Skip to main content
SpringerLink
Log in

Comparison of different adjuvant radiotherapy approaches in childhood bladder/prostate rhabdomyosarcoma treated with conservative surgery

Ein Vergleich dreier Techniken zur adjuvanten Strahlentherapie bei Kindern mit Rhabdomyosarkomen von Blase/Prostata nach blasenerhaltender, konservativer Chirurgie

  • Original Article
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Background and Purpose

Multimodality treatment approaches provide high local control and satisfying overall survival (OS) for children with localized bladder and/or prostate rhabdomyosarcoma (BP-RMS). However, current strategies including surgery and conventional radiotherapy are compromised by high rates of long-term genitourinary adverse effects. Therefore, a planning study combining organ preserving surgery with three different innovative adjuvant radiotherapy approaches was performed.

Patients and Methods

A case of a 21-month-old boy with BP-RMS treated with polychemotherapy according to the CWS 2002-P protocol, prostatectomy, partial cystectomy, and adjuvant high dose rate brachytherapy (HDR-BT) was used to perform a planning study comparing HDR-BT with intensity-modulated radiotherapy (IMRT) and intensity-modulated proton therapy (IMPT) planning.

Results

All modalities provide good coverage of the target volume and spare critical normal tissues. Rectum doses could be reduced by 2/3 using IMPT and by 1/3 using BT compared to IMRT. In terms of sparing the pelvis growth plates, BT and IMPT are also superior to IMRT.

Conclusion

All modalities provide good sparing of normal tissue. BT and IMPT are superior to IMRT with regard to doses on rectum and growth plates. BT is equivalent to IMPT in adequately selected tumors.

Zusammenfassung

Hintergrund und Ziel

Die multimodale Therapie von Rhabdomyosarkomen von Blase und Prostata (BP-RMS) in Frühstadien bei Kindern führt zu hohen lokalen Kontrollraten. Ein Nachteil aktueller Strategien beruht auf den Spätfolgen für den Urogenitaltrakt. Daher wurde nach organerhaltendem chirurgischem Vorgehen eine Planungsstudie mit drei innovativen adjuvanten Strahlentherapie-Strategien durchgeführt.

Patienten und Methoden

Anhand des realen Falles eines 21 Monate alten Jungen mit BP-RMS, der mit einer Polychemotherapie nach CWS-2002-P-Protokoll, partieller Zystektomie, Prostatektomie und Brachytherapie (BT) behandelt worden war, führte man eine Planungsstudie durch, um die BT mit einer optimierten intensitätsmodulierten Radiotherapie (IMRT) und einer Protonenbestrahlung (IMPT) zu vergleichen.

Ergebnisse

Alle drei Radiotherapie-Modalitäten ermöglichten eine gute Zielvolumenerfassung und Normalgewebsschonung. Allerdings war die Rektumbelastung bei der IMPT um zwei Drittel und bei der BT um ein Drittel geringer als bei der IMRT. Darüber hinaus ermöglicht die Anwendung der BT und IMPT im Vergleich zur IMRT eine niedrigere Belastung des Beckenskeletts.

Schlussfolgerung

Alle Radiotherapie-Modalitäten ermöglichen eine gute Normalgewebeschonung. BT und IMPT sind der IMRT bezüglich der Rektum- und Wachstumsfugenschonung überlegen. Die BT ist der IMPT bei adäquat ausgewählten Tumoren ebenbürtig.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Arndt C, Rodeberg D, Breitfeld PP et al. Does bladder preservation (as a surgical principle) lead to retaining bladder function in bladder/prostate rhabdomyosarcoma? Results from intergroup rhabdomyosarcoma study iv. J Urol 2004;171:2396–403.

    Article  PubMed  Google Scholar 

  2. Bolling T, Schuck A, Pape H et al. German register for detection of late sequelae after radiotherapy for children and adolescents (RiSK): present status and first results. Strahlenther Onkol 2007;183:7–8.

    Article  PubMed  Google Scholar 

  3. Bolling T, Schuck A, Rube C et al. [Therapy-associated late effects after irradiation of malignant diseases in childhood and adolescence. Feasibility analyses of a prospective multicenter register study]. Strahlenther Onkol 2006;182:443–9.

