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Int J Radiat Oncol Biol Phys. 2008 Nov 1;72(3):884-91. doi: 10.1016/j.ijrobp.2008.01.058. Epub 2008 May 1.

Intensity-modulated radiotherapy with use of cone-down boost for pediatric head-and-neck rhabdomyosarcoma.

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Department of Radiation Oncology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.



To report our initial experience using intensity-modulated radiotherapy (IMRT) with a cone-down boost for pediatric head-and-neck rhabdomyosarcoma (RMS).


A review of institutional treatment records identified children treated with IMRT for head-and-neck RMS between January 2000 and February 2007. All patients had undergone chemotherapy according to cooperative group RMS protocols. The initial planning target volume (PTV) covered the prechemotherapy tumor extent with variable margins, generally 1-2 cm. The boost PTV covered the postchemotherapy tumor volume, usually with a margin of 0.5-1 cm.


A total of 20 patients were treated with IMRT for head-and-neck RMS. Of these 20 patients, 4 had Group II, 15 Group III, and 1 Group IV disease. The site was parameningeal in 12, nonparameningeal in 6, and orbit primary in 2. Of the 20 patients, 14 were treated with a cone-down boost after a median dose of 36 Gy (range, 30-45.6). The mean initial PTV was 213.5 cm(3), and the mean boost PTV was 76.9 cm(3). Patients received a median total dose of 50.4 Gy. The median follow-up time was 29 months. The 3-year Kaplan-Meier local control rate was 100%, although 1 patient developed an in-field recurrence 50 months after IMRT. The 3-year event-free survival rate, overall survival rate, and risk of central nervous system failure was 74%, 76%, and 7%, respectively.


Our preliminary follow-up of pediatric head-and-neck RMS patients treated with IMRT revealed excellent local control. The initial targeting of the prechemotherapy tumor volume with 1-2-cm margin to 30.6 or 36 Gy followed by a cone-down boost to the postchemotherapy tumor volume with a 0.5-1-cm margin allowed for significant sparing of normal tissues and provided good local control.

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