Pediatric Sarcomas Form A Heterogeneous Group Of Mesenchymal Skeletal And. Extraskeletal Malignancies

2926 WordsDec 12, 201412 Pages
Pediatric sarcomas form a heterogeneous group of mesenchymal skeletal and extraskeletal malignancies [1]. Over the last few decades a multimodal treatment approach has improved dramatically the prognosis for children with localized Ewing sarcomas (EWS) and rhabdomyosarcoma (RMS) (65–70% event-free survival rate) [2, 3]. Though EWS and RMS are considered radiosensitive, the proportion of patients whose primary tumors are treated with external-beam radiotherapy (EBRT) alone has steadily declined over the past 30 years [4]. Increased awareness of the late effects of radiotherapy (particularly second malignancies and growth disturbances) and advances in imaging and orthopedic surgery has increased the use of surgical management for these tumors [5]. Due to the fact that complete resection is often difficult or morbid to perform, adjuvant EBRT still plays an important role in local control (LC) promotion [2, 3]. The challenge of achieving LC with a suitable therapeutic ratio is especially demanding in the pediatric population and results in a very narrow therapeutic window in which to balance benefits and late effects. The known detrimental effects of irradiating large volumes with EBRT, impulsed limited radiation therapy alternatives such us intraoperative radiation therapy (IORT) as an adapted technical opportunity to be explored in innovative practice [6]. Several collaborative groups are trying to determine the optimal radiation therapy dose and volume necessary to further

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