Whole abdominopelvic intensity-modulated radiation therapy for peritoneal disseminated rhabdomyosarcoma with three-year
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CASE REPORT
Open Access
Whole abdominopelvic intensity-modulated radiation therapy for peritoneal disseminated rhabdomyosarcoma with three-year follow-up: a case report Mariko Kawamura1*, Kuniyasu Okudaira2, Yoshiyuki Itoh3, Takeshi Kamomae3, Eri Nishikawa4, Hideki Muramatsu4, Yoshiyuki Takahashi4, Kazuki Yokota5 and Shinji Naganawa1
Abstract Background: The role of local radiotherapy in the treatment of metastatic rhabdomyosarcoma is important. However, with peritoneal dissemination, the application of local therapy is challenging. Although there are few reports addressing the efficacy of the whole abdominopelvic irradiation to peritoneal disseminated rhabdomyosarcoma patients, no precise curse of treatment nor the follow up result is explained in paper nor in the text. Case presentation: Six years old rhabdomyosarcoma boy with peritoneal dissemination was treated at our facility under COG D9803 protocol (vincristine, dactinomycin, and cyclophosphamide (VAC)). He underwent tumor resection on the 14th week according to the protocol. During surgery, the 2-cm residual tumor was completely resected, but in the pelvis, numerous nodules that were suspected as peritoneal disseminated tumors were observed. We administered 30 Gy/20fr whole abdominopelvic radiotherapy using volumetric modulated arc therapy (VMAT) technique and a 6 Gy sequential boost to pelvis after the surgery and completed the protocol treatment. During the course of treatment, the patient experienced G4 hematological toxicity and received multiple transfusions, particularly after whole abdominopelvic irradiation. He has achieved complete remission and is alive without evidence of recurrence and severe late adverse effect for 3 years. In terms of growth, his height and weight are within the average values for Japanese boys at the same age. Conclusion: By using the VMAT technique, a patient with peritoneal disseminated rhabdomyosarcoma can be treated, and a dose of 30 Gy to the whole abdominopelvis with concurrent chemotherapy may be tolerable. Keywords: Whole abdominopelvic IMRT, Rhabdomyosarcoma, Peritoneal dissemination, Pediatric
Background The role of local therapy in the treatment of rhabdomyosarcoma is important, even for patients presenting with metastasis upon diagnosis [1]. However, when peritoneal dissemination is present, the application of local therapy is challenging. Although a few reports have described the efficacy and tolerability of abdominopelvic irradiation using intensity-modulated radiation therapy (IMRT) [2, 3], the precise course of treatment has not been identified. We present the case of a boy who had * Correspondence: [email protected] 1 Department of Radiology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan Full list of author information is available at the end of the article
rhabdomyosarcoma with peritoneal dissemination and was treated with abdominopelvic irradiation using the IMRT technique with concurrent chemotherapy using the Children’s Oncology Group (COG) D9803 vincristine
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