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Assessment of Response to Induction Therapy and Its Influence on 5-Year Failure-Free Survival in Group III Rhabdomyosarcoma: The Intergroup Rhabdomyosarcoma Study-IV Experience—A Report From the Soft Tissue Sarcoma Committee of the Children's Oncology Group

Megan Burke, James R. Anderson, Simon C. Kao, David Rodeberg, Stephen J. Qualman, Suzanne L. Wolden, William H. Meyer, Philip P. Breitfeld

From the Children's Hospital Cleveland Clinic, Cleveland; Children's Hospital, Columbus, OH; University of Nebraska Medical Center, Omaha, NE; University of Iowa College of Medicine, Iowa City, IA; Children's Hospital, Pittsburgh, PA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of Oklahoma Medical Science Center, Oklahoma City, OK; Duke University Medical Center; EMD Pharmaceuticals Inc, Durham, NC; and the Children's Oncology Group, Arcadia, CA

Address reprint requests to Philip P. Breitfeld, MD, Pediatric Hematology-Oncology, Box 2916, Duke University Medical Center, Durham, NC 27710; e-mail: breit003{at}mc.duke.edu

Purpose Initial response to induction chemotherapy predicts failure-free survival (FFS) in osteosarcoma and Ewing's sarcoma. For Intergroup Rhabdomyosarcoma Study (IRS) IV patients with group III rhabdomyosarcoma, we assessed whether reported response assessed by anatomic imaging at week 8 predicted FFS.

Patients and Methods We studied 444 group III patients who received induction therapy, had response assessed at week 8 by anatomic imaging, and continued with protocol therapy. Induction chemotherapy was generally followed by radiation therapy (RT) starting after week 9. Response to induction therapy was determined at weeks 0 and 8. Local institutions coded response.

Results Response rate for the entire cohort at week 8 was 77% (95% CI, 73% to 81%; complete response [CR], 21%; partial response [PR], 56%) but response had no influence on FFS (P = .57). Two hundred seventy-two patients received standard-timing RT at week 9 and thus only chemotherapy during induction. Response rate was 81% (95% CI, 76% to 86%; CR, 22%; PR, 59%). In these patients, response did not influence FFS except for those with alveolar histology. One hundred thirty-two other patients received chemotherapy and RT during induction (up-front RT). Response rate was 65% (95% CI, 57% to 73%; CR, 12%; PR, 53%), but response had no influence on FFS (P = .69). Forty patients received no RT at all (protocol violation) and response to induction therapy had no effect on FFS.

Conclusion In IRS-IV, response rate to induction therapy was 77% in group III patients, was independent of histology, and had no influence on FFS overall.

Supported by Grants No. IRS NIH U10 CA24507 and IRS NIH U10 CA24507, COG Statistics and Data Center Grant No. NIH U10 CA098413, and COG Grant No. CA 98543. A complete list of grant support for research conducted by CCG and POG before initiation of the COG grant in 2003 is available online at: http://www.childrensoncologygroup.org/admin/grantinfo.htm.

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

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