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Late Effects of Pelvic Rhabdomyosarcoma and Its Treatment in Female Survivors

From the Departments of Hematology-Oncology, Biostatistics, and Radiological Sciences (Radiation Oncology Division), St Jude Children's Research Hospital; and the Department of Pediatrics, The University of Tennessee College of Medicine, Memphis, TN

Address reprint requests to Sheri L. Spunt, MD, Department of Hematology-Oncology, St Jude Children's Research Hospital, 332 N Lauderdale St, Memphis, TN 38105-2794; e-mail: sheri.spunt{at}stjude.org

PURPOSE: To document the spectrum and severity of late effects in female survivors of pelvic rhabdomyosarcoma.

PATIENTS AND METHODS: We reviewed the demographic, diagnostic, treatment, and outcome data of the 26 females treated for pelvic rhabdomyosarcoma at our institution between March 1962 and December 1996 who survived free of disease for 5 or more years. Adverse effects that occurred 5 or more years after diagnosis were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0.

RESULTS: The most common tumor sites were vagina (n = 7), pelvis/retroperitoneum (n = 6), and bladder (n = 4). All patients received chemotherapy (alkylating agent, n = 23; doxorubicin, n = 16); 22 received radiotherapy (median dose, 46 Gy). Median follow-up of the 23 survivors was 20.3 years. Late effects occurred in 24 patients, 23 of whom had grade 3/4 late effects (median grade 3/4 late effects per patient, three; range, zero to 14). Fourteen patients (54%) required surgery for late complications. The 22 patients who had received radiotherapy had a greater median number of late effects per patient than did the remaining four (9.5 v one; P = .002). The median number of late effects per patient was higher in the 12 patients treated during or after 1984 than in the 14 treated earlier (12.5 v 6.5; P = .041).

CONCLUSION: The burden of late effects in girls treated for pelvic rhabdomyosarcoma is significant and does not seem to be diminishing with advances in treatment. Prospective studies are needed to better assess the impact of these late effects on quality of life and functional outcome, and to refine the treatment approach to pelvic rhabdomyosarcoma.

Supported by Grants No. CA 23099 and P30 CA 21765 from the National Institutes of Health and by the American Lebanese Syrian Associated Charities.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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