Local control with reduced-dose radiotherapy for low-risk rhabdomyosarcoma: a report from the Children's Oncology Group D9602 study.

Abstract

PURPOSE:

To analyze the effect of reduced-dose radiotherapy on local control in children with low-risk rhabdomyosarcoma (RMS) treated in the Children's Oncology Group D9602 study.

METHODS AND MATERIALS:

Patients with low-risk RMS were nonrandomly assigned to receive radiotherapy doses dependent on the completeness of surgical resection of the primary tumor (clinical group) and the presence of involved regional lymph nodes. After resection, most patients with microscopic residual and uninvolved nodes received 36 Gy, those with involved nodes received 41.4 to 50.4 Gy, and those with orbital primary tumors received 45 Gy. All patients received vincristine and dactinomycin, with cyclophosphamide added for patient subsets with a higher risk of relapse in Intergroup Rhabdomyosarcoma Study Group III and IV studies.

RESULTS:

Three hundred forty-two patients were eligible for analysis; 172 received radiotherapy as part of their treatment. The cumulative incidence of local/regional failure was 15% in patients with microscopic involved margins when cyclophosphamide was not part of the treatment regimen and 0% when cyclophosphamide was included. The cumulative incidence of local/regional failure was 14% in patients with orbital tumors. Protocol-specified omission of radiotherapy in girls with Group IIA vaginal tumors (n = 5) resulted in three failures for this group.

CONCLUSIONS:

In comparison with Intergroup Rhabdomyosarcoma Study Group III and IV results, reduced-dose radiotherapy does not compromise local control for patients with microscopic tumor after surgical resection or with orbital primary tumors when cyclophosphamide is added to the treatment program. Girls with unresected nonbladder genitourinary tumors require radiotherapy for postsurgical residual tumor for optimal local control to be achieved.

• Authors: John Breneman, Jane Meza, Sarah S Donaldson, R Beverly Raney, Suzanne Wolden, Jeff Michalski, Fran Laurie, David A Rodeberg, William Meyer, David Walterhouse, Douglas S Hawkins
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 83 Issue 2 Pg. 720-6 (Jun 01 2012) ISSN: 1879-355X [Electronic] United States
• PMID: 22104356 (Publication Type: Clinical Trial, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Age Factors
• Child
• Child, Preschool
• Combined Modality Therapy (methods)
• Drug Administration Schedule
• Female
• Head and Neck Neoplasms (drug therapy, pathology, radiotherapy, surgery)
• Humans
• Infant
• Infant, Newborn
• Lymph Node Excision
• Lymphatic Metastasis
• Male
• Neoplasm, Residual
• Orbital Neoplasms (drug therapy, pathology, radiotherapy, surgery)
• Prostatic Neoplasms (drug therapy, pathology, radiotherapy, surgery)
• Quality Control
• Radiotherapy Dosage (standards)
• Rhabdomyosarcoma, Embryonal (drug therapy, pathology, radiotherapy, secondary, surgery)
• Second-Look Surgery
• Treatment Failure
• Tumor Burden
• Urogenital Neoplasms (drug therapy, pathology, radiotherapy, surgery)
• Young Adult