TY - JOUR
T1 - A phase II trial evaluation selective use of altered radiation dose and fractionation in patients with unresectable rhabdomyosarcoma
AU - Regine, William F.
AU - Fontanesi, James
AU - Kumar, Parvesh
AU - Zeitzer, Kenneth
AU - Greenwald, Carol
AU - Bowman, Laura
AU - Shapiro, David N.
AU - Rao, Bhaskar N.
AU - Kun, Larry E.
N1 - Funding Information:
only) in the initial Intergroup Rhabdomyosarcoma Study (IRS) clinical staging system, can be expected to achieve long-term disease control with postoperative chemotherapy and selective use of radiation therapy (1, 7, 8, 12, 13, 18, 21, 27). Over 55% of children with RMS present with localized unresectable tumors (Group 3 in the IRS Acknowledgements--Supported in part by Cancer Center Support (CORE) Grant, P30 CA 21765, and the American Lebanese Syrian Associated Charities (ALSAC). The authors would like to thank Ms. Karen Dame for editorial advice and Ms. Sandra Gaither for manuscript preparation. Accepted for publication 16 August 1994.
PY - 1995/2/15
Y1 - 1995/2/15
N2 - Purpose: Between 1987 and 1991, 25 children with advanced rhabdomyosarcoma (20 with IRS Group 3 disease and 5 with Group 4 disease) were entered on a prospective study evaluating selective use of hyperfractionated irradiation (HFI) and reduced-dose conventionally fractionated irradiation (CFI), based on disease status following induction chemotherapy (ifosfamide or melphalan, followed by vincristine, adriamycin, and cyclophosphamide combination) with or without delayed surgery. Methods and Materials: Patients with gross disease following induction chemotherapy with or without delayed surgery, and whose primary tumor sites did not involve the central nervous system, received HFI (n = 12) at 1.1 Gy twice-a-day to 59.4-63.8 Gy total. Patients with parameningeal primaries and intracranial disease extension received HFI with initiation of therapy (n = 2). Those with microscopic disease following induction chemotherapy with or without delayed surgery (n = 11) received reduced-dose CFI to 40 Gy. Active follow-up ranges from 28-75 months (median = 43 months) with no patient lost to follow-up. Results: Eighteen patients (72%) are alive and without disease, including 8 of the children with gross residual disease postinduction therapy. The absolute 2-year continuous local tumor control rate is 86% for all patients. Among the 14 who received HFI, the absolute 2-year continuous local tumor control rate is 75% at 33 to 67 months (median = 38 months) postirradiation. Hyperfractionated irradiation was associated with expected enhancement of acute reactions, which all resolved with conservative medical management. Grade 4 or 5 acute toxicities were not seen. Significant late radiation morbidity has, thus far, been minimal and limited to Grade 1 and 2 events. Among the 11 who received reduced-dose CFI, the absolute 2-year continuous local tumor control rate is 100% at 25 to 70 months (median = 40 months) postirradiation. Conclusion: This limited experience suggests that HFI to a dose level of 60 Gy can be used selectively in children with advanced rhabdomyosarcoma left with gross disease following induction chemotherapy, with or without delayed surgery, with an apparent improvement in local control, and minimization of potential late radiation toxicity. Concurrently, those left with microscopic disease following therapy can be selectively treated with reduced-dose CFI with excellent local control.
AB - Purpose: Between 1987 and 1991, 25 children with advanced rhabdomyosarcoma (20 with IRS Group 3 disease and 5 with Group 4 disease) were entered on a prospective study evaluating selective use of hyperfractionated irradiation (HFI) and reduced-dose conventionally fractionated irradiation (CFI), based on disease status following induction chemotherapy (ifosfamide or melphalan, followed by vincristine, adriamycin, and cyclophosphamide combination) with or without delayed surgery. Methods and Materials: Patients with gross disease following induction chemotherapy with or without delayed surgery, and whose primary tumor sites did not involve the central nervous system, received HFI (n = 12) at 1.1 Gy twice-a-day to 59.4-63.8 Gy total. Patients with parameningeal primaries and intracranial disease extension received HFI with initiation of therapy (n = 2). Those with microscopic disease following induction chemotherapy with or without delayed surgery (n = 11) received reduced-dose CFI to 40 Gy. Active follow-up ranges from 28-75 months (median = 43 months) with no patient lost to follow-up. Results: Eighteen patients (72%) are alive and without disease, including 8 of the children with gross residual disease postinduction therapy. The absolute 2-year continuous local tumor control rate is 86% for all patients. Among the 14 who received HFI, the absolute 2-year continuous local tumor control rate is 75% at 33 to 67 months (median = 38 months) postirradiation. Hyperfractionated irradiation was associated with expected enhancement of acute reactions, which all resolved with conservative medical management. Grade 4 or 5 acute toxicities were not seen. Significant late radiation morbidity has, thus far, been minimal and limited to Grade 1 and 2 events. Among the 11 who received reduced-dose CFI, the absolute 2-year continuous local tumor control rate is 100% at 25 to 70 months (median = 40 months) postirradiation. Conclusion: This limited experience suggests that HFI to a dose level of 60 Gy can be used selectively in children with advanced rhabdomyosarcoma left with gross disease following induction chemotherapy, with or without delayed surgery, with an apparent improvement in local control, and minimization of potential late radiation toxicity. Concurrently, those left with microscopic disease following therapy can be selectively treated with reduced-dose CFI with excellent local control.
KW - Chemotherapy
KW - Radiation fractionation.
KW - Rhabdomyosarcoma
KW - Surgery
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U2 - 10.1016/0360-3016(94)00459-5
DO - 10.1016/0360-3016(94)00459-5
M3 - Article
C2 - 7860391
AN - SCOPUS:0028923709
SN - 0360-3016
VL - 31
SP - 799
EP - 805
JO - International journal of radiation oncology, biology, physics
JF - International journal of radiation oncology, biology, physics
IS - 4
ER -