Outcome after surgical resection of recurrent rhabdomyosarcoma

Hayes‐Jordan, Andrea; Doherty, Debra K.; West, Sonlee D.; Raney, R. Beverly; Blakely, Martin L.; Cox, Charles S.; Andrassy, Richard J.; Lally, Kevin P.

doi:10.1016/j.jpedsurg.2005.12.002

Cited by 41 publications

(24 citation statements)

References 15 publications

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“…[1][2][3] Because of the young patient age and extensive morbidity associated with salvage options after local relapse, [4][5][6][7] it is imperative to explore new strategies to improve local control. Prior strategies explored by the Intergroup Rhabdomyosarcoma Study Group and the Children's Oncology Group (COG), including radiation therapy (RT) dose escalation via a hyperfractionated approach and technical advances in imaging and RT, have not resulted in a difference in local control, although early data suggest that proton therapy may improve toxicity rates.…”

Section: Introductionmentioning

confidence: 99%

“…Prior strategies explored by the Intergroup Rhabdomyosarcoma Study Group and the Children's Oncology Group (COG), including radiation therapy (RT) dose escalation via a hyperfractionated approach and technical advances in imaging and RT, have not resulted in a difference in local control, although early data suggest that proton therapy may improve toxicity rates. [1][2][3] Because of the young patient age and extensive morbidity associated with salvage options after local relapse, [4][5][6][7] it is imperative to explore new strategies to improve local control. One goal of the most recent COG clinical trial for intermediate-risk RMS, ARST0531, was to maximize local control via the early introduction of RT at week 4 and concurrent delivery of RT with irinotecan, a potential radiosensitizer.…”

Section: Introductionmentioning

confidence: 99%

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Increased local failure for patients with intermediate‐risk rhabdomyosarcoma on ARST0531: A report from the Children's Oncology Group

Casey

Yun

Donaldson

et al. 2019

Cancer

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BACKGROUND:The objective of this study was to evaluate local control for patients with intermediate-risk rhabdomyosarcoma (RMS) treated on Children's Oncology Group (COG) protocol ARST0531. METHODS: This study analyzed 424 patients with intermediate-risk RMS. Patients were randomized to chemotherapy with either vincristine, dactinomycin, and cyclophosphamide (VAC) or VAC alternating with vincristine and irinotecan. With the goal of improving local control, radiation therapy (RT) was delivered early at week 4 and was concurrent with irinotecan in the experimental arm. Individualized local control plans for children 24 months old or younger were allowed. Local failure on ARST0531 was compared with local failure on the preceding COG intermediate-risk study, D9803. RESULTS: For patients with group I/II alveolar RMS (n = 55), the 5-year cumulative incidence of local failure was 13.4%; for group III alveolar RMS (n = 141), it was 20.2%; and for group III embryonal RMS (n = 228), it was 27.9% (P = .03). Among patients with group III disease, local failure did not differ by histology, site, nodal status, RT modality, or treatment arm. Local failure was worse for a tumor size >5 cm (32.3% vs 16.7%; P = .001). Among patients with group III embryonal RMS, local failure was higher on ARST0531 than D9803 (27.9% vs 19.4%; P = .03). After the exclusion of patients 24 months old or younger or patients who did not receive radiation, local failure remained significantly increased on ARST0531 (P = .02). After adjustments for clinical prognostic factors, event-free survival and overall survival were worse on ARST0531 (P = .004 and P = .05, respectively). CONCLUSIONS: Despite interventions designed to enhance local control, local control was inferior on ARST0531 in comparison with D9803. The reason for this is unclear, but it could be the reduced cyclophosphamide dose on ARST0531. Cancer 2019;125:3242-3248.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Increased local failure for patients with intermediate‐risk rhabdomyosarcoma on ARST0531: A report from the Children's Oncology Group

Casey

Yun

Donaldson

et al. 2019

Cancer

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“…However, patients with prolonged survival often have recurrent disease. Approximately, 26% of patients with rhabdomyosarcomas will experience tumor recurrence following primary therapy [1]. Therefore, the more precise staging and re-staging for these patients are important for adequate therapy.…”

Section: Introductionmentioning

confidence: 99%

Comparative study of FDG PET/CT and conventional imaging in the staging of rhabdomyosarcoma

