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Treatment of soft tissue sarcomas of the head and neck
Proceedings of the 1st Annual ASTRO Meeting
87
invasion, all in parameningeal sites. There 5 year NED survival was 14%, compared with 84% in the 14 pts without this finding (p=O.OOOS). Clinically positive lymph nodes were also scored in these pts, and the 5 year NED survival for the 13 node (+) pts was 13%, compared to 83% for the 12 node (-) pts (p=O.O3). The pattern of failure for pts with extensive bone or nodal disease was equally divided between local, regional Of 19 pts with parameningeal primary sites, 11 had extensive bone (out of field), and distant sites. Only one received craniospinal radiation therapy, and only one meningeal failure was seen. invasion. This observation does not support the use of meningeal prophylaxis, even in pts with extensive parameningeal The poor prognosis in the 18 T/E pts (30% 5 year NED) made analysis of local and regional primaries.
disease factors difficult, however the influence of age and histology will be discussed. Only 2 failures and one septic death were seen in the 19 P/GU pts (73% 5 year NED survival), and details of treatment will be given. In conclusion, extensive bone invasion and clinical nodal disease are statistically significant predictors of outcome in pts with H/N rhabdomyosarcoma.
21 TREATMENT OF SOFT TISSUE SARCOMAS OF THE HEAD AND
NECK.
Mitchel Fromm'. Philip Littman'. Beverly Raney2, Steven Handler3, Linda Nelson4. and Gary Diamond' Departmeets of Radiation Therapy' at the University of Pennsylvania; epartment 06 Pediatrics, Divisitn of 9 Oncology and Department of Surgery, Divisions of Otorhinolaryngology , Dentistry , and Ophthalmology at the Children's Hospital of Philadelphia. Twenty children with soft tissue sarcomas of the head and neck treated at the Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania from 1972 to 1981 were evaluated for the late deleterious effects of treatment. All patients received radiation therapy (RT) and combination chemotherapy with vincristine, actinomycin-D and cyclophosphamide;certain patients also received adriamycin. All had ophthalmologic, otologic and growth evaluations: 16 also had dental evaluations. The median age at diagnosis was 6 years with a range of 7 months to 13 years. Median follow-up from time of diagnosis was 5.5 years with a minimum of three years in all but four children. Dental evaluation showed significant radiation induced problems in 14 of 16 children: 13 had root agenesis or foreshortening;nine had crown hypoplasia and eight had radiation caries. Nine developed cataracts and three of these had significant xerophthalmia as well. The minimum dose to the lens in these children was 4000 rad except for one child who received 2400 rad. Six children developed growth failure. Of these, five with documented growth hormone deficiency received exogenous growth hormone with improvement in height velocity. One child had severe sensorineural hearing loss attributable to either middle-ear tumor, high-dose RT (5600 rad), or both. It is concluded that children treated for sarcoma of the head and neck who survive show a variety of treatment related effects. Dental problems are almost universal. Cataracts are likely following treatment for orbital or paranasal sinus tumors. Obvious facial asymmetry occured in some patients but true disfugurement was rare. Growth hormone deficiency may follow pituitary doses greater than 4000 rad. Hearing loss is uncommon.
22 CENTRAL NERVOUS SYSTEM (CNS) PROPHYLAXIS IN CHILDREN WITH LOW RISK ACUTE LYMPHOBLASTIC LEUKEMIA (ALL). Philip Littman, Peter Coccia. Werner Bleyer. John Lukens. Stewart Siegel, Denis Miller, Harlan Sather. Denman Hammond Children's Cancer Study Group, Los Angeles, California Four hundred eighty-four children with low risk ALL (ages 3-6. WBC < 10,000) were randomized on Children's Cancer Study Group Protocol #161 from March 1978 through May 1983 to two different CNS prophylaxis regimens (A and B). Regimen A (238 patients) consisted of cranial irradiation (C-XRT), 180 rad x 10. plus intrathecal methotrexate (ITMTX) weekly for 4 weeks. Regimen B (246 patients) consisted of ITNTX weekly times 4 weeks and then ITMTX every 84 days for 12 cycles. CNS relapse, isolated and/or concurrently with marrow relapse, was 5% in each group. Radiotherapy records were reviewed on 226 patients (95%). Portal and/or simulation films were reviewed on 148 patients (62%). Only four patients (2%) were not treated within the prescribed protocol dose, dose rate, or elapsed time. Sixty-one patients (41%) had treatment volumes which were felt to be inadequate to fully cover the meninges and optic nerves: however, in only six patients (3%) were the treatment volumes felt to be grossly inadequate. The relationship between CNS failure and quality of radiation will be discussed. There is no evidence that substituting CNS radiation with ITMTX has resulted in an increase of CNS leukemia either isolated or with concurrent marrow relapse in children with low risk ALL.
