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Session Item

Sunday
May 08
16:55 - 17:55
Mini-Oral Theatre 1
15: Treatment plan optimisation & adaptation
Edmond Sterpin, Belgium;
Lena Nenoff, Germany
Mini-Orals are presented at one of the sessions scheduled in the two mini-oral theatres near the exhibition. Each author will present a 4-slide PowerPoint orally for 4 minutes, followed by 3 minutes for discussion. Sessions will not be streamed but authors are invited to upload per-recordings for the online platform.
Mini-Oral
Physics
Increasing access to highly specialized radiation treatments: the example of pediatric brachytherapy
Cyrus Chargari, France
PD-0923

Abstract

Increasing access to highly specialized radiation treatments: the example of pediatric brachytherapy
Authors:

Cyrus Chargari1, Christine Haie-Meder1, Sophie Espenel1, Myriam Ben-Arush2, Stéphanie Bolle1, Anna Borjesson3, Maja Cesen4, Ana-Rita Costa Lago5, Anne-Sophie Desfachelles6, Barbara De Moerloose7, De Valck8, Nuno Dos Reis Farinha 9, Nadine Francotte10, Heidi Glosli11, Gabriela Guillen Burrieza12, Sylvie Helfre13, Sabine Irtan14, Antonis Kattamis15, Anna Lacerda16, Antonin Levy1, Lisa Lyngsie17, Ludovic Mansuy18, Eric Mascard19, Wojciech Mlynarski20, Daniel Orbach21, Cormac Owens22, Pascale Philippe-Chomette23, Annemarie Peek24, Barry Pizer25, Claire Pluchart26, Anne Gro Rognlien11, Angélique Rome27, Sabine Sarnacki28, Akmal Safwat29, Amalia Schiavetti30, Jill Serre31, Cecile Verite32, Nicolas Von der Weid33, Pernille Wendtland34, Mariusz Wysocki 35, Dominique Valteau-Couanet36, Eric Deutsch1, Véronique Minard-Colin36, Hélène Martelli37, Florent Guérin37

1Gustave Roussy Cancer Campus, Radiation Oncology, Villejuif, France; 2Ruth Rappaport children’s hospital, Pediatric Oncology, Haifa, Israel; 3Lund University Hospital, Department of Pediatric Surgery, Lund, Sweden; 4University Childrens Hospital Ljubljana, Pediatric Oncology, Ljubjiana, Slovenia; 5Centro Hospitalar Universitário de São João, Radiation Oncology Department, Porto, Portugal; 6Centre Oscar Lambret, Pediatric Oncology, Lille, France; 7Ghent University Hospital , Department of Pediatric Hemato-Oncology , Ghent, Belgium; 8Hôpital Universitaire des Enfants Reine Fabiola, Pediatric Oncology, Brussels , Belgium; 9Centro Hospitalar Universitário de São João, Pediatric Oncology Department, Porto, Portugal; 10SUHOPL Service Interhospitalier Universitaire d'Hématologie et d'Oncologie Pédiatrique Liégeois, Pediatric Oncology, Liège, Belgium; 11Oslo University Hospital, Division of Paediatric and Adolescent Medicine, Oslo, Norway; 12Hospital Infantil Universitari Vall d’Hebron, Pediatric Oncology, Barcelona, Spain; 13Institut Curie, Radiation Oncology, Paris, France; 14Pediatric Oncology, Centre Hospitalier Universitaire Armand Trousseau, Paris, France; 15Sophia' Children's Hospital Papadiamantopoulou and Levadias, Division of Pediatric Hematology-Oncology, Athens, Greece; 16Instituto Portugues de Oncologia de Lisboa Francisco gentil, Pediatric Oncology, Lisboa, Portugal; 17University Hospital Rigshospitalet, Department of Pediatrics and Adolescent Medicine, Coppenhaguen, Denmark; 18Centre Hospitalier Universitaire de Nancy, Pediatric Oncology, Nancy, France; 19Centre Hospitalier Universitaire Necker, Pediatric surgery, Paris, France; 20Medical University of Lodz, Department of Pediatrics, Oncology & Hematology, Lodz, Poland; 21institut Curie, SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Paris, France; 22National Pediatric Oncology Unit, Our Lady's Children's Hospital, Pediatric Oncology, Dublin, Ireland; 23Hôpital universitaire Robert-Debré, Pediatric Surgery, Paris, France; 24Princess Máxima Center for pediatric oncology, Pediatric Oncology, Utrecht, The Netherlands; 25Alder Hey Children’s Hospital, Department of Paediatric Oncology, Liverpool, United Kingdom; 26Centre Hospitalier Universitaire de Reims, Service d'oncologie pédiatrique, Reims, France; 27Hôpital La Timone, Pediatric Oncology, Marseille, France; 28Centre Hospitalier Universitaire Necker, Pediatric Surgery, Paris, France; 29Aarhus University hospital, Oncology Department and Danish Center for Particle Therapy, Aahrus, Denmark; 30Sapienza University of Rome, Pediatric Oncology Unit, , Rome, Italy; 31Centre Hospitalier regional et Universitaire Clocheville, Pediatric Oncology, Tours, France; 32Groupe Hospitalier Pellegrin Hôpital des Enfants, Pediatric Oncology, Bordeaux, France; 33Universitäts-Kinderspital beider Basel (UKBB), , Pediatric Oncology, Basels, Switzerland; 34Aarhus Universitetshospital , Hematology and oncology, Aahrus, Denmark; 35University Hospital in Bydgoszcz, Poland, Department of Pediatric Hematology and Oncology , , Bydgoszcz, Poland; 36Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Villejuif, France; 37Bicêtre Hospital. Assistance Publique-Hôpitaux de Paris, Department of pediatric surgery, le Kremlin Bicêtre, France