Tateishi

Hosono²,

Makimoto³

et al. 2009

Ann Nucl Med

102

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“…The total cumulative cyclophosphamide doses for the VAC and VAC/VI arms in ARST0531 were lower than those in EpSSG RMS 2005 (Table 1). 16,17 The study by Casey et al 8 clearly delineates the potential role of cyclophosphamide dosing in the local control of group III rhabdomyosarcoma, although defining a potential threshold for the cumulative dose or dose intensity and ruling out other potential contributors such as timing remain a challenge. However, on the basis of these findings, the COG-STS has adopted maintenance therapy identical to that used in EpSSG RMS 2005 in ARST1431 for intermediaterisk patients but has retained the VAC/VI backbone arm, which, when combined with maintenance therapy, will deliver a total cumulative cyclophosphamide dose of only 12.6 g/m 2 .…”

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confidence: 99%

Optimal dosing of cyclophosphamide in rhabdomyosarcoma: It's complicated

Lucas

Pappo

2019

Cancer

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Rhabdomyosarcoma is the most common soft-tissue sarcoma in children in the United States with an incidence of 4.5 per million, which translates into approximately 350 new diagnoses per year. The use of risk-based multimodal therapies developed by cooperative groups has been largely responsible for improving the 5-year survival rates for this disease, which now exceed 70%. 1 Despite marked improvements in the outcomes of most children with rhabdomyosarcoma, survival rates for patients with metastatic disease and select patients with intermediate-risk disease, such as those with unresectable stage 2/3 tumors, have not significantly improved over the past 30 years. The Children's Oncology Group Soft Tissue Sarcoma Committee (COG-STS) has used vincristine, actinomycin, and cyclophosphamide (VAC) as the main backbone for treating rhabdomyosarcoma. To improve the survival of patients with intermediate-risk disease, the COG-STS conducted a series of clinical trials in which doses of active agents were intensified or novel agents such as camptothecins were incorporated. Promising activity was found in phase 2 window trials of patients with metastatic rhabdomyosarcomas. 2,3 For example, in a prospective single-arm trial of 115 patients with intermediate-risk rhabdomyosarcoma, dose escalation of cyclophosphamide to 4.5 g/m 2 did not result in improved outcomes and was associated with significant gastrointestinal toxicity. 4 In the prospective randomized trial D9803, 516 patients with intermediate-risk rhabdomyosarcoma were randomly assigned to receive VAC chemotherapy with a cyclophosphamide dose of 2.2 g/m 2 or VAC alternating with vincristine, cyclophosphamide, and topotecan (VTC; Table 1). The estimated 4-year failure-free survival and overall survival rates were similar for the 2 arms. 6 In the most recent trial ARST0531, which is the subject of this report, 448 patients with intermediate-risk rhabdomyosarcoma were randomized to receive VAC chemotherapy or VAC alternating with vincristine and irinotecan (VI). The 4-year event-free survival and overall survival rates were similar for both arms, but the VAC/VI arm had fewer hematologic toxicities and more gastrointestinal toxicities than the VAC arm. 7 On the basis of these results, the COG-STS adopted VAC/VI as the new backbone for therapy for patients with intermediate-risk disease in the ongoing study ARST1431.In a study published in Cancer, 8 Casey and investigators of the COG-STS report increased local failure rates in patients with intermediate-risk rhabdomyosarcoma enrolled in ARST0531. Eligibility criteria for this trial included a diagnosis of nonmetastatic alveolar rhabdomyosarcoma or incompletely resected embryonal rhabdomyosarcoma arising at unfavorable sites (stage 2/3, group III). Chemotherapy consisted of VAC at a dose of 1.2 g/m 2 or VAC alternating with VI. Local control started at week 4, and radiation therapy (RT) doses were tailored to the volume of the residual tumor. Patients with node-negative group I/II alveolar tumors received 36 Gy, whereas thos...

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Outcome after surgical resection of recurrent rhabdomyosarcoma

Cited by 41 publications

References 15 publications

Increased local failure for patients with intermediate‐risk rhabdomyosarcoma on ARST0531: A report from the Children's Oncology Group

Increased local failure for patients with intermediate‐risk rhabdomyosarcoma on ARST0531: A report from the Children's Oncology Group

Comparative study of FDG PET/CT and conventional imaging in the staging of rhabdomyosarcoma

Optimal dosing of cyclophosphamide in rhabdomyosarcoma: It's complicated

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