{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,13]],"date-time":"2025-04-13T05:24:47Z","timestamp":1744521887347,"version":"3.37.3"},"reference-count":43,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2020,8,3]],"date-time":"2020-08-03T00:00:00Z","timestamp":1596412800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,8,3]],"date-time":"2020-08-03T00:00:00Z","timestamp":1596412800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Klinikum rechts der Isar der Technischen Universit\u00e4t M\u00fcnchen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Strahlenther Onkol"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background and purpose<\/jats:title>\n<jats:p>Radiotherapy (RT) is persistently gaining significance in the treatment of pediatric tumors. However, individual features of a\u00a0growing body and multifocal stages complicate this approach. Tomotherapy offers advantages in the treatment of anatomically complex tumors with low risks of side effects. Here we report on toxicity incidence and outcome of tomotherapy with a\u00a0focus on multitarget RT (mtRT).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>From 2008 to 2017, 38\u00a0children diagnosed with sarcoma were treated with tomotherapy. The median age was 15\u00a0years (6\u201319\u00a0years). Toxicity was graded according to the Common Terminology Criteria for Adverse Events v.4.03 and classified into symptoms during RT, acutely (0\u20136\u00a0months) and late (&gt;6\u00a0months) after RT, and long-term sideeffects (&gt;24\u00a0months).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The main histologies were Ewing sarcoma (<jats:italic>n<\/jats:italic>\u202f=\u200923 [61%]) and alveolar rhabdomyosarcoma (<jats:italic>n<\/jats:italic>\u202f=\u20095 [13%]). RT was performed with a\u00a0median total dose of 54\u202fGy (40.5\u201366.0\u202fGy) and a\u00a0single dose of 2\u202fGy (1.80\u20132.27\u202fGy). Twenty patients (53%) received mtRT. Median follow-up was 29.7\u00a0months (95% confidence interval 15.3\u201348.2\u00a0months) with a\u00a05-year survival of 55.2% (\u00b19.5%). The 5\u2011year survival rate of patients with mtRT (<jats:italic>n<\/jats:italic>\u202f=\u200920) was 37.1\u202f\u00b1\u200913.2%, while patients who received single-target RT (<jats:italic>n<\/jats:italic>\u202f=\u200918) had a\u00a05-year survival rate of 75\u202f\u00b1\u200910.8%. Severe toxicities (grade\u00a03 and\u00a04) emerged in 14\u00a0patients (70%) with mtRT and 7\u00a0patients (39%) with single-target RT. Two non-hematological grade 4\u00a0toxicities occurred during RT: one mucositis and one radiodermatitis. After mtRT 5\u00a0patients had grade 3\u00a0toxicities acute and after single-target RT 4\u00a0patients. One patient had acute non-hematological grade 4\u00a0toxicities (gastritis, pericarditis, and pericardial effusion) after mtRT. Severe late effects of RT occurred in 2\u00a0patients after mtRT and in none of the single-target RT patients. No severe long-term side effects appeared.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Our results showed acceptable levels of acute and late toxicities, considering the highly advanced diseases and multimodal treatment. Hence, tomotherapy is a\u00a0feasible treatment method for young patients with anatomically complex tumors or multiple targets. Especially mtRT is a\u00a0promising and innovative treatment approach for pediatric sarcomas, delivering unexpectedly high survival rates for patients with multifocal Ewing sarcomas in this study, whereby the limited number of patients should invariably be considered in the interpretation.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00066-020-01670-4","type":"journal-article","created":{"date-parts":[[2020,8,3]],"date-time":"2020-08-03T12:06:33Z","timestamp":1596456393000},"page":"1103-1115","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Prospective evaluation of multitarget treatment of pediatric patients with helical intensity-modulated radiotherapy"],"prefix":"10.1007","volume":"196","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3195-4080","authenticated-orcid":false,"given":"Maria-Elena A.","family":"Salfelder","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kerstin A.","family":"Kessel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uwe","family":"Thiel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Burdach","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Severin","family":"Kampfer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie E.","family":"Combs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,8,3]]},"reference":[{"key":"1670_CR1","first-page":"147","volume":"5","author":"EK Amankwah","year":"2013","unstructured":"Amankwah\u00a0EK, Conley\u00a0AP, Reed\u00a0DR (2013) Epidemiology and therapies for metastatic sarcoma. 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