title: Local control after intensity-modulated radiotherapy for head-and-neck rhabdomyosarcoma.
abstract: OBJECTIVE
  To examine the patterns of failure in patients treated with intensity-modulated radiotherapy (IMRT) for head-and-neck rhabdomyosarcoma (RMS).
  
  
  METHODS
  Between 1998 and 2005, 19 patients with a diagnosis of head-and-neck RMS received IMRT at The Methodist Hospital. There were 11 male and 8 female patients, with a median age of 6 years at time of irradiation. Tumor location was parameningeal in 7, orbital in 6, and other head-and-neck RMS in 6. Chemotherapy was given to all patients, with vincristine, actinomycin D, and cyclophosphamide being the most common regimen (n = 18). The median prescribed dose was 5040 cGy. The clinical target volume included the gross tumor volume with a 1.5-cm margin. The median duration of follow-up for surviving patients was 56 months.
  
  
  RESULTS
  The 4-year overall survival and local control rates were 76% and 92.9%, respectively. One patient developed a local failure in the high-dose region of the radiation field; there were no marginal failures. Distant metastasis was seen in 4 patients. Overall survival was 42.9% for parameningeal sites and 100% for other sites (p < 0.01). Late toxicities were seen in 7 patients. Two secondary malignancies occurred in 1 child with embryonal RMS of the face and a p53 mutation.
  
  
  CONCLUSIONS
  Local control was excellent in patients receiving IMRT for head-and-neck RMS. Patterns of local failure reveal no marginal failures in this group of patients.
authors.affiliation: Section of Radiation Oncology, Department of Radiology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Amarinthia E
authors.initials: AE
authors.lastname: Curtis
authors.forename: M Fatih
authors.initials: MF
authors.lastname: Okcu
authors.forename: Murali
authors.initials: M
authors.lastname: Chintagumpala
authors.forename: Bin S
authors.initials: BS
authors.lastname: Teh
authors.forename: Arnold C
authors.initials: AC
authors.lastname: Paulino
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D020266:Radiotherapy, Conformal / Q000379:methods*; D012208:Rhabdomyosarcoma / Q000532:radiotherapy*; D016019:Survival Analysis; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult