- citati u SCIndeksu: 0
- citati u CrossRef-u:0
- citati u Google Scholaru:[
 ]
- posete u poslednjih 30 dana:2
- preuzimanja u poslednjih 30 dana:1
|
|
|
2013, vol. 141, br. 5-6, str. 375-379
|
|
Izbor optimalne postoperacione tehnike zračenja u lečenju orbitalnog rabdomiosarkoma
Optimal postoperative radiotherapy treatment of orbital rhabdomyosarcoma
aInstitut za onkologiju Vojvodine, Sremska Kamenica bUniverzitet u Novom Sadu, Medicinski fakultet, Katedra za stomatologiju sa maksilofacijalnom hirurgijom cUniverzitet u Novom Sadu, Medicinski fakultet, Institut za kardiovaskularne bolesti
e-adresa: nsbim@eunet.rs
Sažetak
Uvod. Rabdomiosarkom je najčešći sarkom mekog tkiva. Kod većine ljudi javlja se u regiji glave i vrata (orbita, paranazalni sinus). Prema histološkoj klasifikaciji deli se na: embrionalni tip (66-70%), sa boljom prognozom, i alveolarni tip (20%), koji nosi relativno lošu prognozu, i difuzni anaplastični i nediferencirani tip (10%). Zbog multimodalne terapije (hirurško lečenje, hemioterapija, radioterapija), preživljavanje rabdomiosarkoma je znatno poboljšano. Ipak, rano dijagnostikovanje rabdomiosarkoma je od najvećeg značaja za ishod i tok bolesti. Standardna konformalna zračna terapija je za ovu vrstu tumora veoma kompleksna zbog neposredne blizine mnogih kritičnih organa, koji ograničavaju mogućnost postizanja optimalne tumorske raspodele doze. Prikaz bolesnika. Žena stara 59 godina operisana je zbog rabdomiosarkoma gornje vilice u nekoliko navrata. Urađeni su suptotalna resekcija maksile, uklanjanje sadržaja desnog gornjoviličnog sinusa, nosne šupljine, sinusa desne sitaste i klinaste kosti i desne očne duplje. Posle operacije primila je četiri ciklusa monohemioterapije antraciklinima (adriamicin). Standardna priprema bolesnice za konformalnu zračnu terapiju nije dala zadovoljavajuće parametre ovog zračnog plana, te je ponovljena priprema bolesnice uz korekcije koja je dovela do optimalnog terapijskog plana, u skladu s prihvaćenim preporukama. Zaključak. Opisani slučaj prikazuje redak tumor koji se javlja u dečjem uzrastu, a izuzetno retko kod odraslih. Problem neodgovarajuće izodozne raspodele standardnim planiranjem terapije rešen je postavljanjem bolusnog materijala u očnu duplju i preko imobilizacione maske, čime su postignute zadovoljavajuća izodozna raspodela i pokrivenost ležišta tumora.
Abstract
Introduction. Rhabdomyosarcoma (RMS) is the most common sarcoma of the soft tissue, mostly affecting the region of head and neck (orbit, paranasal sinus). Histological types include embryonal (6670%) with better prognosis, and alveolar type (20%) with poorer prognosis. There are also diffuse anaplastic and undifferentiated sarcomas (10%). Due to multimodal therapy approach (surgery, chemotherapy and radiotherapy), RMS survival rate is considerably improving. Nevertheless, early diagnosis of RMS is of crucial importance for the outcome of treatment. Standard conformal radiation therapy is very complex due to closeness of many critical structures of head and neck, thus limiting optimal tumor dose coverage. Case Outline. Patient aged 59 years, surgically treated for RMS of nasal cavity several times before radiation therapy treatment. Due to relapse, patient was reoperated, when subtotal reresection of the maxilla with exenteration of the right orbit was done. The patient received IV cycles of polychemotherapy postoperatively. Standard procedure and planning for conformal radiation therapy did not lead to acceptable irradiation plan, and hence modification in the patient's preparation was done, resulting in optimal therapeutic plan according to internationally recognized recommendations. Conclusion. The reported case shows a rare pediatric tumor, which often occurs in children but extremely rare in adults. The problem of inadequate isodose distribution obtained by standard conformal plan was solved by placing bolus material into the orbital cavity. The outcome of the treatment plan showed much better isodose distribution and tumor bed coverage.
