Radiation therapy dose escalation failed to improve local control for intermediate-risk rhabdomyosarcoma on ARST1431: A report from the Children's Oncology Group Journal Article
| Authors: | Jackson, C. B.; Xue, W.; Gupta, A. A.; Qumseya, A.; Dasgupta, R.; Hill-Kayser, C. E.; Spalding, A. C.; Rodeberg, D. A.; Harrison, D. J.; Venkatramani, R.; Wolden, S. L. |
| Article Title: | Radiation therapy dose escalation failed to improve local control for intermediate-risk rhabdomyosarcoma on ARST1431: A report from the Children's Oncology Group |
| Abstract: | Purpose: To evaluate local failure (LF) rates for patients with intermediate-risk rhabdomyosarcoma treated on the Children's Oncology Group ARST1431 clinical trial, the first and largest international, phase 3 randomized study to use FOXO1 fusion status for risk stratification. To improve local control, radiation therapy (RT) dose was increased to 59.4 Gy for patients with tumors >5 cm and residual gross disease at the time of RT. Methods and Materials: For the 297 patients included, LF was defined as progression or relapse at the primary site. The rate of LF was calculated 3-years after enrollment. Results: LF for group 3, FOXO1 fusion-positive patients (n = 58) compared with fusion-negative patients (n = 175) was 10.7% versus 21.5%, respectively (P = .08). The LF rate for patients with tumors >5 cm at diagnosis (n = 180; 24.4%) was higher than that of patients with tumors ≤5 cm at diagnosis (n = 117; 9.8%), P = .002. The risk of LF for patients who received proton (n = 99) versus photon RT (n = 126) was not different (16.1% vs 15.9%, P = .8). For the 75 patients with tumors >5 cm at diagnosis and gross disease at the time of RT, the boost to 59.4 Gy did not improve the 3-year LF rate compared with that of patients who did not receive the boost (29.7% vs 16.1%, P = .6). For patients with group 3/4 disease, those who underwent delayed primary excision (n = 72) had a lower LF rate compared with those who had RT alone (n = 151) (5.8% vs 19.7%, P < .01). Conclusions: On ARST1431, tumors >5 cm at diagnosis had poor local control despite dose escalation to 59.4 Gy. Proton and photon RT had equivalent local control. For select patients, delayed primary excision significantly improved local control. © 2025 Elsevier Inc. |
| Keywords: | clinical trial; radiotherapy; lung cancer; oncology; risk stratification; local control; rhabdomyosarcoma; disease control; diseases; local failure; failure rate; dose escalation; intermediate risks; methods and materials; photon radiation |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 123 |
| Issue: | 1 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Publication status: | Published |
| Date Published: | 2025-09-01 |
| Online Publication Date: | 2025-04-02 |
| Start Page: | 54 |
| End Page: | 62 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2025.03.038 |
| PUBMED: | 40185209 |
| PROVIDER: | scopus |
| PMCID: | PMC12353335 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Suzanne Wolden -- Source: Scopus |
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