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. 2021 Oct:163:215-220.
doi: 10.1016/j.radonc.2021.05.017. Epub 2021 May 21.

Proton radiotherapy for infant rhabdomyosarcoma: Rethinking young age as an adverse prognostic factor

Akash D Parekh  1 , Daniel J Indelicato  1 , Raymond B Mailhot Vega  1 , Ronny L Rotondo  2 , Christopher G Morris  1 , Scott Bradfield  3 , Julie A Bradley  4
Affiliations

Proton radiotherapy for infant rhabdomyosarcoma: Rethinking young age as an adverse prognostic factor

Akash D Parekh et al. Radiother Oncol. 2021 Oct.

Abstract

Background & purpose: In infants with rhabdomyosarcoma, young age is considered an adverse prognostic factor and treatment is often attenuated to reduce side effects. Proton therapy may improve the therapeutic ratio in these patients. We report outcomes in infants with rhabdomyosarcoma treated with proton therapy.

Materials & methods: Between 2009 and 2019, 37 infants <24 months old with non-metastatic rhabdomyosarcoma received proton therapy. Local control (LC), progression-free survival (PFS), and overall survival (OS) were estimated using the Kaplan-Meier product limit. The log-rank test assessed significance between selected prognostic factors. Toxicity was graded per CTCAEv5.0.

Results: Median follow-up was 5.1 years. Overall, 76% of patients had an unfavorable primary site. Median dose was 50.4GyRBE. At 5 years, LC, PFS, and OS rates were 83%, 78%, and 83%. On univariate analysis, 5-year LC and OS were inferior for favorable versus unfavorable disease sites (67% vs 89%, 67% vs 89%, respectively; p < .05) and 5-year OS was superior in stage 3 versus stage 1-2 disease (91% vs 69%; p = .05), owing to inclusion of nasal ala patients among stage 1. Of 9 recurrences, 7 were in-field, 4 occurring in infants with nasal ala primaries. Recategorizing nasal ala as an unfavorable site resulted in 100% 5-year LC and OS for favorable sites. Six infants experienced late grade 3 toxicity. None developed grade 4 or 5 late toxicity.

Conclusions: Young age alone may not be an adverse prognostic factor provided infants receive local therapy similar to older children. Consideration should be given to classifying nasal ala primaries as an unfavorable site.

Keywords: Outcomes; Particle therapy; Pediatric oncology; Radiation therapy; Soft tissue sarcoma.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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