Περίληψη:
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.
Συγγραφείς:
Chargari, Cyrus
Haie-Meder, Christine
Espenel, Sophie
Garcia, Max-Adrien
Ben-Arush, Myriam
Bolle, Stéphanie
Borjesson, Anna
Cesen, Maja
Lago, Rita Costa
Defachelles, Anne-Sophie
De Moerloose, Barbara
Devalck, Christine
Edslev, Pernille
Farinha, Nuno Jorge
Francotte, Nadine
Glosli, Heidi
Gouy, Sebastien
Burrieza, Gabriela Guillen
Helfre, Sylvie
Irtan, Sabine
Kattamis, Antonis
Lacerda, Ana
Levy, Antonin
Hjalgrim, Lisa Lyngsie
Mansuy, Ludovic
Mascard, Eric
Moalla, Salma
Orbach, Daniel
Owens, Cormac
Philippe-Chomette, Pascale
Pizer, Barry
Pluchart, Claire
Renard, Marleen
Rognlien, Anne Gro Wesenberg
Rome, Angélique
Sarnacki, Sabine
Safwat, Akmal
Schiavetti, Amalia
Serre, Jill
Verite, Cécile
Weid, Nicolas Von Der
Wysocki, Mariusz
Valteay-Couanet, Dominique
Deutsch, Eric
Minard-Colin, Véronique
Martelli, Hélène
Guérin, Florent
Λέξεις-κλειδιά:
cancer, pediatrics, brachytherapy, bladder-prostate rhabdomyosarcoma, conservative treatment, malignant germ-cell tumors, radiation oncology, referral networks, rhabdomyosarcoma, vaginal cancer
