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van der Plas E, Darji H, Srivastava K, Schapiro M, Jeffe D, Perkins S, Howell R, Leisenring W, Armstrong GT, Oeffinger K, Krull K, Edelstein K, Hayashi RJ. Risk factors for neurocognitive impairment, emotional distress, and poor quality of life in survivors of pediatric rhabdomyosarcoma: A report from the Childhood Cancer Survivor Study. Cancer 2024; 130:2224-2236. [PMID: 38373075 PMCID: PMC11139574 DOI: 10.1002/cncr.35236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Prevalence and risk of poor psychological outcomes following rhabdomyosarcoma (RMS) are not well-established. METHODS Participants in this cross-sectional, case-control study (n = 713 survivors, 42.5% female; mean [SD] age, 30.5 [6.6] years; n = 706 siblings, 57.2% female; mean age, 32.8,[7.9] years) completed measures of neurocognition, emotional distress, and health-related quality of life (HRQOL). Multivariable logistic regression models identified treatments, health behaviors, and chronic conditions associated with impairment. RESULTS Relative to siblings, more survivors reported neurocognitive impairment (task efficiency: 21.1% vs. 13.7%, emotional regulation: 16.7% vs. 11.0%, memory: 19.3% vs. 15.1%), elevated emotional distress (somatic distress: 12.9% vs. 4.7%, anxiety: 11.7% vs. 5.9%, depression: 22.8% vs. 16.9%) and poorer HRQOL (physical functioning: 11.1% vs. 2.8%, role functioning due to physical problems: 16.8% vs. 8.2%, pain: 17.5% vs. 10.0%, vitality: 22.3% vs. 13.8%, social functioning: 14.4% vs. 6.8%, emotional functioning: 17.1% vs. 10.6%). Cranial radiation increased risk for impaired task efficiency (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.14-4.63), whereas chest and pelvic radiation predicted increased risk of physical functioning (OR, 2.68; 95% CI, 1.16-6.21 and OR, 3.44; 95% CI, 1.70-6.95, respectively). Smoking was associated with impaired task efficiency (OR, 2.06; 95% CI, 1.14-3.70), memory (OR, 2.23; 95% CI, 1.26-3.95), anxiety (OR, 2.71; 95% CI, 1.36-5.41) and depression (OR, 1.77; 95% CI, 1.01-3.11). Neurologic conditions increased risk of anxiety (OR, 2.30; 95% CI, 1.04-5.10), and hearing conditions increased risk of depression (OR, 1.79; 95% CI, 1.05-3.03). Neurologic and hearing conditions, respectively, were associated with impaired memory (OR, 2.44; 95% CI, 1.20-4.95 and OR, 1.87; 95% CI, 1.05-3.35) and poor health perception (OR, 2.62; 95% CI, 1.62-1.28 and OR, 2.33; 95% CI, 1.34-4.06). CONCLUSIONS RMS survivors are at significant risk for poor psychological outcomes. Advancing therapies for local control, smoking cessation, and managing chronic medical conditions may mitigate poor outcomes following RMS.
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Affiliation(s)
- Ellen van der Plas
- Arkansas Children’s Hospital, Department of Hematology/Oncology, Little Rock, AR, USA
- University of Arkansas for Medical Sciences, Department of Pediatrics, Little Rock, AR, USA
| | - Himani Darji
- Stanford University, Quantitative Sciences Unit, Department of Medicine, Stanford, CA, USA
- St. Jude Children’s Research Hospital, Biostatistics Department, Memphis, TN, USA
| | - Kumar Srivastava
- St. Jude Children’s Research Hospital, Biostatistics Department, Memphis, TN, USA
| | - Melissa Schapiro
- SSM Health Cardinal Glennon Children’s Hospital-St. Louis University, Department of Pediatrics, St Louis, MO, USA
| | - Donna Jeffe
- Washington University School of Medicine in St Louis, John T. Milliken Department of Medicine, St Louis, MO, USA
| | - Stephanie Perkins
- Washington University in St Louis, Department of Radiation Oncology, St Louis, MO, USA
| | - Rebecca Howell
- MD Anderson Cancer Center, Department of Radiation Physics, Houston, TX, USA
| | - Wendy Leisenring
- Fred Hutch Cancer Center, Clinical Research Division, Seattle, WA, USA
| | - Gregory T. Armstrong
- St. Jude Children’s Research Hospital, Epidemiology and Cancer Control, Memphis, TN, USA
| | | | - Kevin Krull
- St. Jude Children’s Research Hospital, Psychology & Biobehavioral Sciences, Memphis, TN, USA
| | - Kim Edelstein
- Princess Margaret Cancer Center, Department of Supportive Care, Toronto, Canada
| | - Robert J. Hayashi
- Washington University School of Medicine in St Louis, Department of Pediatrics, St Louis Childrens Hospital, Siteman Cancer Center, St Louis, MO, USA
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Wang T, Wang J, Tang T, Li Q, Li Y, Song X. Surgery for adult head and neck rhabdomyosarcoma: A retrospective report from one institution. Int Forum Allergy Rhinol 2024; 14:1110-1114. [PMID: 38153372 DOI: 10.1002/alr.23313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023]
Abstract
KEY POINTS Surgery in adults with head and neck rhabdomyosarcoma does not improve survival rates. Surgery should be performed deliberately and focused on the timing of combined treatment modality. Adult head and neck rhabdomyosarcoma benefits from salvage surgery following chemoradiotherapy.