87
invasion, all in parameningeal sites. There 5 year NED survival was 14%, compared with 84% in the 14 pts without this finding (p=O.OOOS). Clinically positive lymph nodes were also scored in these pts, and the 5 year NED survival for the 13 node (+) pts was 13%, compared to 83% for the 12 node (-) pts (p=O.O3). The pattern of failure for pts with extensive bone or nodal disease was equally divided between local, regional Of 19 pts with parameningeal primary sites, 11 had extensive bone (out of field), and distant sites. Only one received craniospinal radiation therapy, and only one meningeal failure was seen. invasion. This observation does not support the use of meningeal prophylaxis, even in pts with extensive parameningeal The poor prognosis in the 18 T/E pts (30% 5 year NED) made analysis of local and regional primaries.
disease factors difficult, however the influence of age and histology will be discussed. Only 2 failures and one septic death were seen in the 19 P/GU pts (73% 5 year NED survival), and details of treatment will be given. In conclusion, extensive bone invasion and clinical nodal disease are statistically significant predictors of outcome in pts with H/N rhabdomyosarcoma.
21 TREATMENT OF SOFT TISSUE SARCOMAS OF THE HEAD AND
NECK.
Mitchel Fromm'. Philip Littman'. Beverly Raney2, Steven Handler3, Linda Nelson4. and Gary Diamond' Departmeets of Radiation Therapy' at the University of Pennsylvania; epartment 06 Pediatrics, Divisitn of 9 Oncology and Department of Surgery, Divisions of Otorhinolaryngology , Dentistry , and Ophthalmology at the Children's Hospital of Philadelphia. Twenty children with soft tissue sarcomas of the head and neck treated at the Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania from 1972 to 1981 were evaluated for the late deleterious effects of treatment. All patients received radiation therapy (RT) and combination chemotherapy with vincristine, actinomycin-D and cyclophosphamide;certain patients also received adriamycin. All had ophthalmologic, otologic and growth evaluations: 16 also had dental evaluations. The median age at diagnosis was 6 years with a range of 7 months to 13 years. Median follow-up from time of diagnosis was 5.5 years with a minimum of three years in all but four children. Dental evaluation showed significant radiation induced problems in 14 of 16 children: 13 had root agenesis or foreshortening;nine had crown hypoplasia and eight had radiation caries. Nine developed cataracts and three of these had significant xerophthalmia as well. The minimum dose to the lens in these children was 4000 rad except for one child who received 2400 rad. Six children developed growth failure. Of these, five with documented growth hormone deficiency received exogenous growth hormone with improvement in height velocity. One child had severe sensorineural hearing loss attributable to either middle-ear tumor, high-dose RT (5600 rad), or both. It is concluded that children treated for sarcoma of the head and neck who survive show a variety of treatment related effects. Dental problems are almost universal. Cataracts are likely following treatment for orbital or paranasal sinus tumors. Obvious facial asymmetry occured in some patients but true disfugurement was rare. Growth hormone deficiency may follow pituitary doses greater than 4000 rad. Hearing loss is uncommon.
22 CENTRAL NERVOUS SYSTEM (CNS) PROPHYLAXIS IN CHILDREN WITH LOW RISK ACUTE LYMPHOBLASTIC LEUKEMIA (ALL). Philip Littman, Peter Coccia. Werner Bleyer. John Lukens. Stewart Siegel, Denis Miller, Harlan Sather. Denman Hammond Children's Cancer Study Group, Los Angeles, California Four hundred eighty-four children with low risk ALL (ages 3-6. WBC < 10,000) were randomized on Children's Cancer Study Group Protocol #161 from March 1978 through May 1983 to two different CNS prophylaxis regimens (A and B). Regimen A (238 patients) consisted of cranial irradiation (C-XRT), 180 rad x 10. plus intrathecal methotrexate (ITMTX) weekly for 4 weeks. Regimen B (246 patients) consisted of ITNTX weekly times 4 weeks and then ITMTX every 84 days for 12 cycles. CNS relapse, isolated and/or concurrently with marrow relapse, was 5% in each group. Radiotherapy records were reviewed on 226 patients (95%). Portal and/or simulation films were reviewed on 148 patients (62%). Only four patients (2%) were not treated within the prescribed protocol dose, dose rate, or elapsed time. Sixty-one patients (41%) had treatment volumes which were felt to be inadequate to fully cover the meninges and optic nerves: however, in only six patients (3%) were the treatment volumes felt to be grossly inadequate. The relationship between CNS failure and quality of radiation will be discussed. There is no evidence that substituting CNS radiation with ITMTX has resulted in an increase of CNS leukemia either isolated or with concurrent marrow relapse in children with low risk ALL.