Brachytherapy for Pediatric Patients at Gustave Roussy Cancer Campus : A Model of International Cooperation for Highly Specialized Treatments
(2022) In International Journal of Radiation Oncology Biology Physics 113(3). p.602-613- Abstract
Purpose: Childhood cancer is rare, and treatment is frequently associated with long-term morbidity. Disparities in survival and long-term side effects encourage the establishment of networks to increase access to complex organ-conservative strategies, such as brachytherapy. We report our experience of an international cooperation model in childhood cancers. Methods and Materials: We examined the outcome of all children referred to our center from national or international networks to be treated according to a multimodal organ-conservative approach, including brachytherapy. Results: We identified 305 patients whose median age at diagnosis was 2.2 years (range, 1.4 months to 17.2 years). Among these patients, 99 (32.4%) were treated... (More)
Purpose: Childhood cancer is rare, and treatment is frequently associated with long-term morbidity. Disparities in survival and long-term side effects encourage the establishment of networks to increase access to complex organ-conservative strategies, such as brachytherapy. We report our experience of an international cooperation model in childhood cancers. Methods and Materials: We examined the outcome of all children referred to our center from national or international networks to be treated according to a multimodal organ-conservative approach, including brachytherapy. Results: We identified 305 patients whose median age at diagnosis was 2.2 years (range, 1.4 months to 17.2 years). Among these patients, 99 (32.4%) were treated between 2015 and 2020; 172 (56.4%) were referred from national centers; and 133 (43.6%) were international patients from 31 countries (mainly Europe). Also, 263 patients were referred for primary treatment and 42 patients were referred for salvage treatment. Genitourinary tumors were the most frequent sites, with 56.4% bladder/prostate rhabdomyosarcoma and 28.5% gynecologic tumors. In addition to brachytherapy, local treatment consisted of partial tumor resection in 207 patients (67.9%), and 39 patients (13%) had additional external radiation therapy. Median follow-up was 58 months (range, 1 month to 48 years), 93 months for national patients, and 37 months for international patients (P < .0001). Five-year local control, disease-free survival, and overall survival rates were 90.8% (95% confidence interval [CI], 87.3%-94.4%), 84.4% (95% CI, 80.1%-89.0%), and 93.3% (95% CI, 90.1%-96.5%), respectively. Patients referred for salvage treatment had poorer disease-free survival (P < .01). Implementation of image guided pulse-dose-rate brachytherapy was associated with better local control among patients with rhabdomyosarcoma referred for primary treatment (hazard ratio, 9.72; 95% CI, 1.24-71.0). At last follow-up, 16.7% patients had long-term severe treatment-related complications, and 2 patients (0.7%) had developed second malignancy. Conclusions: This retrospective series shows the feasibility of a multinational referral network for brachytherapy allowing high patient numbers in rare pediatric cancers. High local control probability and acceptable late severe complication probability could be achieved despite very challenging situations. This cooperation model could serve as a basis for generating international reference networks for high-tech radiation such as brachytherapy to increase treatment care opportunities and cure probability.
(Less)
- author
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- in
- International Journal of Radiation Oncology Biology Physics
- volume
- 113
- issue
- 3
- pages
- 12 pages
- publisher
- Elsevier
- external identifiers
-
- scopus:85127811386
- pmid:35278672
- ISSN
- 0360-3016
- DOI
- 10.1016/j.ijrobp.2022.03.003
- language
- English
- LU publication?