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Purpose or Objective

Childhood cancer is a rare disease. Disparities in survival and long-term side-effects encourage the establishment of networks to increase access to complex radiotherapy procedures, such as brachytherapy (BT). We report our 50-year experience of BT for childhood cancers treatment.

Material and Methods

We examined the outcome of all children referred to our center from national or international networks between 1971 and 2020 and treated according to a multimodal approach including BT. Treatment characteristics were reported and patient outcome examined with focus on local control, survival, and probability of severe complication. 

Results

A total of 305 patients were treated, median age at diagnosis 2.2 years (1.4 months–17.2 years). 99 (32.4%) were treated within the last five years. 172 (56.4%) were referred from national centers and 133 (43.6%) were international patients, from 31 countries (mainly Europe). Genito-urinary tumors were the most frequent sites, with 56.4% bladder/prostate rhabdomyosarcoma and 28.5% gynecological tumors; other sites were head and neck tumors (6.9%), perineum (4.9%) and limbs (3.2%). Tumor size at diagnosis was ≥5 cm in 46.2%. Prior to BT, all rhabdomyosarcoma (RMS) patients had received primary chemotherapy, median number of 6 cycles (range: 3–18 cycles). In addition to BT, local treatment comprised a partial resection of primary tumor in 207 (67.9%) and 39 had additional external radiotherapy. Catheters placement was performed as perioperative procedure in 180 (59.0%). 225 (73.8%) patients had interstitial BT only, 68 (22.3%) had intracavitary BT only, and 12 (3.9%) had a combined technique. Median BT dose was 60 Gy (range: 10–80 Gy), delivered through low dose rate (59.0%) or pulse-dose rate BT (41.0%). Median follow-up was 58 months (range: 1 month – 48 years). It was 93 months for national patients and 37 months for international patients (p<.0001). 79 patients (26%) had a follow-up time > 10 years. At last follow-up, 16.4% patients had long-term severe complications. Five-year estimated local control (LC) was 91.2% (CI95: 87.8–94.7%), disease-free survival (DFS) was 84.7% (CI95: 80.4-89.2) and overall survival (OS) was 93.2% (CI95: 90.1-96.5). In multivariate analysis, alveolar RMS histology was poor prognostic factor for DFS (HR: 5.47; 95%CI: 2.65-11.30, p<0.01) and OS (HR: 4.46; 95%CI: 1.80-11.06, p<0.01). The only factor associated with LC was referral at time of relapse (HR: 3.03; 95%CI: 1.34-6.83, p<0.01). Two patients (0.7%) developed second malignancy. 

Conclusion

A multinational collaboration is possible, offering patients an access to highly specialized treatments such as brachytherapy. Despite paths for improvement (especially for long-term follow-up in international patients), this cooperation model could serve as a basis for generating international reference networks for high-tech radiation to increase treatment care opportunities and cure rates.