title: Whole abdominopelvic intensity-modulated radiation therapy for desmoplastic small round cell tumor after surgery.
abstract: OBJECTIVE
  Desmoplastic small round cell tumor (DSCRT) is an uncommon pediatric tumor with a poor prognosis. Aggressive multimodality therapy is the current treatment approach; however. treatment toxicity is of concern. We report our results with whole abdominopelvic intensity-modulated radiation therapy (WAP-IMRT) as a component of multimodality therapy for DSCRT at a single institution.
  
  
  METHODS
  Medical records of all patients with DSCRT who received WAP-IMRT as part of definitive treatment at MD Anderson (2006-2010) were identified and reviewed.
  
  
  RESULTS
  Eight patients with DSRCT received WAP-IMRT with a median follow-up of 15.2 months. All patients received multiple courses of chemotherapy followed by surgical debulking of intra-abdominal disease; seven also had intraoperative hyperthermic cisplatin. WAP-IMRT was delivered to a total dose of 30 Gy postoperatively; four patients received a simultaneous boost (6-10 Gy) to sites of gross residual disease. Seven patients received concurrent chemotherapy during WAP-IMRT. No Radiation Therapy Oncology Group Grade 4 nausea, vomiting, or diarrhea occurred during RT. Red-cell transfusions were given to two patients to maintain hemoglobin levels >10 g/dL. Grade 4 cytopenia requiring growth factor support occurred in only one patient; no other significant cytopenias were noted. WAP-IMRT resulted in 25% lower radiation doses to the lumbosacral vertebral bodies and pelvic bones than conventional RT plans. The median time to local or distant failure after WAP-IMRT was 8.73 months in seven patients. One patient who had completed RT 20 months before the last follow-up remains alive without evidence of disease. Five patients (63%) experienced treatment failure in the abdomen. Distant failure occurred in three patients (37.5%).
  
  
  CONCLUSIONS
  WAP-IMRT with concurrent radiosensitizing chemotherapy was well tolerated after aggressive surgery for DSCRT. Enhanced bone sparing with IMRT probably accounts for the low hematologic toxicity (vs. conventional WAP-RT). This modality should be considered as an additional local-regional control option for DSRCT.
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Chelsea C
authors: CC
authors: Pinnix
authors: Hiral P
authors: HP
authors: Fontanilla
authors: Andrea
authors: A
authors: Hayes-Jordan
authors: Vivek
authors: V
authors: Subbiah
authors: Stephen D
authors: SD
authors: Bilton
authors: Eric L
authors: EL
authors: Chang
authors: David R
authors: DR
authors: Grosshans
authors: Mary F
authors: MF
authors: McAleer
authors: Eric P
authors: EP
authors: Sulman
authors: Shiao Y
authors: SY
authors: Woo
authors: Peter
authors: P
authors: Anderson
authors: Holly L
authors: HL
authors: Green
authors: Anita
authors: A
authors: Mahajan
mesh_terms: D000008:Abdominal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D000293:Adolescent; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000068258:Bevacizumab; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods; D003520:Cyclophosphamide / Q000008:administration & dosage; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives; D058405:Desmoplastic Small Round Cell Tumor / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D017707:Erythrocyte Transfusion / Q000379:methods; D005240:Feasibility Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D007372:Interferons / Q000008:administration & dosage; D000077146:Irinotecan; D008113:Liver Neoplasms / Q000532:radiotherapy / Q000556:secondary; D008297:Male; D010386:Pelvic Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D000077204:Temozolomide; D013921:Thrombocytopenia / Q000209:etiology; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D011838:Radiation-Sensitizing Agents; D000068258:Bevacizumab; D014747:Vinblastine; D000077146:Irinotecan; D003606:Dacarbazine; D003520:Cyclophosphamide; D007372:Interferons; D002945:Cisplatin; D000077235:Vinorelbine; D002166:Camptothecin; D000077204:Temozolomide