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Affiliation(s)
- Tian Wang
- Department of Radiation Oncology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai, China
| | - Jie Wang
- Department of Radiation Oncology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai, China
| | - Tianci Tang
- Department of Radiation Oncology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai, China
| | - Qiang Li
- Department of Otorhinolaryngology, Jinshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yi Li
- Department of Oncology, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Xinmao Song
- Department of Radiation Oncology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai, China
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Topkan E, Somay E, Selek U, Pehlivan B. Letter to the Editor: Local Treatment of Children Suffering From Parameningeal Rhabdomyosarcoma - A Retrospective Single-Center Study From China. Cancer Control 2024; 31:10732748241254702. [PMID: 38728060 PMCID: PMC11088293 DOI: 10.1177/10732748241254702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/09/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024] Open
Affiliation(s)
- Erkan Topkan
- Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Efsun Somay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - Ugur Selek
- Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey
| | - Berrin Pehlivan
- Department of Radiation Oncology, School of Medicine, Bahcesehir University, Istanbul, Turkey
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Yang N, Kong D, Wang X, Liu Y. Perianal rhabdomyosarcoma in an adult: A case report and review of the literature. Medicine (Baltimore) 2023; 102:e36276. [PMID: 38050209 PMCID: PMC10695526 DOI: 10.1097/md.0000000000036276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023] Open
Abstract
Perianal/perineal rhabdomyosarcomas (PRMS) is rare, and the outcome is poor. A 29-year-old female presented with perineal rhabdomyosarcomas revealed metastases to inguinal lymph nodes on the bilateral side. Disease progression was discovered when the patient got adjuvant epirubicin, ifosfamide, and bevacizumab for 2 cycles. After 3 cycles of nivolumab, dacarbazine, cisplatin, and vinblastine therapy, a partial response was identified in the patient. The surgical resection was performed. The patient received neoadjuvant chemotherapy before surgery and was weak after surgery, so he did not receive chemoradiotherapy. The patient succumbed after 11 months postoperatively due to widespread intraabdominal metastasis.
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Affiliation(s)
- Ning Yang
- Department of General Surgery, The First Affiliated Hospital, Hebei Medical University, Shijiazhuang, China
| | - Dexian Kong
- Department of Endocrinology, The Fourth Affiliated Hospital, Hebei Medical University, Shijiazhuang, China
| | - Xv Wang
- Department of Pathology, The Fourth Affiliated Hospital, Hebei Medical University, Shijiazhuang, China
| | - Yabin Liu
- Department of General Surgery, The Fourth Affiliated Hospital, Hebei Medical University, Shijiazhuang, China
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Totadri S, Bansal D, Donaldson SS, Binitie O, Teot L, Gupta AA, Oberoi S. Common queries in managing rhabdomyosarcoma in low- and middle-income countries: An Indo-North American collaboration. Pediatr Blood Cancer 2023; 70:e30616. [PMID: 37574816 DOI: 10.1002/pbc.30616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/01/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma among children and adolescents. The management of RMS involves risk stratification of the patients based on various clinicopathological characteristics. The multimodality treatment approach requires chemotherapy, surgery, and/or radiation. The treatment of RMS necessitates the involvement of multiple disciplines, such as pathology, pediatric oncology, surgery, and radiation oncology. The disease heterogeneity, molecular testing, evolving treatment regimens, and limited resources are some of the challenges faced by clinicians while treating a patient with RMS in low- and middle-income countries (LMICs). In this review, we endeavor to bring experts from varying fields to address clinicians' common questions while managing a child or adolescent with RMS in LMICs. This review is most applicable to level 2 centers in LMICs as per the levels of services described by the Adapted Treatment Regimens Working Group of the Pediatric Oncology in Developing Countries committee of the International Society of Pediatric Oncology.
