Brachytherapy combined with surgery for conservative treatment of children with bladder neck and/or prostate rhabdomyosarcoma
Menée à partir de données portant sur 100 patients pédiatriques atteints d'un rhabdomyosarcome de la prostate et/ou du col de la vessie traité entre 1991 et 2015 (âge médian : 28 mois ; durée médiane de suivi : 64 mois), cette étude évalue l'efficacité, du point de vue de la survie sans maladie et de la survie globale à 5 ans, et les complications d'un traitement conservateur combinant curiethérapie et chirurgie
Purpose : To report the results of a conservative strategy based on partial surgery combined with brachytherapy in a prospective cohort of children with bladder-prostate rhabdomyosarcoma (BP RMS). Patients and Methods : We prospectively documented the outcome of children treated in our department between 1991 and 2015 for a BP RMS and undergoing a multimodal approach combining a conservative surgery (partial cystectomy and/or partial prostatectomy) and a perioperative interstitial low-dose rate or pulse-dose rate brachytherapy. Prior to brachytherapy, children had received chemotherapy with modalities depending on their risk group of treatment. Results : 100 patients were identified, median age of 28 months (5.6 months-14 years). According to the Intergroup Rhabdomyosarcoma Study (IRS) Group group, 84 were IRS-III and 12 were IRS-IV tumors. Four patients were treated at relapse. Median number of chemotherapy cycles before local therapy was 6 (4–13). After surgery, 63 patients had a macroscopical tumor residuum. Five patients underwent a brachytherapy boost before pelvic external beam radiotherapy (EBRT) because of nodal involvement and 95 had exclusive brachytherapy. Median follow-up was 64 months (6 months-24.5 years). Five year disease-free and overall survival rates were 84% (95%CI: 80–88%) and 91% (95%CI: 87–95%), respectively. At last follow-up, most survivors presented with only mild to moderate genito-urinary sequelae and a normal diurnal urinary continence. Five patients required a secondary total cystectomy: 3 for a nonfunctional bladder and 2 for relapse. Conclusion : Brachytherapy is effective as part of a conservative strategy on BP RMS, with a relatively low delayed toxicity as compared with previously published studies using EBRT. Longer follow-up is required to ensure that the functional results are maintained over time.
http://www.redjournal.org/article/S0360-3016(17)30404-2/fulltext