TY - JOUR
T1 - Local failure in parameningeal rhabdomyosarcoma correlates with poor response to induction chemotherapy
AU - Ladra, Matthew M.
AU - Mandeville, Henry C.
AU - Niemierko, Andrzej
AU - Padera, Timothy P.
AU - Friedmann, Alison M.
AU - Macdonald, Shannon M.
AU - Ebb, David
AU - Chen, Yen Lin
AU - Tarbell, Nancy J.
AU - Yock, Torunn I.
N1 - Funding Information:
Supported by the Federal Share of program income earned by Massachusetts General Hospital on C06 CA059267 , Proton Therapy Research and Treatment Center.
Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.ijrobp.2015.01.049
DO - 10.1016/j.ijrobp.2015.01.049
M3 - Article
C2 - 25864172
AN - SCOPUS:84928938553
SN - 0360-3016
VL - 92
SP - 358
EP - 367
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 2
ER -