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

Matthew 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 journalArticle

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

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Induction Chemotherapy
Rhabdomyosarcoma
chemotherapy
induction
Radiotherapy
radiation therapy
Embryonal Rhabdomyosarcoma
tumors
Tumor Burden
Drug Therapy
Proton Therapy
Pediatrics
Neoplasms
Survivors
magnetic resonance
Magnetic Resonance Imaging
Survival
dosage
protons

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research
  • Medicine(all)

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Local failure in parameningeal rhabdomyosarcoma correlates with poor response to induction chemotherapy. / Ladra, Matthew; Mandeville, Henry C.; Niemierko, Andrzej; Padera, Timothy P.; Friedmann, Alison M.; Macdonald, Shannon M.; Ebb, David; Chen, Yen Lin; Tarbell, Nancy J.; Yock, Torunn I.

In: International Journal of Radiation Oncology Biology Physics, Vol. 92, No. 2, 01.06.2015, p. 358-367.

Research output: Contribution to journalArticle

Ladra, M, Mandeville, HC, Niemierko, A, Padera, TP, Friedmann, AM, Macdonald, SM, Ebb, D, Chen, YL, Tarbell, NJ & Yock, TI 2015, 'Local failure in parameningeal rhabdomyosarcoma correlates with poor response to induction chemotherapy', International Journal of Radiation Oncology Biology Physics, vol. 92, no. 2, pp. 358-367. https://doi.org/10.1016/j.ijrobp.2015.01.049
Ladra, Matthew ; Mandeville, Henry C. ; Niemierko, Andrzej ; Padera, Timothy P. ; Friedmann, Alison M. ; Macdonald, Shannon M. ; Ebb, David ; Chen, Yen Lin ; Tarbell, Nancy J. ; Yock, Torunn I. / Local failure in parameningeal rhabdomyosarcoma correlates with poor response to induction chemotherapy. In: International Journal of Radiation Oncology Biology Physics. 2015 ; Vol. 92, No. 2. pp. 358-367.
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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.",
author = "Matthew Ladra and Mandeville, {Henry C.} and Andrzej Niemierko and Padera, {Timothy P.} and Friedmann, {Alison M.} and Macdonald, {Shannon M.} and David Ebb and Chen, {Yen Lin} and Tarbell, {Nancy J.} and Yock, {Torunn I.}",
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T1 - Local failure in parameningeal rhabdomyosarcoma correlates with poor response to induction chemotherapy

AU - Ladra, Matthew

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.

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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