Srpski arhiv za celokupno lekarstvo 2013 Volume 141, Issue 5-6, Pages: 375-379
https://doi.org/10.2298/SARH1306375P
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Optimal postoperative radiotherapy treatment of orbital rhabdomyosarcoma
Petrović Borislava (Institut za onkologiju Vojvodine, Zavod za radioterapiju, Sremska Kamenica)
Đan Igor (Institut za onkologiju Vojvodine, Zavod za radioterapiju, Sremska Kamenica)
Markov Borislav (Klinički centar Vojvodine, Klinika za maksilofacijalnu hirurgiju, Novi Sad)
Petrović Milovan (Institut za kardiovaskularne bolesti Vojvodine, Klinika za kardiologiju, Sremska Kamenica)
Erak Marko (Institut za onkologiju Vojvodine, Zavod za radioterapiju, Sremska Kamenica)
Teodorović Milan (Institut za onkologiju Vojvodine, Zavod za radioterapiju, Sremska Kamenica)
Baucal Milutin (Institut za onkologiju Vojvodine, Zavod za radioterapiju, Sremska Kamenica)
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.
Keywords: conformal radiotherapy, computer assisted radiotherapy planning, rhabdomyosarcoma, alveolar, radiation therapy isodose plan