Local control with reduced-dose radiotherapy for low-risk rhabdomyosarcoma

A report from the Children'S Oncology Group D9602 study

John Breneman, Jane L Meza, Sarah S. Donaldson, R. Beverly Raney, Suzanne Wolden, Jeff Michalski, Fran Laurie, David A. Rodeberg, William Meyer, David Walterhouse, Douglas S. Hawkins

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Abstract

Purpose: To analyze the effect of reduced-dose radiotherapy on local control in children with low-risk rhabdomyosarcoma (RMS) treated in the Children's Oncology Group D9602 study. Methods and Materials: Patients with low-risk RMS were nonrandomly assigned to receive radiotherapy doses dependent on the completeness of surgical resection of the primary tumor (clinical group) and the presence of involved regional lymph nodes. After resection, most patients with microscopic residual and uninvolved nodes received 36 Gy, those with involved nodes received 41.4 to 50.4 Gy, and those with orbital primary tumors received 45 Gy. All patients received vincristine and dactinomycin, with cyclophosphamide added for patient subsets with a higher risk of relapse in Intergroup Rhabdomyosarcoma Study Group III and IV studies. Results: Three hundred forty-two patients were eligible for analysis; 172 received radiotherapy as part of their treatment. The cumulative incidence of local/regional failure was 15% in patients with microscopic involved margins when cyclophosphamide was not part of the treatment regimen and 0% when cyclophosphamide was included. The cumulative incidence of local/regional failure was 14% in patients with orbital tumors. Protocol-specified omission of radiotherapy in girls with Group IIA vaginal tumors (n = 5) resulted in three failures for this group. Conclusions: In comparison with Intergroup Rhabdomyosarcoma Study Group III and IV results, reduced-dose radiotherapy does not compromise local control for patients with microscopic tumor after surgical resection or with orbital primary tumors when cyclophosphamide is added to the treatment program. Girls with unresected nonbladder genitourinary tumors require radiotherapy for postsurgical residual tumor for optimal local control to be achieved.

Original languageEnglish (US)
Pages (from-to)720-726
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume83
Issue number2
DOIs
StatePublished - Jun 1 2012

Fingerprint

Rhabdomyosarcoma
radiation therapy
Radiotherapy
tumors
dosage
Cyclophosphamide
Neoplasms
orbitals
incidence
lymphatic system
Incidence
Residual Neoplasm
Dactinomycin
Vincristine
completeness
set theory
margins
Therapeutics
Lymph Nodes
Recurrence

Keywords

  • Local control
  • Low risk
  • Radiotherapy
  • Rhabdomyosarcoma

ASJC Scopus subject areas

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

Cite this

Local control with reduced-dose radiotherapy for low-risk rhabdomyosarcoma : A report from the Children'S Oncology Group D9602 study. / Breneman, John; Meza, Jane L; Donaldson, Sarah S.; Raney, R. Beverly; Wolden, Suzanne; Michalski, Jeff; Laurie, Fran; Rodeberg, David A.; Meyer, William; Walterhouse, David; Hawkins, Douglas S.

In: International Journal of Radiation Oncology Biology Physics, Vol. 83, No. 2, 01.06.2012, p. 720-726.

Research output: Contribution to journalArticle

Breneman, J, Meza, JL, Donaldson, SS, Raney, RB, Wolden, S, Michalski, J, Laurie, F, Rodeberg, DA, Meyer, W, Walterhouse, D & Hawkins, DS 2012, 'Local control with reduced-dose radiotherapy for low-risk rhabdomyosarcoma: A report from the Children'S Oncology Group D9602 study', International Journal of Radiation Oncology Biology Physics, vol. 83, no. 2, pp. 720-726. https://doi.org/10.1016/j.ijrobp.2011.06.2011
Breneman, John ; Meza, Jane L ; Donaldson, Sarah S. ; Raney, R. Beverly ; Wolden, Suzanne ; Michalski, Jeff ; Laurie, Fran ; Rodeberg, David A. ; Meyer, William ; Walterhouse, David ; Hawkins, Douglas S. / Local control with reduced-dose radiotherapy for low-risk rhabdomyosarcoma : A report from the Children'S Oncology Group D9602 study. In: International Journal of Radiation Oncology Biology Physics. 2012 ; Vol. 83, No. 2. pp. 720-726.
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abstract = "Purpose: To analyze the effect of reduced-dose radiotherapy on local control in children with low-risk rhabdomyosarcoma (RMS) treated in the Children's Oncology Group D9602 study. Methods and Materials: Patients with low-risk RMS were nonrandomly assigned to receive radiotherapy doses dependent on the completeness of surgical resection of the primary tumor (clinical group) and the presence of involved regional lymph nodes. After resection, most patients with microscopic residual and uninvolved nodes received 36 Gy, those with involved nodes received 41.4 to 50.4 Gy, and those with orbital primary tumors received 45 Gy. All patients received vincristine and dactinomycin, with cyclophosphamide added for patient subsets with a higher risk of relapse in Intergroup Rhabdomyosarcoma Study Group III and IV studies. Results: Three hundred forty-two patients were eligible for analysis; 172 received radiotherapy as part of their treatment. The cumulative incidence of local/regional failure was 15{\%} in patients with microscopic involved margins when cyclophosphamide was not part of the treatment regimen and 0{\%} when cyclophosphamide was included. The cumulative incidence of local/regional failure was 14{\%} in patients with orbital tumors. Protocol-specified omission of radiotherapy in girls with Group IIA vaginal tumors (n = 5) resulted in three failures for this group. Conclusions: In comparison with Intergroup Rhabdomyosarcoma Study Group III and IV results, reduced-dose radiotherapy does not compromise local control for patients with microscopic tumor after surgical resection or with orbital primary tumors when cyclophosphamide is added to the treatment program. Girls with unresected nonbladder genitourinary tumors require radiotherapy for postsurgical residual tumor for optimal local control to be achieved.",
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AU - Wolden, Suzanne

AU - Michalski, Jeff

AU - Laurie, Fran

AU - Rodeberg, David A.

AU - Meyer, William

AU - Walterhouse, David

AU - Hawkins, Douglas S.

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