Indications for radiotherapy and chemotherapy after complete resection in rhabdomyosarcoma: A report from the Intergroup Rhabdomyosarcoma Studies I to III Journal Article


Authors: Wolden, S. L.; Anderson, J. R.; Crist, W. M.; Breneman, J. C.; Wharam, M. D. Jr; Wiener, E. S.; Qualman, S. J.; Donaldson, S. S.
Article Title: Indications for radiotherapy and chemotherapy after complete resection in rhabdomyosarcoma: A report from the Intergroup Rhabdomyosarcoma Studies I to III
Abstract: Purpose: To evaluate the outcome of patients with rhabdomyosarcoma (RMS) treated with complete surgical resection and multiagent chemotherapy, with or without local radiotherapy (RT). Patients and Methods: Four hundred thirty- nine patients with completely resected (ie, group I) RMS were further treated with chemotherapy (vincristine and actinomycin D ± cyclophosphamide, doxorubicin, and cisplatin) on Intergroup Rhabdomyosarcoma Studies (IRS) I to III between 1972 and 1991. Eighty-three patients (19%) also received local RT as a component of initial treatment. Results: Eighty-six patients relapsed (10-year failure-free survival [FFS] 79%, overall survival 89%). Six percent of failure sites were local, 6% were regional, and 7% were distant. Poor prognostic factors were tumor size greater than 5 cm, alveolar or undifferentiated histology, primary tumor sites other than genitourinary, and treatment on IRS-I or II. For patients with embryonal RMS who were treated with RT, there was a trend for improved FFS but no difference in overall survival. On IRS-I and II, patients with alveolar or undifferentiated sarcoma who received RT compared with those who did not receive RT had greater 10- year FFS rates (73% v 44%, respectively; P = .03) and overall survival rates (82% v 52%, respectively; (P = .02). Such patients who received RT on IRS III also benefited more than those who did not receive RT (10-year FFS, 95% v 69%; P = .01; overall survival, 95% v 86%; P = .23). Conclusion: Patients with group I embryonal RMS have an excellent prognosis when treated with adjuvant multiagent chemotherapy without RT. Patients with alveolar RMS or undifferentiated sarcoma fare worse; however, FFS and overall survival are substantially improved when RT is added to multiagent chemotherapy (IRS-I and II). The best outcome occurred in IRS-III, when RT was used in conjunction with intensified chemotherapy.
Keywords: cancer survival; child; treatment outcome; child, preschool; survival analysis; cancer surgery; survival rate; treatment failure; major clinical study; cisplatin; doxorubicin; cancer combination chemotherapy; cancer radiotherapy; combined modality therapy; treatment indication; antineoplastic combined chemotherapy protocols; cyclophosphamide; vincristine; clinical protocol; infant; dactinomycin; rhabdomyosarcoma; clinical trials; humans; prognosis; human; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 17
Issue: 11
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 1999-11-01
Start Page: 3468
End Page: 3475
Language: English
PUBMED: 10550144
PROVIDER: scopus
DOI: 10.1200/JCO.1999.17.11.3468
DOI/URL:
Notes: Article -- Export Date: 16 August 2016 -- Source: Scopus
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MSK Authors
  1. Suzanne L Wolden
    419 Wolden