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Affiliation(s)
- Sidharth Totadri
- Department of Paediatrics, Paediatric Haematology-Oncology Unit, Christian Medical College, Vellore, India
| | - Deepak Bansal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Pediatric Hematology-Oncology Unit, Advanced Pediatrics Center, Chandigarh, India
| | - Sarah S Donaldson
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Odion Binitie
- Department of Sarcoma, Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Lisa Teot
- Department of Pathology, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Abha A Gupta
- Division of Pediatric Hematology-Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sapna Oberoi
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Koscielniak E, Timmermann B, Münter M, Weclawek-Tompol J, Ladenstein R, Niggli F, Ljungman G, Brecht IB, Blank B, Hallmen E, Scheer M, Fuchs J, Seitz G, Blattmann C, Sparber-Sauer M, Klingebiel T. Which Patients With Rhabdomyosarcoma Need Radiotherapy? Analysis of the Radiotherapy Strategies of the CWS-96 and CWS-2002P Studies and SoTiSaR Registry. J Clin Oncol 2023; 41:4916-4926. [PMID: 37725766 DOI: 10.1200/jco.22.02673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/20/2023] [Accepted: 07/18/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE To analyze and compare the indications, doses, and application methods of radiotherapy (RT) and their influence on prognosis of patients with localized rhabdomyosarcoma (RMS). METHODS One thousand four hundred seventy patients with localized RMS 21 years and younger entered on CWS-96, CWS-2002P, and SoTiSaR were eligible for the analysis. The median follow-up was 6.5 years (IQR, 3.3-9.5). RESULTS The 5-year event-free survival (EFS) and local control survival (LCS) for 910 (62%) irradiated versus nonirradiated patients were 71% versus 69% and 78% versus 73% (P = .03), respectively. Ninety-five percent of patients in IRS I (90% embryonal RMS [eRMS]) were nonirradiated (EFS, 87%). Irradiated patients with IRS II had improved LCS (91% v 80%; P = .01) and EFS (not significant). In IRS III, EFS and LCS were significantly better for RT patients: 71% versus 56% (P = 3.1e-06) and 76% versus 61% (P = 4.1e-07). Patients with tumors in the head and neck region (orbita, parameningeal, and nonparameningeal) and in other sites had significantly better EFS and LCS and in parameningeal also overall survival (OS). The efficacy of low RT doses of 32 Gy (hyperfractionated, accelerated RT [HART]) and 36 and 41.4 Gy (conventional fractionated RT [CFRT]) in the favorable groups and higher doses of 44.8 Gy (HART) and 50.4 and 55.4 Gy (CFRT) in the unfavorable groups was comparable. Proton RT was used predominantly in head/neck-parameningeal (HN-PM) tumors, with similar EFS and LCS to photon RT. CONCLUSION RT can be omitted in patients with IRS I eRMS. RT improves LCS and EFS in IRS II and III. RT improves OS in patients with HN-PM, with proton RT comparable with photon RT. Doses of 32 Gy (HART) or 36 and 41.4 Gy (CFRT) had comparable efficacy in patients with favorable risk profiles and 44.8 Gy (HART) or 50.4 and 55.8 Gy (CFRT) in the unfavorable groups.
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Affiliation(s)
- Ewa Koscielniak
- Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
- Medical Faculty, University of Tübingen, Tübingen, Germany
| | - Beate Timmermann
- West German Cancer Center (WTZ), University Hospital Essen, Essen, Germany
| | - Marc Münter
- Hospital for Radiation Oncology, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
| | | | | | - Felix Niggli
- Department of Pediatric Oncology, University of Zürich, Zurich, Switzerland
| | - Gustaf Ljungman
- Department of Women's and Children's Health, Pediatric Oncology, Uppsala University, Uppsala, Sweden
| | - Ines B Brecht
- Department of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University of Tübingen, Tübingen, Germany
| | - Bernd Blank
- Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Erika Hallmen
- Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Monika Scheer
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin, Berlin, Germany
| | - Joerg Fuchs
- Department of Pediatric Surgery and Urology, Hospital for Children and Adolescents, University of Tübingen, Tübingen, Germany
| | - Guido Seitz
- Department of Pediatric Surgery and Urology, University Hospital Giessen-Marburg, Marburg, Germany
| | - Claudia Blattmann
- Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
- Medical Faculty, University of Tübingen, Tübingen, Germany
| | - Monika Sparber-Sauer
- Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
- Medical Faculty, University of Tübingen, Tübingen, Germany
| | - Thomas Klingebiel
- Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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7
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Polites SF, Rhee DS, Routh JC, Lautz TB, Rodeberg DA, Dasgupta R. Critical elements of pediatric rhabdomyosarcoma surgery. Semin Pediatr Surg 2023; 32:151341. [PMID: 38042091 DOI: 10.1016/j.sempedsurg.2023.151341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
Rhabdomyosarcoma (RMS), the most common soft tissue sarcoma in children, requires multimodal therapy which is determined by risk group stratification. Local control may be achieved by surgical resection, radiation, or both. Resection may occur upfront or following induction chemotherapy as a delayed primary excision. An R1 resection may allow a reduction in radiation exposure; however, debulking is not indicated nor is excision of residual masses at the end of therapy. Regional lymph node assessment is an important component of surgical care, as positive nodal basins require radiation. Depending on the tumor site and biology, sentinel lymph node biopsy vs biopsy of clinically or radiographically concerning nodes is indicated. Therapeutic lymph node dissection is never indicated. Familiarity with site-specific oncologic principles for RMS and participation in a multidisciplinary team including Pediatric Oncology and Radiation Oncology are necessary components of surgical care to ensure optimal outcomes.
