Re‑irradiation plus hyperthermia for recurrent pediatric sarcoma; a simulation study to investigate feasibility

H Petra Kok, Irma W E M Van Dijk, Koen F Crama, Nicolaas A P Franken, Coen R N Rasch, Johannes H M Merks, Johannes Crezee, Brian V Balgobind, Arjan Bel

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7 Citations (Scopus)


Recurrent pediatric tumors pose a challenge since treatment options may be limited, particularly after previous irradiation. Positive results have been reported for chemotherapy and hyperthermia, but the combination of re‑irradiation and hyperthermia has not been investigated thus far, although it is a proven treatment strategy in adults. The theoretical feasibility of re‑irradiation plus hyperthermia was investigated for infield recurrent pediatric sarcoma in the pelvic region and the extremities. A total of 46 recurrent pediatric sarcoma cases diagnosed at the Academic Medical Center (Amsterdam, The Netherlands) between 2002 and 2017 were evaluated. Patients not previously irradiated, outfield recurrences and locations other than the pelvis and extremities were excluded, ultimately yielding four eligible patients: Two with sarcomas in the pelvis and two in an extremity. Re‑irradiation and hyperthermia treatment plans were simulated for 23x2 Gy treatment schedules and weekly hyperthermia. The radiosensitizing effect of hyperthermia was quantified using biological modelling with a temperature‑dependent change in the parameters of the linear‑quadratic model. The possible effectiveness of re‑irradiation plus hyperthermia was estimated by calculating the equivalent radiotherapy dose distribution. Treatment planning revealed that tumors located in the pelvis and the extremities can be effectively heated in children. Equivalent dose distributions indicated that hyperthermic radiosensitization can be quantified as a target‑selective additional D95% of typically 10 Gy, thereby delivering a possibly curative dose of 54 Gy, without substantially increasing the equivalent dose to the organs at risk. Therefore, re‑irradiation plus hyperthermia is a theoretically feasible and possibly effective treatment option for recurrent pediatric sarcoma in the pelvic region and the extremities, and its clinical feasibility is worthy of evaluation.

Original languageEnglish
Pages (from-to)209-218
Number of pages10
JournalInternational journal of oncology
Issue number1
Publication statusPublished - Nov 2018
Externally publishedYes


  • Adolescent
  • Child, Preschool
  • Combined Modality Therapy
  • Disease-Free Survival
  • Dose Fractionation, Radiation
  • Feasibility Studies
  • Female
  • Humans
  • Hyperthermia, Induced/methods
  • Male
  • Neoplasm Recurrence, Local/therapy
  • Netherlands
  • Radiotherapy Planning, Computer-Assisted
  • Re-Irradiation/methods
  • Sarcoma/therapy
  • Treatment Outcome


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