PMID- 29152430
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200929
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 9
IP  - 9
DP  - 2017 Sep 10
TI  - A Dosimetric Comparison of Intensity-Modulated Proton Therapy, 
      Volumetric-Modulated Arc Therapy, and 4pi Non-Coplanar Intensity-Modulated 
      Radiation Therapy for a Patient with Parameningeal Rhabdomyosarcoma.
PG  - e1673
LID - 10.7759/cureus.1673 [doi]
LID - e1673
AB  - Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and 
      manifests as two major histological subtypes: embryonal and alveolar. The 
      five-year local failure rate for RMS at parameningeal sites (middle ear, mastoid 
      region, nasal cavity, etc.) is around 17% despite multiple Intergroup 
      Rhabdomyosarcoma Study Group (IRS) trials conducted to determine the optimal 
      radiation treatment regimen. This case report explores the use of 
      intensity-modulated proton therapy (IMPT) for a 10-year-old child who presented 
      with left eye irritation, facial pain, and headaches and was found to have an 
      alveolar parameningeal rhabdomyosarcoma. He received systemic therapy as well as 
      radiation therapy to 5,640 cGy and 4,320 cGy over 24 fractions, prescribed for 
      gross tumor extension and adjacent high-risk involved sites, respectively, via 
      simultaneous integrated boost. Approximately two years following treatment, the 
      patient has had no recurrence of his RMS with no distant metastases. In addition, 
      his presenting symptom of left eye irritation has improved. His only side effect 
      from radiation at this point is short stature, possibly due to growth hormone 
      deficiency. The patient's IMPT plan was compared with volumetric-modulated arc 
      therapy (VMAT) and 4pi non-coplanar intensity-modulated radiation therapy (IMRT) 
      plans, and comparisons of isodose lines show decreased dose to the distal brain 
      tissue with preserved target conformality by IMPT. IMPT also allowed for 
      increased sparing of the patient's retina, lens, and lacrimal gland. All 
      radiation plans achieved conformal dose coverage to the planning/scanning target 
      volumes, while the IMPT plan is potentially better at sparing the patient from 
      developing long-term optic apparatus side effects and neurocognitive defects. In 
      this case, IMPT is comparable, if not favorable, when long-term side effects can 
      be reduced while maintaining dose conformality and local control.
FAU - Chen, Tiffany W
AU  - Chen TW
AD  - Department of Radiation Oncology, UT Health San Antonio Cancer Center.
FAU - Sison, Julian
AU  - Sison J
AD  - Robert Wood Johnson Medical School.
FAU - Lee, Becky
AU  - Lee B
AD  - David Geffen School of Medicine, UCLA.
FAU - Olch, Arthur J
AU  - Olch AJ
AD  - Department of Radiation Oncology, Keck School of Medicine of the University of 
      Southern California, Los Angeles, CA.
FAU - Chang, Andrew
AU  - Chang A
AD  - Department of Radiation Oncology, Scripps Proton Therapy Center.
FAU - Giebeler, Annelise
AU  - Giebeler A
AD  - Department of Radiation Oncology, Scripps Proton Therapy Center.
FAU - Wong, Kenneth
AU  - Wong K
AD  - Department of Radiation Oncology, Keck School of Medicine of the University of 
      Southern California, Los Angeles, CA.
LA  - eng
PT  - Case Reports
DEP - 20170910
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC5679771
OTO - NOTNLM
OT  - 4pi radiotherapy
OT  - alveolar
OT  - intensity modulated proton therapy (impt)
OT  - intensity-modulated radiotherapy (imrt)
OT  - parameningeal
OT  - pm-rms
OT  - proton therapy
OT  - rhabdomyosarcoma
OT  - volumetric modulated arc therapy (vmat)
COIS- The authors have declared that no competing interests exist.
EDAT- 2017/11/21 06:00
MHDA- 2017/11/21 06:01
PMCR- 2017/09/10
CRDT- 2017/11/21 06:00
PHST- 2017/11/21 06:00 [entrez]
PHST- 2017/11/21 06:00 [pubmed]
PHST- 2017/11/21 06:01 [medline]
PHST- 2017/09/10 00:00 [pmc-release]
AID - 10.7759/cureus.1673 [doi]
PST - epublish
SO  - Cureus. 2017 Sep 10;9(9):e1673. doi: 10.7759/cureus.1673.