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Affiliation(s)
- Stephanie F Polites
- Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Daniel S Rhee
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan C Routh
- Department of Urology, Duke University School of Medicine, Durham, NC, USA
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - David A Rodeberg
- Department of Surgery, Department of Pediatric Surgery, University of Kentucky, Lexington, KY, USA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA.
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8
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Kobayashi K, Hanai N, Yoshimoto S, Saito Y, Homma A. Current topics and management of head and neck sarcomas. Jpn J Clin Oncol 2023; 53:743-756. [PMID: 37309253 PMCID: PMC10533342 DOI: 10.1093/jjco/hyad048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/18/2023] [Indexed: 06/14/2023] Open
Abstract
Given the low incidence, variety of histological types, and heterogeneous biological features of head and neck sarcomas, there is limited high-quality evidence available to head and neck oncologists. For resectable sarcomas, surgical resection followed by radiotherapy is the principle of local treatment, and perioperative chemotherapy is considered for chemotherapy-sensitive sarcomas. They often originate in anatomical border areas such as the skull base and mediastinum, and they require a multidisciplinary treatment approach considering functional and cosmetic impairment. Moreover, head and neck sarcomas may exhibit different behaviour and characteristics than sarcomas of other areas. In recent years, the molecular biological features of sarcomas have been used for the pathological diagnosis and development of novel agents. This review describes the historical background and recent topics that head and neck oncologists should know about this rare tumour from the following five perspectives: (i) epidemiology and general characteristics of head and neck sarcomas; (ii) changes in histopathological diagnosis in the genomic era; (iii) current standard treatment by histological type and clinical questions specific to head and neck; (iv) new drugs for advanced and metastatic soft tissue sarcomas; and (v) proton and carbon ion radiotherapy for head and neck sarcomas.
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Affiliation(s)
- Kenya Kobayashi
- Department of Otolaryngology–Head and Neck Surgery, University of Tokyo, Tokyo
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo
| | - Yuki Saito
- Department of Otolaryngology–Head and Neck Surgery, University of Tokyo, Tokyo
| | - Akihiro Homma
- Department of Otolaryngology–Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Doppalapudi SK, Chua KJ, Tabakin AL, Park JH, Ahmed H, Moerdler S, Jang TL, Barone JG. Chemotherapy Refractory Spindle-Cell Rhabdomyosarcoma of the Bladder Treated With Consolidative Ovarian-Sparing Radical Surgery. Urology 2023; 172:182-185. [PMID: 36402274 DOI: 10.1016/j.urology.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022]
Abstract
We present a case of chemotherapy refractory spindle cell rhabdomyosarcoma of the lower urinary tract in a 15-month-old female that ultimately required consolidative surgery with cystectomy, urethrectomy, ovarian-sparing hysterectomy, bilateral salpingectomy, anterior vaginal wall resection, and bilateral pelvic lymph node dissection. Genitourinary reconstruction was performed by ileal conduit creation and vaginoplasty. After completion of her maintenance postoperative chemotherapy regimen, the patient has remained disease-free for approximately 27 months.