|
|
|
|
Reference
|
|
|
Breneman, J.C., Donaldson, S.S. (2004) Rhabdomyosarcoma. u: Perez C.A., Brady L.W., Halperin E.C., Schmidt Ullrich R.K. [ur.] Principles and Practice of Radiation Oncology, Philadelphia: Lippincott Williams & Wilkins, str. 2261-2277
|
|
 
|
Crist, W.M., Anderson, J.R., Meza, J.L., Fryer, C., Raney, R.B., Ruymann, F.B., Breneman, J., Qualman, S.J., Wiener, E., Wharam, M., Lobe, T., Webber, B., Maurer, H.M., Donaldson, S.S. (2001) Intergroup rhabdomyosarcoma study-IV: results for patients with nonmetastatic disease. Journal of clinical oncology, 19(12): 3091-102
|
|
|
Hicks, J., Flaitz, C. (2002) Rhabdomyosarcoma of the head and neck in children. Oral oncology, 38(5): 450-9
|
|
1
|
International Comission on Radiation Units and Measurements (1993) ICRU Report 50: Prescribing, Recording, and Reporting Photon Beam Therapy. Bethesda, MD: ICRU
|
|
2
|
International Commission on Radiation Units and Measurements (1999) Prescribing, recording and reporting photon beam therapy. ICRU News December, Report 62: supplement to ICRU Report 50
|
|
|
Jun, L., Thompson, T.D., Miller, J.W., Pollack, L.A., Stewart, S.L. (2008) Cancer incidence among children and adolescents in the United States, 2001-2003. Pediatrics, 121: 1470-1477
|
|
|
Macarthur, C.J., Mcgill, T.J.I., Healy, G.B. (1992) Pediatric Head and Neck Rhabdomyosarcoma. Clinical Pediatrics, 31(2): 66-70
|
|
|
Marks, L.B., Yorke, D.Y., Jackson, A. (2010) Ten Haken RK, Constine LS, Eisbruch A, et al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys, Suppl
|
|
|
Meza, J.L., Anderson, J., Pappo, A.S., Meyer, W.H. (2006) Analysis of prognostic factors in patients with nonmetastatic rhabdomyosarcoma treated on intergroup rhabdomyosarcoma studies III and IV: the Children's Oncology Group. Journal of clinical oncology, 24(24): 3844-51
|
|
|
Miralbell, R., Cella, L., Weber, D., Lomax, A. (2000) Optimizing radiotherapy of orbital and paraorbital tumors: intensity-modulated X-ray beams vs. Intensity-modulated proton beams. Int J Radiation Oncology Biol Phys., 47(4): 1111-1119
|
|
|
Purdy, J.A. (2004) Current ICRU definitions of volumes: limitations and future directions. Seminars in radiation oncology, 14(1): 27-40
|
|
|
Qualman, S.J., Coffin, C.M., Newton, W.A., Hojo, H., Triche, T.J., Parham, D.M., Crist, W.M. (1998) Intergroup Rhabdomyosarcoma Study: update for pathologists. Pediatric and developmental pathology, 1(6): 550-61
|
|
|
Stevens, M.C.G., Rey, A., Bouvet, N., Ellershaw, C., Flamant, F., Habrand, J.L., Marsden, B.H., Martelli, H., de Sanchez, T.J., Spicer, R.D., Spooner, D., Terrier-Lacombe, M.J. (2005) Treatment of nonmetastatic rhabdomyosarcoma in childhood and adolescence: third study of the International Society of Paediatric Oncology--SIOP Malignant Mesenchymal Tumor 89. Journal of clinical oncology, 23(12): 2618-28
|
|
|
|
|