Brachytherapy for Pediatric Patients at Gustave Roussy Cancer Campus: A Model of International Cooperation for Highly Specialized Treatments

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  • Cyrus Chargari, Institut Gustave Roussy
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  • Christine Haie-Meder, Institut Gustave Roussy
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  • Sophie Espenel, Institut Gustave Roussy
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  • Max Adrien Garcia, Centre Hygée
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  • Myriam Ben-Arush, Ruth Rappaport Children's Hospital
  • ,
  • Stéphanie Bolle, Institut Gustave Roussy
  • ,
  • Anna Borjesson, Lund University
  • ,
  • Maja Cesen, University of Ljubljana
  • ,
  • Rita Costa Lago, Centro Hospitalar Universitário de São João
  • ,
  • Anne Sophie Defachelles, Centre Oscar Lambret
  • ,
  • Barbara De Moerloose, Ghent University
  • ,
  • Christine Devalck, Queen Fabiola Children's University Hospital
  • ,
  • Pernille Edslev
  • ,
  • Nuno Jorge Farinha, Centro Hospitalar Universitário de São João
  • ,
  • Nadine Francotte, Service Interhospitalier Universitaire d'Hématologie et d'Oncologie Pédiatrique Liégeois
  • ,
  • Heidi Glosli, University of Oslo
  • ,
  • Sebastien Gouy, Institut Gustave Roussy
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  • Gabriela Guillen Burrieza, Autonomous University of Barcelona
  • ,
  • Sylvie Helfre, Institut Curie
  • ,
  • Sabine Irtan, Sorbonne Université
  • ,
  • Antonis Kattamis, University of Athens
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  • Ana Lacerda, Instituto Portugues de Oncologia de Francisco Gentil Lisboa
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  • Antonin Levy, Institut Gustave Roussy
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  • Lisa Lyngsie Hjalgrim, Københavns Universitet
  • ,
  • Ludovic Mansuy, CHU de Nancy
  • ,
  • Eric Mascard, Universite Paris 5
  • ,
  • Salma Moalla, Institut Gustave Roussy
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  • Daniel Orbach, Laboratoire de Géologie de l’ENS - PSL Research University – CNRS UMR8538
  • ,
  • Cormac Owens, Our Lady's Hospital for Sick Children
  • ,
  • Pascale Philippe-Chomette, Hopital Robert-Debre AP-HP
  • ,
  • Barry Pizer, Alder Hey Children's Hospital
  • ,
  • Claire Pluchart, CHU de Reims
  • ,
  • Marleen Renard, KU Leuven
  • ,
  • Anne Gro Wesenberg Rognlien, University of Oslo
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  • Angélique Rome, Aix-Marseille Université
  • ,
  • Sabine Sarnacki, Universite Paris 5
  • ,
  • Akmal Safwat
  • Amalia Schiavetti, University of Rome La Sapienza
  • ,
  • Jill Serre, Université de Tours
  • ,
  • Cécile Verite, Groupe Hospitalier Pellegrin
  • ,
  • Nicolas Von Der Weid, University of Basel
  • ,
  • Mariusz Wysocki, Dr Antoni Jurasz Memorial University Hospital
  • ,
  • Dominique Valteay-Couanet, Institut Gustave Roussy
  • ,
  • Eric Deutsch, Institut Gustave Roussy
  • ,
  • Véronique Minard-Colin, Institut Gustave Roussy
  • ,
  • Hélène Martelli, Universite Paris-Saclay
  • ,
  • Florent Guérin, Universite Paris-Saclay

Purpose: Childhood cancer is rare, and treatment is frequently associated with long-term morbidity. Disparities in survival and long-term side effects encourage the establishment of networks to increase access to complex organ-conservative strategies, such as brachytherapy. We report our experience of an international cooperation model in childhood cancers. Methods and Materials: We examined the outcome of all children referred to our center from national or international networks to be treated according to a multimodal organ-conservative approach, including brachytherapy. Results: We identified 305 patients whose median age at diagnosis was 2.2 years (range, 1.4 months to 17.2 years). Among these patients, 99 (32.4%) were treated between 2015 and 2020; 172 (56.4%) were referred from national centers; and 133 (43.6%) were international patients from 31 countries (mainly Europe). Also, 263 patients were referred for primary treatment and 42 patients were referred for salvage treatment. Genitourinary tumors were the most frequent sites, with 56.4% bladder/prostate rhabdomyosarcoma and 28.5% gynecologic tumors. In addition to brachytherapy, local treatment consisted of partial tumor resection in 207 patients (67.9%), and 39 patients (13%) had additional external radiation therapy. Median follow-up was 58 months (range, 1 month to 48 years), 93 months for national patients, and 37 months for international patients (P < .0001). Five-year local control, disease-free survival, and overall survival rates were 90.8% (95% confidence interval [CI], 87.3%-94.4%), 84.4% (95% CI, 80.1%-89.0%), and 93.3% (95% CI, 90.1%-96.5%), respectively. Patients referred for salvage treatment had poorer disease-free survival (P < .01). Implementation of image guided pulse-dose-rate brachytherapy was associated with better local control among patients with rhabdomyosarcoma referred for primary treatment (hazard ratio, 9.72; 95% CI, 1.24-71.0). At last follow-up, 16.7% patients had long-term severe treatment-related complications, and 2 patients (0.7%) had developed second malignancy. Conclusions: This retrospective series shows the feasibility of a multinational referral network for brachytherapy allowing high patient numbers in rare pediatric cancers. High local control probability and acceptable late severe complication probability could be achieved despite very challenging situations. This cooperation model could serve as a basis for generating international reference networks for high-tech radiation such as brachytherapy to increase treatment care opportunities and cure probability.

OriginalsprogEngelsk
TidsskriftInternational Journal of Radiation Oncology Biology Physics
Vol/bind113
Nummer3
Sider (fra-til)602-613
Antal sider12
ISSN0360-3016
DOI
StatusUdgivet - jul. 2022

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