- yes
- id
- 0ffa8ff2-d149-4621-ab26-5956978c44a1
- date added to LUP
- 2022-06-28 12:51:52
- date last changed
- 2024-06-12 03:16:20
@article{0ffa8ff2-d149-4621-ab26-5956978c44a1,
abstract = {{<p>Purpose: Childhood cancer is rare, and treatment is frequently associated with long-term morbidity. Disparities in survival and long-term side effects encourage the establishment of networks to increase access to complex organ-conservative strategies, such as brachytherapy. We report our experience of an international cooperation model in childhood cancers. Methods and Materials: We examined the outcome of all children referred to our center from national or international networks to be treated according to a multimodal organ-conservative approach, including brachytherapy. Results: We identified 305 patients whose median age at diagnosis was 2.2 years (range, 1.4 months to 17.2 years). Among these patients, 99 (32.4%) were treated between 2015 and 2020; 172 (56.4%) were referred from national centers; and 133 (43.6%) were international patients from 31 countries (mainly Europe). Also, 263 patients were referred for primary treatment and 42 patients were referred for salvage treatment. Genitourinary tumors were the most frequent sites, with 56.4% bladder/prostate rhabdomyosarcoma and 28.5% gynecologic tumors. In addition to brachytherapy, local treatment consisted of partial tumor resection in 207 patients (67.9%), and 39 patients (13%) had additional external radiation therapy. Median follow-up was 58 months (range, 1 month to 48 years), 93 months for national patients, and 37 months for international patients (P < .0001). Five-year local control, disease-free survival, and overall survival rates were 90.8% (95% confidence interval [CI], 87.3%-94.4%), 84.4% (95% CI, 80.1%-89.0%), and 93.3% (95% CI, 90.1%-96.5%), respectively. Patients referred for salvage treatment had poorer disease-free survival (P < .01). Implementation of image guided pulse-dose-rate brachytherapy was associated with better local control among patients with rhabdomyosarcoma referred for primary treatment (hazard ratio, 9.72; 95% CI, 1.24-71.0). At last follow-up, 16.7% patients had long-term severe treatment-related complications, and 2 patients (0.7%) had developed second malignancy. Conclusions: This retrospective series shows the feasibility of a multinational referral network for brachytherapy allowing high patient numbers in rare pediatric cancers. High local control probability and acceptable late severe complication probability could be achieved despite very challenging situations. This cooperation model could serve as a basis for generating international reference networks for high-tech radiation such as brachytherapy to increase treatment care opportunities and cure probability.</p>}},
author = {{Chargari, Cyrus and Haie-Meder, Christine and Espenel, Sophie and Garcia, Max Adrien and Ben-Arush, Myriam and Bolle, Stéphanie and Borjesson, Anna and Cesen, Maja and Lago, Rita Costa and Defachelles, Anne Sophie and De Moerloose, Barbara and Devalck, Christine and Edslev, Pernille and Farinha, Nuno Jorge and Francotte, Nadine and Glosli, Heidi and Gouy, Sebastien and Burrieza, Gabriela Guillen and Helfre, Sylvie and Irtan, Sabine and Kattamis, Antonis and Lacerda, Ana and Levy, Antonin and Hjalgrim, Lisa Lyngsie and Mansuy, Ludovic and Mascard, Eric and Moalla, Salma and Orbach, Daniel and Owens, Cormac and Philippe-Chomette, Pascale and Pizer, Barry and Pluchart, Claire and Renard, Marleen and Rognlien, Anne Gro Wesenberg and Rome, Angélique and Sarnacki, Sabine and Safwat, Akmal and Schiavetti, Amalia and Serre, Jill and Verite, Cécile and Weid, Nicolas Von Der and Wysocki, Mariusz and Valteay-Couanet, Dominique and Deutsch, Eric and Minard-Colin, Véronique and Martelli, Hélène and Guérin, Florent}},
issn = {{0360-3016}},
language = {{eng}},
number = {{3}},
pages = {{602--613}},
publisher = {{Elsevier}},
series = {{International Journal of Radiation Oncology Biology Physics}},
title = {{Brachytherapy for Pediatric Patients at Gustave Roussy Cancer Campus : A Model of International Cooperation for Highly Specialized Treatments}},
url = {{http://dx.doi.org/10.1016/j.ijrobp.2022.03.003}},
doi = {{10.1016/j.ijrobp.2022.03.003}},
volume = {{113}},
year = {{2022}},
}