Daniel V Wakefield1, Bree R Eaton2, Austin P H Dove3, Chih-Yang Hsu4, Thomas E Merchant4, Alberto Pappo5, Andrew M Davidoff6, Natia Esiashvili2, Matthew J Krasin4, John T Lucas7. 1. University of Tennessee West Cancer Center, Department of Radiation Oncology, Germantown, USA. 2. Emory University Winship Cancer Institute, Department of Radiation Oncology, Atlanta, USA. 3. University of Tennessee, College of Medicine, Memphis, USA. 4. St. Jude Children's Research Hospital, Department of Radiation Oncology, Memphis, USA. 5. St. Jude Children's Research Hospital, Department of Pediatric Oncology, Memphis, USA. 6. St. Jude Children's Research Hospital, Department of Surgery, Memphis, USA. 7. St. Jude Children's Research Hospital, Department of Radiation Oncology, Memphis, USA. Electronic address: john.lucas@stjude.org.
Abstract
BACKGROUND AND PURPOSE: Limited data exist detailing the role of salvage reirradiation following local-regional recurrence (LR) in previously irradiated pediatric patients with rhabdomyosarcoma (RMS). MATERIALS AND METHODS: We evaluated outcomes and prognostic factors in a multi-institutional cohort of 23 patients with LR-only (N = 19) or LR with distant failure (N = 4) RMS managed with (N = 12) or without (N = 11) re-irradiation who were treated from 1996 to 2012. RESULTS: At a median follow-up of 4.6 years from LR, 7 (30%) patients were alive and 5 (22%) had no evidence of disease. Median OS and PFS from LR were 19.3 and 16.9 months, respectively. LFFS and DFFS at 3 years from relapse were 54% and 56%, respectively. Salvage re-irradiation occurred in 12 (52%) patients, with 9 (75%) receiving resection before re-irradiation. Patients classified as low-risk at diagnosis with favorable primary tumor location had improved 3-year PFS 80% (95% CI 51.6-100%) vs. 47.1% (95% CI 27.3-81.2%), p = 0.066], and OS 80% [(95% CI 22.4-100%) vs. 47.1% (95% CI 27.3-81.3%), p = 0.051] following LR. Median LFFS and OS in unirradiated vs. re-irradiated patients was 12.4 vs. 19.6 (p = 0.1) and 18.8 vs. 26.1 months (p = 0.46). No patients experienced ≥grade 4 acute toxicity from re-irradiation. LR failure was a component of cancer-related death in 60% vs. 40% of the unirradiated and re-irradiated group (p = 0.02). CONCLUSION: Salvage re-irradiation appears tolerable with acceptable morbidity and may reduce the risk of subsequent LR as a component of death in patients with LR RMS.
BACKGROUND AND PURPOSE: Limited data exist detailing the role of salvage reirradiation following local-regional recurrence (LR) in previously irradiated pediatric patients with rhabdomyosarcoma (RMS). MATERIALS AND METHODS: We evaluated outcomes and prognostic factors in a multi-institutional cohort of 23 patients with LR-only (N = 19) or LR with distant failure (N = 4) RMS managed with (N = 12) or without (N = 11) re-irradiation who were treated from 1996 to 2012. RESULTS: At a median follow-up of 4.6 years from LR, 7 (30%) patients were alive and 5 (22%) had no evidence of disease. Median OS and PFS from LR were 19.3 and 16.9 months, respectively. LFFS and DFFS at 3 years from relapse were 54% and 56%, respectively. Salvage re-irradiation occurred in 12 (52%) patients, with 9 (75%) receiving resection before re-irradiation. Patients classified as low-risk at diagnosis with favorable primary tumor location had improved 3-year PFS 80% (95% CI 51.6-100%) vs. 47.1% (95% CI 27.3-81.2%), p = 0.066], and OS 80% [(95% CI 22.4-100%) vs. 47.1% (95% CI 27.3-81.3%), p = 0.051] following LR. Median LFFS and OS in unirradiated vs. re-irradiated patients was 12.4 vs. 19.6 (p = 0.1) and 18.8 vs. 26.1 months (p = 0.46). No patients experienced ≥grade 4 acute toxicity from re-irradiation. LR failure was a component of cancer-related death in 60% vs. 40% of the unirradiated and re-irradiated group (p = 0.02). CONCLUSION: Salvage re-irradiation appears tolerable with acceptable morbidity and may reduce the risk of subsequent LR as a component of death in patients with LR RMS.
Authors: R B Raney; J R Anderson; F G Barr; S S Donaldson; A S Pappo; S J Qualman; E S Wiener; H M Maurer; W M Crist Journal: J Pediatr Hematol Oncol Date: 2001-05 Impact factor: 1.289
Authors: W M Crist; J R Anderson; J L Meza; C Fryer; R B Raney; F B Ruymann; J Breneman; S J Qualman; E Wiener; M Wharam; T Lobe; B Webber; H M Maurer; S S Donaldson Journal: J Clin Oncol Date: 2001-06-15 Impact factor: 44.544
Authors: Avani Dholakia Rao; Qinyu Chen; Ralph P Ermoian; Sara R Alcorn; Maria Luisa S Figueiredo; Michael J Chen; Karin Dieckmann; Shannon M MacDonald; Matthew M Ladra; Daria Kobyzeva; Alexey V Nechesnyuk; Kristina Nilsson; Eric C Ford; Brian A Winey; Rosangela C Villar; Stephanie A Terezakis Journal: Pediatr Blood Cancer Date: 2017-07-11 Impact factor: 3.167
Authors: Patrick Van Winkle; Anne Angiolillo; Mark Krailo; Ying-Kuen Cheung; Barry Anderson; Virginia Davenport; Gregory Reaman; Mitchell S Cairo Journal: Pediatr Blood Cancer Date: 2005-04 Impact factor: 3.167
Authors: J P Neglia; A T Meadows; L L Robison; T H Kim; W A Newton; F B Ruymann; H N Sather; G D Hammond Journal: N Engl J Med Date: 1991-11-07 Impact factor: 91.245
Authors: Lois B Travis; Deirdre A Hill; Graça M Dores; Mary Gospodarowicz; Flora E van Leeuwen; Eric Holowaty; Bengt Glimelius; Michael Andersson; Tom Wiklund; Charles F Lynch; Mars B Van't Veer; Ingrid Glimelius; Hans Storm; Eero Pukkala; Marilyn Stovall; Rochelle Curtis; John D Boice; Ethel Gilbert Journal: JAMA Date: 2003-07-23 Impact factor: 56.272
Authors: Brenda J Weigel; Elizabeth Lyden; James R Anderson; William H Meyer; David M Parham; David A Rodeberg; Jeff M Michalski; Douglas S Hawkins; Carola A S Arndt Journal: J Clin Oncol Date: 2015-10-26 Impact factor: 44.544
Authors: Rochelle Bagatell; Robin Norris; Ashish M Ingle; Charlotte Ahern; Stephan Voss; Elizabeth Fox; Anthony R Little; Brenda J Weigel; Peter C Adamson; Susan Blaney Journal: Pediatr Blood Cancer Date: 2013-11-19 Impact factor: 3.167
Authors: Dana L Casey; Yueh-Yun Chi; Sarah S Donaldson; Douglas S Hawkins; Jing Tian; Carola A Arndt; David A Rodeberg; Jonathan C Routh; Timothy B Lautz; Abha A Gupta; Torunn I Yock; Suzanne L Wolden Journal: Cancer Date: 2019-06-07 Impact factor: 6.860