TY - JOUR
TI - Brachytherapy for pediatric patients at Gustave Roussy Cancer Campus: A model of international cooperation for highly specialized treatments.
AU - Chargari, Cyrus
AU - Haie-Meder, Christine
AU - Espenel, Sophie
AU - Garcia, Max-Adrien
AU - Ben-Arush, Myriam
AU - Bolle, Stéphanie
AU - Borjesson, Anna
AU - Cesen, Maja
AU - Lago, Rita Costa
AU - Defachelles, Anne-Sophie
AU - De Moerloose, Barbara
AU - Devalck, Christine
AU - Edslev, Pernille
AU - Farinha, Nuno Jorge
AU - Francotte, Nadine
AU - Glosli, Heidi
AU - Gouy, Sebastien
AU - Burrieza, Gabriela Guillen
AU - Helfre, Sylvie
AU - Irtan, Sabine
AU - Kattamis, Antonis
AU - Lacerda, Ana
AU - Levy, Antonin
AU - Hjalgrim, Lisa Lyngsie
AU - Mansuy, Ludovic
AU - Mascard, Eric
AU - Moalla, Salma
AU - Orbach, Daniel
AU - Owens, Cormac
AU - Philippe-Chomette, Pascale
AU - Pizer, Barry
AU - Pluchart, Claire
AU - Renard, Marleen
AU - Rognlien, Anne Gro Wesenberg
AU - Rome, Angélique
AU - Sarnacki, Sabine
AU - Safwat, Akmal
AU - Schiavetti, Amalia
AU - Serre, Jill
AU - Verite, Cécile
AU - Weid, Nicolas Von Der
AU - Wysocki, Mariusz
AU - Valteay-Couanet, Dominique
AU - Deutsch, Eric
AU - Minard-Colin, Véronique
AU - Martelli, Hélène
AU - Guérin, Florent
JO - International Journal of Radiation, Oncology, Biology, Physics
PY - 2022
VL - null
TODO - null
SP - S0360--3016(22)00196--1
PB - 
SN - 0360-3016
TODO - 10.1016/j.ijrobp.2022.03.003
TODO - cancer, pediatrics, brachytherapy, bladder-prostate rhabdomyosarcoma, conservative treatment, malignant germ-cell tumors, radiation oncology, referral networks, rhabdomyosarcoma, vaginal cancer
TODO - 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.
ER -