    Article  PubMed  Google Scholar 

  4. Castillo LA, Craft AW, Kernahan J et al. Gonadal function after 12-Gy testicular irradiation in childhood acute lymphoblastic leukaemia. Med Pediatr Oncol 1990;18:185–9.

    Article  PubMed  CAS  Google Scholar 

  5. Centola GM, Keller JW, Henzler M et al. Effect of low-dose testicular irradiation on sperm count and fertility in patients with testicular seminoma. J Androl 1994;15:608–13.

    PubMed  CAS  Google Scholar 

  6. Clifton DK, Bremner WJ. The effect of testicular X-irradiation on spermatogenesis in man. A comparison with the mouse. J Androl 1983;4:387–92.

    PubMed  CAS  Google Scholar 

  7. Cotter SE, Herrup DA, Friedmann A et al. Proton radiotherapy for pediatric bladder/prostate rhabdomyosarcoma: clinical outcomes and dosimetry compared to intensity-modulated radiation therapy. Int J Radiat Oncol Biol Phys 2010 Oct 7 [Epub ahead of print].

  8. Donaldson SS, Meza J, Breneman JC et al. Results from the IRS-IV randomized trial of hyperfractionated radiotherapy in children with rhabdomyosarcoma- a report from the IRSG. Int J Radiat Oncol Biol Phys 2001;51:718–28.

    Article  PubMed  CAS  Google Scholar 

  9. Dorr W, Herrmann T. Second tumors after oncologic treatment. Strahlenther Onkol 2008;184:67–72.

    Article  PubMed  Google Scholar 

  10. Eifel PJ, Donaldson SS, Thomas PR. Response of growing bone to irradiation: a proposed late effects scoring system. Int J Radiat Oncol Biol Phys 1995;31:1301–7.

    Article  PubMed  CAS  Google Scholar 

  11. Ferrer FA. Re: Does bladder preservation (as a surgical principle) lead to retaining bladder function in bladder/prostate rhabdomyosarcoma? Results from Intergroup Rhabdomyosarcoma Study IV. J Urol 2004;172:2084.

    PubMed  Google Scholar 

  12. Ferrer FA, Isakoff M, Koyle MA. Bladder/prostate rhabdomyosarcoma: past, present and future. J Urol 2006;176:1283–91.

    Article  PubMed  Google Scholar 

  13. Gonzalez DG, van Dijk JD. Experimental studies on the response of growing bones to X ray and neutron irradiation. Int J Radiat Oncol Biol Phys 1983;9:671–7.

    Article  PubMed  CAS  Google Scholar 

  14. Haie-Meder C, Breton-Callu C, Oberlin O et al. [Brachytherapy in the treatment of vesicoprostatic rhabdomyosarcomas in children]. Cancer Radiother 2000;4:145s–9s.

    PubMed  Google Scholar 

  15. Hahn EW, Feingold SM, Nisce L. Aspermia and recovery of spermatogenesis in cancer patients following incidental gonadal irradiation during treatment: a progress report. Radiology 1976;119:223–5.

    PubMed  CAS  Google Scholar 

  16. Hays DM, Raney RB, Jr., Lawrence W, Jr. et al. Bladder and prostatic tumors in the Intergroup Rhabdomyosarcoma Study (IRS-I): results of therapy. Cancer 1982;50:1472–82.

    Article  PubMed  CAS  Google Scholar 

  17. Hays DM, Raney RB, Wharam MD et al. Children with vesical rhabdomyosarcoma (RMS) treated by partial cystectomy with neoadjuvant or adjuvant chemotherapy, with or without radiotherapy. A report from the Intergroup Rhabdomyosarcoma Study (IRS) Committee. J Pediatr Hematol Oncol 1995;17:46–52.

    Article  PubMed  CAS  Google Scholar 

  18. Hermesse J, Biver S, Jansen N, et al. A dosimetric selectivity intercomparison of HDR brachytherapy, IMRT and helical tomotherapy in prostate cancer radiotherapy. Strahlenther Onkol 2009;185:736–42.

    Article  PubMed  Google Scholar 

  19. Howell SJ, Shalet SM. Spermatogenesis after cancer treatment: damage and recovery. J Natl Cancer Inst Monogr 2005:12–7.

