Impact of tumor viability at second-look procedures performed before completing treatment on the Intergroup Rhabdomyosarcoma Study Group protocol IRS-IV, 1991-1997: a report from the children's oncology group

• Published in: Journal of pediatric surgery 2010-11, Vol.45 (11), p.2160-2168
• Main Authors: Raney, Beverly, Stoner, Julie, Anderson, James, Andrassy, Richard, Arndt, Carola, Brown, Ken, Crist, William, Maurer, Harold, Qualman, Stephen, Wharam, Moody, Wiener, Eugene, Meyer, William, Hayes-Jordan, Andrea
• Format: Article
• Language: English
• Subjects: Antineoplastic Agents - therapeutic use; Child; Childhood rhabdomyosarcoma; Diagnostic Imaging - methods; Disease-Free Survival; Dose Fractionation; Female; Follow-Up Studies; Humans; IRS-IV protocol; Male; Neoplasm Staging; Neoplasm, Residual; Pediatrics; Retrospective Studies; Rhabdomyosarcoma - diagnosis; Rhabdomyosarcoma - epidemiology; Rhabdomyosarcoma - therapy; Second-look procedures; Second-Look Surgery - methods; Surgery; Survival Rate; Time Factors; Treatment Outcome; United States - epidemiology
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2010.07.021

Abstract Purposes The aims of the study were to compare results of clinical/radiographic studies before second-look procedures (SLP) with SLP specimens from patients with gross residual sarcoma at diagnosis and to relate tumor viability to outcome. Patients Seventy-three patients underwent SLP before completing chemotherapy, with (n = 59) or without (n = 14) radiotherapy. Tumor sites were bladder/prostate (n = 27), head/orbit/parameningeal (n = 22), extremity/trunk (n = 14), and retroperitoneum/pelvis (n = 10). Results Of 14 patients, 1 (7%) with clinical/radiographic complete response (CR) had viable tumor. Of 59 patients, 35 (59%) without CR had viable tumor. Five-year failure-free survival (FFS) rates were 81% in 37 patients without viable tumor and 53% in 36 patients with viable tumor (Cox proportional hazards adjusted P = .05). Five-year FFS rates were 67% in 15 patients with clear margins and 43% in 21 patients with tumor-involved margins (n = 18) or viable gross tumor (n = 3) (Cox proportional hazards adjusted P = .04). Five-year survival was 78% to 79% among 73 patients with and 333 patients without SLP during treatment. Conclusions Second-look procedures can show whether viable tumor is present and may be beneficial in selected patients with rhabdomyosarcoma. Disappearance of tumor (CR) usually correlated with no viable tumor at SLP. However, 41% of patients without CR had no viable tumor. Those without viable tumor had increased FFS but not survival compared to those with viable tumor.