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Von Werne K, Mair K, Fader ME, DeAngulo G, Eiseler N, Kalman NS, Press RH, Daghistani D, Jimenez R, Paraliticci G, Pretell J, Chang JHC, Vern-Gross TZ, Mihalcik SA, Kwok Y, Tsai HK, Zeng J, Rotondo R, Wolden SL, Hall MD. Multi-Institutional Experience of Proton Therapy for Rhabdomyosarcoma and Ewing Sarcoma in the Proton Collaborative Group (PCG) Prospective Registry. Int J Radiat Oncol Biol Phys 2023; 117:e551-e552. [PMID: 37785696 DOI: 10.1016/j.ijrobp.2023.06.1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To report on outcomes, acute toxicities, and the use of dose-escalation with proton therapy (PT) in patients with rhabdomyosarcoma and Ewing sarcoma in a prospective multi-institutional registry (PCG). MATERIALS/METHODS Data on patients with primary rhabdomyosarcoma and Ewing sarcoma treated with definitive PT (defined as ≥45 Gy) were queried from the PCG registry. A similar query was performed of our institutional database with IRB approval. Overall survival rates were calculated by Kaplan-Meier. Toxicities were scored using CTCAE v4.0. RESULTS A total of 354 patients across 10 institutions (203 rhabdomyosarcoma, 151 Ewing sarcoma) met the eligibility criteria. Median age was 9 years (Interquartile Range: 5-15). Median dose was 50.4 GyRBE for rhabdomyosarcoma patients (Range: 45-66 GyRBE) and 55.8 GyRBE for Ewing sarcoma patients (Range: 45-66 GyRBE). Median follow-up was 2.4 years (Range 0.3-12.3 years). Two-year overall survival rates were 81.1% (95% CI: 73.7%-88.5%) for rhabdomyosarcoma and 79.1% (95% CI: 71.7%-86.2%) for Ewing sarcoma. The Table lists the prescription doses delivered by tumor histology; 28.1% of rhabdomyosarcoma and 21.9% of Ewing sarcoma patients, respectively, received dose-escalated radiotherapy (defined as >50.4 Gy for rhabdomyosarcoma and >55.8 Gy for Ewing sarcoma). Excluding alopecia and skin desquamation, 153 patients (43.2%) developed any acute grade 2+ non-hematologic toxicity, while 49 patients (13.8%) developed one or more grade 3 toxicities. The most common grade 3 toxicities were anorexia/weight loss (7.3%), pain (7.3%) mucositis/esophagitis (4.8%), and nausea/vomiting (3.1%). One grade 4 toxicity (esophagitis) and no deaths were reported during treatment. CONCLUSION In this multi-institutional prospective registry, 28.1% of rhabdomyosarcoma and 21.9% of Ewing sarcoma patients received dose-escalated PT, with 13.8% of patients developing grade 3 toxicities. Long-term outcomes for disease control and late toxicity and anticipated cooperative group trial results are needed to fully assess the benefits and risks of dose-escalated radiotherapy for these tumors.
