Is there a role for salvage re-irradiation in pediatric patients with locoregional recurrent rhabdomyosarcoma? Clinical outcomes from a multi-institutional cohort

• Type of Material: Article
• Authors: Daniel V Wakefield, University of Tennessee West Cancer Center; Bree Eaton, Emory University; Austin PH Dove, University of Tennessee West Cancer Center; Chih-Yang Hsu, St. Jude Children’s Research Hospital; Thomas E Merchant, St. Jude Children’s Research Hospital; Alberto Pappo, St. Jude Children’s Research Hospital; Andrew M Davidoff, St. Jude Children’s Research Hospital; Natia Esiashvili, Emory University; Matthew J Krasin, St. Jude Children’s Research Hospital; John T Lucas, St. Jude Children’s Research Hospital
• Language: English
• Date: 2018-12-01
• Publisher: ELSEVIER IRELAND LTD
• Publication Version: Preprint (Prior to Peer Review)
• Copyright Statement: © 2018 Elsevier B.V. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.radonc.2018.06.041
• Title of Journal or Parent Work: RADIOTHERAPY AND ONCOLOGY
• Volume: 129
• Issue: 3
• Start Page: 513
• End Page: 519
• Keywords: RADIATION; Recurrent; CHILDREN; Re-irradiation; Relapse; SOFT-TISSUE SARCOMA; Rhabdomyosarcoma; Radiology, Nuclear Medicine & Medical Imaging; ADOLESCENTS; CHEMOTHERAPY; ONCOLOGY; TRIAL; IRINOTECAN; Radiation; Oncology; Science & Technology; Life Sciences & Biomedicine; RELAPSE; Pediatrics; METASTATIC RHABDOMYOSARCOMA

Abstract

Background and purpose: Limited data exist detailing the role of salvage reirradiation following local-regional recurrence (LR) in previously irradiated pediatric patients with rhabdomyosarcoma (RMS). Materials and methods: We evaluated outcomes and prognostic factors in a multi-institutional cohort of 23 patients with LR-only (N = 19) or LR with distant failure (N = 4) RMS managed with (N = 12) or without (N = 11) re-irradiation who were treated from 1996 to 2012. Results: At a median follow-up of 4.6 years from LR, 7 (30%) patients were alive and 5 (22%) had no evidence of disease. Median OS and PFS from LR were 19.3 and 16.9 months, respectively. LFFS and DFFS at 3 years from relapse were 54% and 56%, respectively. Salvage re-irradiation occurred in 12 (52%) patients, with 9 (75%) receiving resection before re-irradiation. Patients classified as low-risk at diagnosis with favorable primary tumor location had improved 3-year PFS 80% (95% CI 51.6–100%) vs. 47.1% (95% CI 27.3–81.2%), p = 0.066], and OS 80% [(95% CI 22.4–100%) vs. 47.1% (95% CI 27.3–81.3%), p = 0.051] following LR. Median LFFS and OS in unirradiated vs. re-irradiated patients was 12.4 vs. 19.6 (p = 0.1) and 18.8 vs. 26.1 months (p = 0.46). No patients experienced ≥grade 4 acute toxicity from re-irradiation. LR failure was a component of cancer-related death in 60% vs. 40% of the unirradiated and re-irradiated group (p = 0.02). Conclusion: Salvage re-irradiation appears tolerable with acceptable morbidity and may reduce the risk of subsequent LR as a component of death in patients with LR RMS.