  20. Kaatsch P, Debling D, Blettner M et al. Second malignant neoplasms after childhood cancer in Germany-results from the long-term follow-up of the German Childhood Cancer Registry. Strahlenther Onkol 2009;185:8–10.

    Article  PubMed  Google Scholar 

  21. Kinsella TJ, Trivette G, Rowland J et al. Long-term follow-up of testicular function following radiation therapy for early-stage Hodgkin’s disease. J Clin Oncol 1989;7:718–24.

    PubMed  CAS  Google Scholar 

  22. Krasin MJ, Constine LS, Friedman DL et al. Radiation-related treatment effects across the age spectrum: differences and similarities or what the old and young can learn from each other. Semin Radiat Oncol 2010;20:21–9.

    Article  PubMed  Google Scholar 

  23. Lee CT, Bilton SD, Famiglietti RM et al. Treatment planning with protons for pediatric retinoblastoma, medulloblastoma, and pelvic sarcoma: how do protons compare with other conformal techniques? Int J Radiat Oncol Biol Phys 2005;63:362–72.

    Article  PubMed  Google Scholar 

  24. Lott S, Lopez-Beltran A, Maclennan GT et al. Soft tissue tumors of the urinary bladder, Part I: myofibroblastic proliferations, benign neoplasms, and tumors of uncertain malignant potential. Hum Pathol 2007;38:807–23.

    Article  PubMed  Google Scholar 

  25. Lott S, Lopez-Beltran A, Montironi R et al. Soft tissue tumors of the urinary bladder Part II: malignant neoplasms. Hum Pathol 2007;38:963–77.

    Article  PubMed  CAS  Google Scholar 

  26. Martelli H, Haie-Meder C, Branchereau S et al. Conservative surgery plus brachytherapy treatment for boys with prostate and/or bladder neck rhabdomyosarcoma: a single team experience. J Pediatr Surg 2009;44:190–6.

    Article  PubMed  Google Scholar 

  27. McDowell HP. Update on childhood rhabdomyosarcoma. Arch Dis Child 2003;88:354–7.

    Article  PubMed  CAS  Google Scholar 

  28. McKenney JK, Amin MB. The role of immunohistochemistry in the diagnosis of urinary bladder neoplasms. Semin Diagn Pathol 2005;22:69–87.

    Article  PubMed  Google Scholar 

  29. Merchant TE. Proton beam therapy in pediatric oncology. Cancer J 2009;15:298–305.

    Article  PubMed  Google Scholar 

  30. Mizumoto M, Sugahara S, Nakayama H, et al. Clinical results of proton-beam therapy for locoregionally advanced esophageal cancer. Strahlenther 2010;186:482–8.

    Article  Google Scholar 

  31. Muzik J, Soukup M, Alber M. Comparison of fixed-beam IMRT, helical tomotherapy, and IMPT for selected cases. Med Phys 2008;35:1580–1592.

    Article  PubMed  Google Scholar 

  32. Paulino AC, Constine LS, Rubin P et al. Normal tissue development, homeostasis, senescence, and the sensitivity to radiation injury across the age spectrum. Semin Radiat Oncol 2010;20:12–20.

    Article  PubMed  Google Scholar 

  33. Peeters J, Meitert J, Paulides M et al. Late effects surveillance system after childhood cancer in Germany, Austria and parts of Switzerland-update 2009. Strahlenther Onkol 2009;185:5–7.

    Article  PubMed  Google Scholar 

  34. Raney, B, Anderson, J, Jenney, M, et al. Late effects in 164 patients with rhabdomyosarcoma of the bladder/prostate region: a report from the international workshop. J Urol 2006;176:2190–4; discussion 2194-5.

    Article  PubMed  Google Scholar 

  35. Rowley MJ, Leach DR, Warner GA et al. Effect of graded doses of ionizing radiation on the human testis. Radiat Res 1974;59:665–78.

    Article  PubMed  CAS  Google Scholar 

  36. Seitz G, Dantonello TM, Int-Veen C, et al. Treatment efficiency, outcome and surgical treatment problems in patients suffering from localized embryonal bladder/prostate rhabdomyosarcoma: a report from the cooperative soft tissue sarcoma trial CWS-96. Pediatr Blood Cancer 2011;56(5):718–24.