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Affiliation(s)
- K Von Werne
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - K Mair
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - M E Fader
- Nicklaus Children's Hospital, Miami, FL
| | | | - N Eiseler
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - N S Kalman
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - R H Press
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - D Daghistani
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - R Jimenez
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - G Paraliticci
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - J Pretell
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - J H C Chang
- Oklahoma Proton Center/OU Health Science Center, Oklahoma City, OK
| | - T Z Vern-Gross
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - S A Mihalcik
- Northwestern Medicine Chicago Proton Center, Warrenville, IL
| | - Y Kwok
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - H K Tsai
- ProCure Proton Therapy Center, Somerset, NJ
| | - J Zeng
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - R Rotondo
- University of Kansas, Kansas City, KS
| | - S L Wolden
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - M D Hall
- Miami Cancer Institute, Miami, FL
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Mair K, Von Werne K, Kalman NS, Eiseler N, Jimenez R, Paraliticci G, Pretell J, Press RH, Chang JHC, Vern-Gross TZ, Mihalcik SA, Zeng J, Kwok Y, Tsai HK, Simone CB, Chuong MD, Hall MD. Multi-Institutional Experience of Proton Therapy for Osteosarcoma in the Proton Collaborative Group (PCG) Prospective Registry. Int J Radiat Oncol Biol Phys 2023; 117:e322. [PMID: 37785149 DOI: 10.1016/j.ijrobp.2023.06.2363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To report on the utilization of dose-escalated radiotherapy, acute toxicities, and survival following definitive proton therapy (PT) for osteosarcoma patients in a prospective multi-institutional study. MATERIALS/METHODS Data on patients with osteosarcoma treated with definitive intent PT were queried from the Proton Collaborative Group (PCG) prospective registry. A similar query was performed on an institutional database with IRB approval. Overall survival rates were calculated by Kaplan-Meier. Toxicities were scored using CTCAE v4.0. RESULTS Forty osteosarcoma patients across 9 institutions received definitive intent PT between 2011-2021 and met the eligibility criteria. Median age was 32 years (Range: 6-86 years). Median PT dose was 66.6 GyRBE (Range: 50.4-80.0 GyRBE); 38 patients received proton therapy alone, whereas 2 received combined proton/photon therapy. Seventeen (42.5%) patients received doses ≥70 GyRBE. Median follow-up was 3.1 years (Range: 0.9-10.5 years). One-year and three-year overall survival rates were 83.5% and 59.1%, respectively, with 14 deaths due to disease. Excluding skin desquamation and alopecia, 22 patients (55.0%) developed any acute grade 2+ toxicity, and 5 patients (12.5%) developed any grade 3 toxicities. No acute grade 4-5 toxicities were reported. The most frequent grade 2+ non-skin toxicities were fatigue (37.5%), anorexia/weight loss (17.5%), mucositis/esophagitis (22.5%), pain (20.0%), and nausea/vomiting (10.0%). The most frequent grade 3 toxicities were anorexia/weight loss (5.0%), mucositis/esophagitis (5.0%), and neurologic symptoms (5.0%). CONCLUSION In this multi-institutional study, 42.5% of osteosarcoma patients treated with PT received doses between 70-80 Gy, with 12.5% experiencing any grade 3 toxicity. Long-term outcomes for disease control, late toxicity, and quality-of-life are needed to more fully assess the benefits and risks of dose-escalated radiotherapy in this radioresistant tumor. The authors plan to assess the outcomes of osteosarcoma patients treated with dose-escalated radiotherapy for unresectable or gross residual disease in future studies.
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Affiliation(s)
- K Mair
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - K Von Werne
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - N S Kalman
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - N Eiseler
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - R Jimenez
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - G Paraliticci
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - J Pretell
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - R H Press
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - J H C Chang
- Oklahoma Proton Center/OU Health Science Center, Oklahoma City, OK
| | | | - S A Mihalcik
- Northwestern Medicine Chicago Proton Center, Warrenville, IL
| | - J Zeng
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - Y Kwok
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - H K Tsai
- ProCure Proton Therapy Center, Somerset, NJ
| | | | - M D Chuong
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - M D Hall
- Miami Cancer Institute, Miami, FL
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Von Werne K, Naranjo M, Appel H, Rehrer W, Rubens M, Larson G, Hartsell W, Ermoian R, Tsai H, Vargas C, Chuong M, Mehta M, Kotecha R, Hall M. Safety of Proton Therapy for Patients With Primary Central Nervous System Germinoma and Non-Germinomatous Germ Cell Tumors: Report from a Multi-Institutional Database Analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rehrer W, Rubens M, Von Werne K, Odia Y, Chuong M, Kotecha R, Mehta M, Hall M. The Use of Adjuvant Radiotherapy and Chemotherapy in Low Grade Glioma Patients in the United States from 2010-2016. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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