Stephanie Fetzko1, Adriana Fonseca2, Mary Frances Wedekind3, Abha A Gupta2, Bhuvana A Setty3, Jeremy Schraw1, Philip J Lupo1, Robert P Guillerman4, Anish A Butala5, Heidi Russell1,6, Lauren Nicholls1, David Walterhouse5, Douglas S Hawkins7, Mehmet F Okcu1. 1. Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital. 2. Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada. 3. Division of Hematology/Oncology/BMT, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH. 4. Department of Radiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX. 5. Division of Hematology/Oncology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 6. Center for Medical Ethics and Health Policy, Baylor College of Medicine. 7. Division of Hematology/Oncology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA.
Abstract
BACKGROUND: We investigated whether surveillance imaging had an impact on post-relapse survival in patients with rhabdomyosarcoma (RMS). We hypothesized that relapse detected by imaging (group IM) would be associated with longer survival compared with relapse detected with a clinical sign or symptom (group SS). MATERIALS AND METHODS: We performed an observational multi-institutional study in 127 patients with relapsed RMS comparing overall survival (OS) after relapse using Kaplan-Meier and Cox proportional hazards analyses. RESULTS: Relapse was detected in 60 (47%) group IM and 67 (53%) SS patients. Median follow-up in survivors was 4 years (range 1.0 to 16.7 y). Four-year OS rates were similar between group IM (28%, 95% confidence interval [CI]: 14%-40%) and SS (21%, 95% CI: 11%-31%) ( P =0.14). In multivariable analyses accounting for institution, age at diagnosis, time to relapse, risk group at diagnosis, and primary site, not receiving chemotherapy (hazard ratio [HR]: 6.8, 95% CI: 2.8-16.6), radiation (HR: 3, 95% CI: 1.7-5.3), or surgery (HR: 2.8, 95% CI: 1.6-4.8) after relapse were independently associated with poor OS. CONCLUSION: These results on whether surveillance imaging provides survival benefit in patients with relapsed RMS are inconclusive. Larger studies are needed to justify current surveillance recommendations. Chemotherapy, radiotherapy and surgery to treat recurrence prolong OS.
BACKGROUND: We investigated whether surveillance imaging had an impact on post-relapse survival in patients with rhabdomyosarcoma (RMS). We hypothesized that relapse detected by imaging (group IM) would be associated with longer survival compared with relapse detected with a clinical sign or symptom (group SS). MATERIALS AND METHODS: We performed an observational multi-institutional study in 127 patients with relapsed RMS comparing overall survival (OS) after relapse using Kaplan-Meier and Cox proportional hazards analyses. RESULTS: Relapse was detected in 60 (47%) group IM and 67 (53%) SS patients. Median follow-up in survivors was 4 years (range 1.0 to 16.7 y). Four-year OS rates were similar between group IM (28%, 95% confidence interval [CI]: 14%-40%) and SS (21%, 95% CI: 11%-31%) ( P =0.14). In multivariable analyses accounting for institution, age at diagnosis, time to relapse, risk group at diagnosis, and primary site, not receiving chemotherapy (hazard ratio [HR]: 6.8, 95% CI: 2.8-16.6), radiation (HR: 3, 95% CI: 1.7-5.3), or surgery (HR: 2.8, 95% CI: 1.6-4.8) after relapse were independently associated with poor OS. CONCLUSION: These results on whether surveillance imaging provides survival benefit in patients with relapsed RMS are inconclusive. Larger studies are needed to justify current surveillance recommendations. Chemotherapy, radiotherapy and surgery to treat recurrence prolong OS.
Authors: Anja E Eisenhardt; Zacharias Brugger; Ute Lausch; Jurij Kiefer; Johannes Zeller; Alexander Runkel; Adrian Schmid; Peter Bronsert; Julius Wehrle; Andreas Leithner; Bernadette Liegl-Atzwanger; Riccardo E Giunta; Steffen U Eisenhardt; David Braig Journal: Cancers (Basel) Date: 2022-04-21 Impact factor: 6.575
Authors: Markus G Seidel; Karl Kashofer; Tina Moser; Andrea Thueringer; Bernadette Liegl-Atzwanger; Andreas Leithner; Joanna Szkandera; Martin Benesch; Amin El-Heliebi; Ellen Heitzer Journal: Front Pediatr Date: 2022-08-15 Impact factor: 3.569