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Clinical Trial
. 2017 Sep;64(9):10.1002/pbc.26540.
doi: 10.1002/pbc.26540. Epub 2017 May 26.

45 Gy is not sufficient radiotherapy dose for Group III orbital embryonal rhabdomyosarcoma after less than complete response to 12 weeks of ARST0331 chemotherapy: A report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group

Ralph P Ermoian  1 , John Breneman  2 , David O Walterhouse  3 , Yueh-Yun Chi  4 , Jane Meza  5 , James Anderson  5 , Douglas S Hawkins  6 , Andrea A Hayes-Jordan  7 , David M Parham  8 , Torunn I Yock  9 , Sarah S Donaldson  10 , Suzanne L Wolden  11
Affiliations
Clinical Trial

45 Gy is not sufficient radiotherapy dose for Group III orbital embryonal rhabdomyosarcoma after less than complete response to 12 weeks of ARST0331 chemotherapy: A report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group

Ralph P Ermoian et al. Pediatr Blood Cancer. 2017 Sep.

Erratum in

Abstract

Background: Recent Children's Oncology Group (COG) trials tested the efficacy of reduced therapy in an effort to lessen late effects compared to the Intergroup Rhabdomyosarcoma Study (IRS) IV regimen with associated hematologic and hepatic toxicity, and infertility. Here, we analyze the efficacy of 45 Gray (Gy) local radiotherapy (RT) in patients with Group III orbital embryonal rhabdomyosarcoma (ERMS) enrolled on the COG low-risk study ARST0331.

Procedure: Sixty-two patients with Group III orbital ERMS were treated on ARST0331 with four cycles of vincristine (VCR), dactinomycin (DACT), and cyclophosphamide (CPM; VAC, total cumulative CPM dose 4.8 g/m2 ) followed by four cycles of VCR and DACT over 22 weeks. Forty-five Gray of radiation was administered in 25 fractions beginning at week 13 of therapy.

Results: Fifty-three patients were evaluable for this response analysis; seven had missing week 12 response evaluation data and two had progressive disease prior to starting RT. Median follow-up was 7.8 years. None of the 15 patients with radiographic complete response (CR) compared to 6 of the 38 patients with <CR after 12 weeks of VAC chemotherapy had local recurrences (P = 0.11). There was no difference in overall survival by response at week 12 (P = 0.52).

Conclusions: For patients with Group III orbital ERMS achieving a CR following VAC chemotherapy that includes modest dose CPM, 45 Gy may be sufficient for durable failure-free survival. However, for those with <CR treated with the ARST0331 systemic therapy, a different local therapy approach may be needed to achieve the control rate of IRS-IV without its toxicity.

Keywords: orbital rhabdomyosarcoma; radiotherapy; response based.

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Conflict of interest statement

CONFLICT OF INTEREST

Dr. Anderson previously served on independent Data Monitoring Committees for Amgen, Merck, and SFJ Parma sponsored studies. There is no other conflict of interest.

Figures

FIGURE 1
FIGURE 1
Failure-free survival for patients with Group III orbital embryonal rhabdomyosarcoma by response to induction chemotherapy
See this image and copyright information in PMC

Comment in

  • Pediatric Radiation Therapy-When Too Much Is Not Enough.
    Breneman J, Laack NNI, MacDonald S, Ermoian R, Baldini E. Breneman J, et al. Int J Radiat Oncol Biol Phys. 2019 Aug 1;104(5):963-966. doi: 10.1016/j.ijrobp.2019.04.022. Int J Radiat Oncol Biol Phys. 2019. PMID: 31327424 No abstract available.

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