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Long-term disease-free survival following salvage brachytherapy for recurrent pediatric rhabdomyosarcoma: Two case reports and review of relevant literature

  • Mahdi Aghili
    Affiliations
    Radiation Oncology Research Center (RORC), Cancer Institute, Imam Khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran

    Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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  • Kasra Kolahdouzan
    Affiliations
    Radiation Oncology Research Center (RORC), Cancer Institute, Imam Khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran

    Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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  • Mahya Shabani
    Affiliations
    Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
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  • Fatemeh Jafari
    Correspondence
    Corresponding author. Department of Radiation Oncology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran, Tel.: +98-21-66581535, Fax: +98-21-61192585.
    Affiliations
    Radiation Oncology Research Center (RORC), Cancer Institute, Imam Khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran

    Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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  • Ramin Jaberi
    Affiliations
    Radiation Oncology Research Center (RORC), Cancer Institute, Imam Khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran

    Department of Physics, University of Surrey, Guildford, United Kingdom
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      ABSTRACT

      PURPOSE

      Rhabdomyosarcoma (RMS) is the most common pediatric soft-tissue sarcoma, mostly involving the genitourinary (GU) tract, head and neck, and extremities. This study reports the long-term outcome of two infants with recurrent GU-RMS who underwent combination therapy with chemotherapy (ChT) and salvage brachytherapy (BT).

      METHODS AND MATERIALS

      An 18-month-old girl with vaginal bleeding and a 7-month-old boy with urinary retention presented with a diagnosis of vaginal, and bladder/prostate embryonal RMS, respectively. Surgical resection and ChT were done for both patients. However, both developed local recurrences after one year and subsequently, underwent second-line ChT and salvage interstitial high dose rate BT.

      RESULTS

      The clinical target volumes for the first and second patients were treated to a totaldose of 32 Gy in 10 fractions and 35 Gy in 10 fractions, respectively, with two fractions delivered per day with a 6-h interval between fractions. After 9 years of follow-up, both patients are alive with natural growth and no late complication or evidence of recurrence.

      CONCLUSIONS

      Our report shows that BT (for patients with no prior history of irradiation) could result in long-term disease-free survival in well-selected pediatric patients with recurrent GU embryonal RMS without inflicting expected adverse effects of external beam radiotherapy.

      Keywords

      Abbreviations:

      RMS (rhabdomyosarcoma), GU (genitourinary), ChT (chemotherapy), BT (brachytherapy), CTV (clinical target volume), HDR (high dose rate), EBRT (external beam radiotherapy), IMRT (intensity modulated radiotherapy), IMPT (intensity modulated proton therapy), LDR (low dose rate)
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