title: Favorable outcomes after whole abdominopelvic radiation therapy for pediatric and young adult sarcoma.
abstract: BACKGROUND
  Current Children's Oncology Group (COG) guidelines recommend 24 Gy whole abdominopelvic radiation therapy (WAP-RT) for pediatric patients with sarcoma with peritoneal dissemination and/or malignant ascites. However, WAP-RT has never been described for pediatric sarcoma excluding desmoplastic small round-cell tumor (DSRCT). The objective of this study was to evaluate feasibility, outcomes, and toxicity of WAP-RT in children with sarcoma and peritoneal dissemination.
  
  
  METHODS
  Detailed records of all 10 pediatric patients with sarcoma (excluding DSRCT) treated with WAP-RT from 2001 to 2013 were reviewed.
  
  
  RESULTS
  Median age was 9.9 years (range, 1.7-33.8). Seven patients had rhabdomyosarcoma, 2 embryonal undifferentiated sarcoma of the liver, and 1 Ewing sarcoma. Patients received a median dose of 24 Gy with intensity-modulated radiation therapy (IMRT) to the whole abdomen and pelvis. Two patients did not complete treatment, one due to transfusion-resistant pancytopenia and one due to moderate acute gastrointestinal toxicity. At a median follow-up of 4.0 years, both relapse-free survival and overall survival were 100%. Acute hematologic toxicities were common, with 40% of patients developing a grade 4 hematologic toxicity. Most acute gastrointestinal toxicities were grade 1 and managed appropriately with anti-diarrheals and anti-emetics. Late effects varied, and half of patients are without long-term sequelae.
  
  
  CONCLUSIONS
  All patients remain free of disease, both locally and distantly. Although WAP-RT was associated with acute and late toxicity, treatment was feasible with supportive care. Given the excellent rates of tumor control, we recommend that all providers give WAP-RT with IMRT to patients with pediatric sarcoma and peritoneal dissemination and/or malignant ascites.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Dana L
authors.initials: DL
authors.lastname: Casey
authors.forename: Leonard H
authors.initials: LH
authors.lastname: Wexler
authors.forename: Michael P
authors.initials: MP
authors.lastname: LaQuaglia
authors.forename: Paul A
authors.initials: PA
authors.lastname: Meyers
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Wolden
mesh_terms: D000005:Abdomen / Q000528:radiation effects*; D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008297:Male; D010388:Pelvis / Q000528:radiation effects*; D011379:Prognosis; D011832:Radiation Injuries / Q000175:diagnosis / Q000517:prevention & control; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000532:radiotherapy*; D012512:Sarcoma, Ewing / Q000532:radiotherapy*; D055815:Young Adult
keywords: late effects of cancer treatment; radiation oncology; radiation therapy; sarcoma