@article{3203586,
    title = "Brachytherapy for pediatric patients at Gustave Roussy Cancer Campus: A model of international cooperation for highly specialized treatments.",
    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",
    journal = "International Journal of Radiation, Oncology, Biology, Physics",
    year = "2022",
    pages = "S0360--3016(22)00196--1",
    issn = "0360-3016",
    doi = "10.1016/j.ijrobp.2022.03.003",
    keywords = "cancer, pediatrics, brachytherapy, bladder-prostate rhabdomyosarcoma, conservative treatment, malignant germ-cell tumors, radiation oncology, referral networks, rhabdomyosarcoma, vaginal cancer",
    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 (BT). 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 BT. RESULTS: 305 patients were identified; median age at diagnosis was 2.2  years (1.4 months-17.2 years). Ninety-nine (32.4%) were treated within 2015-2020.  One hundred seventy-two (56.4%) were referred from national centers and 133 (43.6%)  were international patients, from 31 countries (mainly Europe). Two hundred sixty  three patients were referred for primary treatment and 42 for salvage treatment.  Genito-urinary tumors were the most frequent sites, with 56.4% bladder/prostate  rhabdomyosarcoma (RMS) and 28.5% gynecological tumors. In addition to BT, local  treatment comprised partial tumor resection in 207 (67.9%) and 39 (13%) had  additional external radiotherapy. Median follow-up was 58 months (range: 1 month-48  years), 93 months for national patients and 37 months for international patients  (p<.0001). Five-year local control (LC), disease-free survival (DFS) and overall  survival rates were 90.8% (CI95%: 87.3-94.4%), 84.4% (CI95%:80.1-89.0) and 93.3%  (CI95%:90.1-96.5), respectively. Patients referred for salvage treatment had poorer  DFS (p<0.01). Implementation of image-guided pulse-dose rate BT was associated with  better LC among RMS patients referred for primary treatment (HR: 9.72;  CI95%:1.24-71.0). At last follow-up, 16.7% patients had long-term severe  treatment-related complications and two (0.7%) had developed second malignancy.  CONCLUSION: This retrospective series shows the feasibility of a multinational  referral network for brachytherapy allowing high patient number 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."
}