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Affiliation(s)
- Sai K Doppalapudi
- Rutgers Robert Wood Johnson Medical School, Department of Surgery, Division of Urology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Kevin J Chua
- Rutgers Robert Wood Johnson Medical School, Department of Surgery, Division of Urology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Alexandra L Tabakin
- Rutgers Robert Wood Johnson Medical School, Department of Surgery, Division of Urology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Ji Hae Park
- Rutgers Robert Wood Johnson Medical School, Department of Surgery, Division of Urology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Haris Ahmed
- Rutgers Robert Wood Johnson Medical School, Department of Surgery, Division of Urology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Scott Moerdler
- Rutgers Robert Wood Johnson Medical School, Department of Pediatrics, Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Thomas L Jang
- Rutgers Robert Wood Johnson Medical School, Department of Surgery, Division of Urology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Joseph G Barone
- Rutgers Robert Wood Johnson Medical School, Department of Surgery, Division of Urology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
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Developments in the Surgical Approach to Staging and Resection of Rhabdomyosarcoma. Cancers (Basel) 2023; 15:cancers15020449. [PMID: 36672397 PMCID: PMC9857078 DOI: 10.3390/cancers15020449] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
Although survival after rhabdosarcoma treatment has improved over the years, one third of patients still develop locoregional relapse. This review aims to highlight developments pertaining to staging and local treatment of specific RMS tumor sites, including head and neck, chest/trunk, bladder-prostate, female genito-urinary, perianal, and extremity sites.
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11
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Xu P, Chen C, Chen B, Bi E, Du W, Jiang N, Liu Z, Lan H, Cao M, Liu Y, Huang J, Shen H, Liu C, Liu C, Xu A. Long-term Follow-up of Detaenial Sigmoid Neobladder Reconstruction for Paediatric Patients with Bladder and Prostate Rhabdomyosarcoma: Technique and Results from a Single High-volume Centre. Eur Urol 2022; 82:543-550. [PMID: 36050131 DOI: 10.1016/j.eururo.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/21/2022] [Accepted: 08/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rhabdomyosarcoma (RMS) is the most common paediatric soft-tissue sarcoma. Approximately 15-20% of RMS cases arise from the bladder and prostate (B/P). The optimal treatment strategy for B/P RMS remains unclear. OBJECTIVE To retrospectively evaluate the applicability of our procedure performed to treat paediatric patients with B/P RMS. DESIGN, SETTING, AND PARTICIPANTS This is a retrospective analysis from a single tertiary referral hospital. From August 2003 to March 2021, 62 children pathologically diagnosed with B/P RMS underwent radical cystectomy and orthotopic detaenial sigmoid neobladder reconstruction in our centre. SURGICAL PROCEDURE Surgical procedures included laparoscopic radical cystectomy and detaenial sigmoid neobladder reconstruction, which is demonstrated in the accompanying video. MEASUREMENTS Demographic, clinical, and follow-up data were collected. Perioperative and long-term oncological and functional outcomes were reported. A logistic regression analysis was also performed. RESULTS AND LIMITATIONS All surgeries, including three intracorporeal laparoscopic surgeries, were completed successfully. Of the 62 patients, 54 were alive without evidence of disease recurrence or metastasis at the last follow-up. Five of the 14 >12-yr-old boys reported that they experienced erections. Two female patients >12 yr old reported that they menstruated. However, this was a retrospective study conducted at a single centre with limited surgeon experience. CONCLUSIONS Our results confirmed the safety and feasibility of primary orthotopic sigmoid neobladder reconstruction after radical cystectomy for paediatric patients with B/P RMS. Good outcomes in terms of oncological control and functional recovery were achieved. The high histocompatibility and tissue adaptability of children are inspiring. PATIENT SUMMARY We describe our stepwise technique of radical cystectomy and detaenial sigmoid neobladder reconstruction for paediatric patients with bladder and prostate rhabdomyosarcoma. With this technique, we were able to achieve good functional recovery without compromising cancer control and significantly increasing complications.
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Affiliation(s)
- Peng Xu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chunxiao Chen
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Binshen Chen
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Enguang Bi
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Biochemistry and Molecular Biology, School of Basic Medical Science, Guangdong Provincial Key Laboratory of Single Cell Technology and Application, Southern Medical University, Guangzhou, China
| | - Wei Du
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ning Jiang
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhe Liu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hekui Lan
- Department of Paediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Manming Cao
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yazhen Liu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jingwen Huang
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Haiyan Shen
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Cunrong Liu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chunxiao Liu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
| | - Abai Xu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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Castle JT, Levy BE, Rodeberg DA. Abdominal Tumors. Surg Clin North Am 2022; 102:715-737. [DOI: 10.1016/j.suc.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Salerno KE, Hill-Kayser C, Esiashvili N, Ermoian R. In Pediatric Sarcomas, Less is Sometimes More. