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Indications for Radiotherapy and Chemotherapy After Complete Resection in Rhabdomyosarcoma: A Report From the Intergroup Rhabdomyosarcoma Studies I to III

From the Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN; Department of Radiation Oncology, University Hospital of Cincinnati, Cincinnati, and Department of Laboratory Medicine, Columbus Children's Hospital, Columbus, OH; Department of Radiation Oncology, Johns Hopkins Oncology Center, Baltimore, MD; Department of Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA; and Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA.

Address reprint requests to Suzanne Wolden, MD, Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021.

PURPOSE: To evaluate the outcome of patients with rhabdomyosarcoma (RMS) treated with complete surgical resection and multiagent chemotherapy, with or without local radiotherapy (RT).

PATIENTS AND METHODS: Four hundred thirty-nine patients with completely resected (ie, group I) RMS were further treated with chemotherapy (vincristine and actinomycin D ± cyclophosphamide, doxorubicin, and cisplatin) on Intergroup Rhabdomyosarcoma Studies (IRS) I to III between 1972 and 1991. Eighty-three patients (19%) also received local RT as a component of initial treatment.

RESULTS: Eighty-six patients relapsed (10-year failure-free survival [FFS] 79%, overall survival 89%). Six percent of failure sites were local, 6% were regional, and 7% were distant. Poor prognostic factors were tumor size greater than 5 cm, alveolar or undifferentiated histology, primary tumor sites other than genitourinary, and treatment on IRS-I or II. For patients with embryonal RMS who were treated with RT, there was a trend for improved FFS but no difference in overall survival. On IRS-I and II, patients with alveolar or undifferentiated sarcoma who received RT compared with those who did not receive RT had greater 10-year FFS rates (73% v 44%, respectively; P = .03) and overall survival rates (82% v 52%, respectively; (P = .02). Such patients who received RT on IRS III also benefited more than those who did not receive RT (10-year FFS, 95% v 69%; P = .01; overall survival, 95% v 86%; P = .23).

CONCLUSION: Patients with group I embryonal RMS have an excellent prognosis when treated with adjuvant multiagent chemotherapy without RT. Patients with alveolar RMS or undifferentiated sarcoma fare worse; however, FFS and overall survival are substantially improved when RT is added to multiagent chemotherapy (IRS-I and II). The best outcome occurred in IRS-III, when RT was used in conjunction with intensified chemotherapy.

Presented in part at the American Society of Therapeutic Radiology and Oncology Meeting, Phoenix, AZ, October 28, 1998.

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