(36~50.4)Gy。肿瘤部位包括脑膜旁(80%)、眼眶(13%)和其他(7%)。常见的晚期毒性是面部毁容(n=23，77%)、生长激素缺乏(n=11，37%)、白内障(n=10，34%)和牙科问题(n=10，33%)。2 2例患者(73%)出现≥2晚期毒性，14例患者(47%)出现≥3晚期毒性。17名患者(57%)经历了二级毒性，10名患者(33%)经历了三级毒性。3级毒性包括视力障碍、白内障、面部毁容、慢性鼻窦炎/中耳炎和听力损失。9名患者(30%)出现严重面部畸形，3名患者接受了整容手术。患有严重面部畸形的患者接受治疗的年龄更小(中位数为6.0岁，而没有/不严重面部畸形的患者为8.1岁)，而且更有可能患有颞下窝肿瘤。无继发性实体瘤。儿童头颈部横纹肌肉瘤患者接受调强放射治疗后出现晚期放射毒性是常见的。虽然大多数后遗症都是轻微到中度的，但它们会显著影响生活质量，特别是面部毁容。
To examine the late effects of intensity modulated radiation therapy (IMRT) in pediatric patients with rhabdomyosarcoma of the head and neck. All one-year survivors of pediatric head and neck rhabdomyosarcoma treated with IMRT at a single institution from 1999-2014 were assessed for long term complications. Late toxicities were graded according to CTCAE version 4.03. 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 fourteen patients (47%) had ≥ 3 late toxicities. Seventeen patients (57%) experienced grade 2 toxicity and ten 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 versus 8.1 years for patients with no/non-severe facial deformity) and more likely to have infratemporal fossa tumors. There were no secondary solid malignancies. 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.