Reduced Toxicity With Intensity Modulated Radiation Therapy (IMRT) for Desmoplastic Small Round Cell Tumor (DSRCT): An Update on the Whole Abdominopelvic Radiation Therapy (WAP-RT) Experience
Reduced Toxicity With Intensity Modulated Radiation Therapy (IMRT) for Desmoplastic Small Round Cell Tumor (DSRCT): An Update on the Whole Abdominopelvic Radiation Therapy (WAP-RT) Experience
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DOI：
10.1016/j.ijrobp.2012.09.005
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发表时间：
2013-01-01
影响因子：
7
通讯作者：
Wolden, Suzanne L.
中科院分区：
文献类型：
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作者：
Desai, Neil B.;Stein, Nicholas F.;Wolden, Suzanne L.
目的：结缔组织增生小圆细胞瘤（DSRCT）是一种罕见的恶性肿瘤，通常累及腹膜，多发于年轻男性。全盆腔放射治疗（WAP-RT）采用传统的二维（2D）放射治疗（RT）用于治疗局部复发，但由于毒性而受到限制。我们的目的是评估调强放疗（IMRT）对毒性的益处，并更新DSRCT最大的放疗系列。方法与材料：回顾性分析1992 ~ 2011年31例WAP-RT治疗DSRCT患者的临床资料，其中2D-RT 22例，IMRT 9例。所有患者均接受了多药化疗和最大限度的手术切除，随后接受了30 Gy的WAP-RT。在12例中使用了12至24 Gy的进一步聚焦增强。Boost RT和自体干细胞移植几乎只适用于接受2D-RT治疗的患者。用不良事件通用术语标准评估毒性。剂量学分析比较了IMRT和模拟2D-RT的剂量分布。结果：31例患者中，30例完成了WAP-RT，中位随访时间为19个月。与2D-RT相比，IMRT降低了急性毒性：2级或以上胃肠道毒性P= 0.04 (33% vs 77%)；4级血液学毒性P= 0.02 (33% vs 86%)；粒细胞集落刺激因子率P= 0.01；血小板输注率P= 0.04。治疗后红细胞和血小板输注率也降低（P= 0.01）。IMRT改善了靶均匀性（[D05- d95]/D05分别为21%和46%），导致平均骨剂量减少21%。小肠梗阻是最常见的晚期毒性（23%）。更新的3年总生存率和无进展生存率分别为50%和24%。在多因素分析中，总生存率与诊断远处转移有关。大多数失败仍然是腹腔内的（88%）。结论：在DSRCT中，IMRT用于巩固性WAP-RT尤其能改善血液学毒性。尽管目前治疗方案的长期疗效仍然令人失望，但IMRT治疗指数的提高可能有助于推广其使用，并允许增加新的方法，如腹腔免疫治疗。(C) 2013爱思唯尔公司
Purpose: Desmoplastic small round cell tumor (DSRCT) is a rare malignancy typically involving the peritoneum in young men. Whole abdominopelvic radiation therapy (WAP-RT) using conventional 2-dimensional (2D) radiation therapy (RT) is used to address local recurrence but has been limited by toxicity. Our objectives were to assess the benefit of intensity modulated radiation therapy (IMRT) on toxicity and to update the largest series on radiation for DSRCT.Methods and Materials: The records of 31 patients with DSRCT treated with WAP-RT (22 with 2D-RT and 9 with IMRT) between 1992 and 2011 were retrospectively reviewed. All received multi-agent chemotherapy and maximal surgical debulking followed by 30 Gy of WAP-RT. A further focal boost of 12 to 24 Gy was used in 12 cases. Boost RT and autologous stem cell transplantation were nearly exclusive to patients treated with 2D-RT. Toxicities were assessed with the Common Terminology Criteria for Adverse Events. Dosimetric analysis compared IMRT and simulated 2D-RT dose distributions.Results: Of 31 patients, 30 completed WAP-RT, with a median follow-up after RT of 19 months. Acute toxicity was reduced with IMRT versus 2D-RT: P=.04 for gastrointestinal toxicity of grade 2 or higher (33% vs 77%); P=.02 for grade 4 hematologic toxicity (33% vs 86%); P=.01 for rates of granulocyte colony-stimulating factor; and P=.04 for rates of platelet transfusion. Post treatment red blood cell and platelet transfusion rates were also reduced (P=.01). IMRT improved target homogeneity ([D05-D95]/D05 of 21% vs 46%) and resulted in a 21% mean bone dose reduction. Small bowel obstruction was the most common late toxicity (23% overall). Updated 3-year overall survival and progression-free survival rates were 50% and 24%, respectively. Overall survival was associated with distant metastasis at diagnosis on multi-variate analysis. Most failures remained intraperitoneal (88%).Conclusions: IMRT for consolidative WAP-RT in DSRCT improves hematologic toxicity in particular. Although the long-term efficacy of current treatment options remains disappointing, the improved therapeutic index of IMRT may aid in generalizing its use and allowing the addition of novel approaches such as intraperitoneal immunotherapy. (C) 2013 Elsevier Inc.