Proton beam therapy in treating rhabdomyosarcoma in children: a systematic review.
Theresa O'Donovan,
Ireland
PO-1570
Abstract
Proton beam therapy in treating rhabdomyosarcoma in children: a systematic review.
Authors: Theresa O'Donovan1, Lauren Noonan2, Annemarie Devine1, Professor Mark McEntee1, Professor Aisling Barry1,2, Dr. Andrew England1
1University College Cork, Medical Imaging and Radiation Therapy, Co. Cork, Ireland; 2Cork University Hospital, Radiation Oncology, Co. Cork, Ireland
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Purpose or Objective
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children requiring multimodality treatment with chemotherapy, surgery, and radiation therapy (RT) for curative intent. Proton beam therapy (PBT) presents a method of local therapy in paediatric RMS patients that has been associated with increased sparing of healthy tissue but with similar disease control. Despite this, the level of high-quality randomised evidence in the literature is lacking, especially in the setting of localised RMS disease. For this reason, a systematic review of the literature on PBT for paediatric RMS patients was conducted to determine its clinical efficacy and identify toxicities.
Material and Methods
A review protocol was developed as per PROSPERO guidelines. A search of five databases (PUBMED/MEDLINE, EMBASE, CINAHL, Scopus and Cochrane Library) was carried out according to PRISMA guidelines between January 2010 – December 2021. Eligible studies included paediatric and adolescent patients (≤ 18 years) who received proton beam RT for localised RMS or metastatic disease and in whom clinical outcomes of local control (LC), overall survival (OS) or toxicity as graded by the common terminology criteria for adverse events (CTCAE) were reported.
Results
198 publications were eligible for title and abstract screening by two reviewers with five studies eligible for inclusion (90 patients). All five studies were case series, four retrospective, and one prospective. The majority of patients had embryonal subtype, the median dose delivered was 47.7GyE (36 – 50/4GyE) and the median follow-up was 37 (18 – 60) months. Local control (LC) and Overall survival (OS) were reported in three studies. 2-year LC and OS rates were reported as 88% and 89%, respectively in one publication, and 5-year LC and OS rates of 83-97% and 83-100%, respectively in 2 publications. Acute (N=2) and late (N=5) CTCAE were reported, with no grade 4 or higher RT-related toxicities. Cataracts were the most commonly reported late toxicity.
Conclusion
PBT appears to be a safe and effective method of local therapy as part of the multimodality treatment of paediatric RMS patients with localised disease. However, a better quality of evidence is required.