Local failure in parameningeal rhabdomyosarcoma correlates with poor response to induction chemotherapy

Matthew M. Ladra, Henry C. Mandeville, Andrzej Niemierko, Timothy P. Padera, Alison M. Friedmann, Shannon M. Macdonald, David Ebb, Yen Lin Chen, Nancy J. Tarbell, Torunn I. Yock

Research output: Contribution to journalArticlepeer-review

Abstract

Background Local control remains a challenge in pediatric parameningeal rhabdomyosarcoma (PM-RMS), and survival after local failure (LF) is poor. Identifying patients with a high risk of LF is of great interest to clinicians. In this study, we examined whether tumor response to induction chemotherapy (CT) could predict LF in embryonal PM-RMS. Methods We identified 24 patients with embryonal PM-RMS, age 2 to 18 years, with complete magnetic resonance imaging and gross residual disease after surgical resection. All patients received proton radiation therapy (RT), median dose 50.4 GyRBE (50.4-55.8 GyRBE). Tumor size was measured before initial CT and before RT. Results With a median follow-up time of 4.1 years for survivors, LF was seen in 9 patients (37.5%). The median time from the initiation of CT to the start of RT was 4.8 weeks. Patients with LF had a similar initial (pre-CT) tumor volume compared with patients with local controlled (LC) (54 cm3 vs 43 cm3, P=.9) but a greater median volume before RT (pre-RT) (40 cm3 vs 7 cm3, P=.009) and a smaller median relative percent volume reduction (RPVR) in tumor size (0.4% vs 78%, P<.001). Older age (P=.05), larger pre-RT tumor volume (P=.03), and smaller RPVR (P=.003) were significantly associated with actuarial LF on univariate Cox analysis. Conclusions Poor response to induction CT appears to be associated with an increased risk of LF in pediatric embryonal PM-RMS.

Original languageEnglish (US)
Pages (from-to)358-367
Number of pages10
JournalInternational Journal of Radiation Oncology Biology Physics
Volume92
Issue number2
DOIs
StatePublished - Jun 1 2015
Externally publishedYes

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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