    Article  PubMed  Google Scholar 

  37. Shalet SM. Gonadal function following radiation and cytotoxic chemotherapy in childhood. Ergeb Inn Med Kinderheilkd 1989;58:1–21.

    Article  PubMed  CAS  Google Scholar 

  38. Silverman CL, Thomas PR, McAlister WH et al. Slipped femoral capital epiphyses in irradiated children: dose, volume and age relationships. Int J Radiat Oncol Biol Phys 1981;7:1357–63.

    Article  PubMed  CAS  Google Scholar 

  39. Sklar CA, Robison LL, Nesbit ME et al. Effects of radiation on testicular function in long-term survivors of childhood acute lymphoblastic leukemia: a report from the Children Cancer Study Group. J Clin Oncol 1990;8:1981–7.

    PubMed  CAS  Google Scholar 

  40. Soukup M, Sohn M, Yan D et al. Study of robustness of IMPT and IMRT for prostate cancer against organ movement. Int J Radiat Oncol Biol Phys 2009;75:941–9.

    Article  PubMed  Google Scholar 

  41. Spunt SL, Sweeney TA, Hudson MM et al. Late effects of pelvic rhabdomyosarcoma and its treatment in female survivors. J Clin Oncol 2005;23:7143–51.

    Article  PubMed  Google Scholar 

  42. Stevens MC, Rey A, Bouvet N et al. Treatment of nonmetastatic rhabdomyosarcoma in childhood and adolescence: third study of the International Society of Paediatric Oncology-SIOP Malignant Mesenchymal Tumor 89. J Clin Oncol 2005;23:2618–28.

    Article  PubMed  Google Scholar 

  43. Strege RJ, Kovacs G, Meyer JE et al. Perioperative intensity-modulated brachytherapy for refractory orbital rhabdomyosarcomas in children. Strahlenther Onkol 2009;185:789–98.

    Article  PubMed  Google Scholar 

  44. Thomson AB, Critchley HO, Kelnar CJ et al. Late reproductive sequelae following treatment of childhood cancer and options for fertility preservation. Best Pract Res Clin Endocrinol Metab 2002;16:311–34.

    Article  PubMed  Google Scholar 

  45. Timmermann B, Schuck A, Niggli F et al. [“Spot-scanning” proton therapy for rhabdomyosarcomas of early childhood. First experiences at PSI]. Strahlenther Onkol 2006;182:653–9.

    Article  PubMed  Google Scholar 

  46. Wang C, Nakayama H, Sugahara S et al. Comparisons of dose-volume histograms for proton-beam versus 3-D conformal x-ray therapy in patients with stage I non-small cell lung cancer. Strahlenther Onkol 2009;185:231–4.

    Article  PubMed  Google Scholar 

  47. Willich N, Ernst I, Pape H et al. Evaluation of side effects after radiotherapy in childhood and adolescence: from retrospective case reports to a prospective, multicentric and transnational approach. Strahlenther Onkol 2009;185:3–4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University of Tuebingen, Tuebingen, Germany

    Frank Heinzelmann, Michael Bamberg &  Martin Weinmann

  2. Department of Radiation Oncology/Medical Physics, University of Tuebingen, Tuebingen, Germany

    Daniela Thorwarth, Ulf Lamprecht & Theodor W. Kaulich

  3. Department of Pediatric Surgery, University of Tuebingen, Tuebingen, Germany

    Jörg Fuchs & Guido Seitz

  4. Department of Pediatric Oncology, University of Tuebingen, Tuebingen, Germany

    Martin Ebinger & Rupert Handgretinger

  5. Department of Radiation Oncology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany

    Martin Weinmann

Authors
  1. Frank Heinzelmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniela Thorwarth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ulf Lamprecht
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Theodor W. Kaulich
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jörg Fuchs
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guido Seitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Martin Ebinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rupert Handgretinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michael Bamberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Martin Weinmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Weinmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heinzelmann, F., Thorwarth, D., Lamprecht, U. et al. Comparison of different adjuvant radiotherapy approaches in childhood bladder/prostate rhabdomyosarcoma treated with conservative surgery. Strahlenther Onkol 187, 715–721 (2011). https://doi.org/10.1007/s00066-011-2261-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-011-2261-3

Key Words

Schlüsselwörter

Search

Navigation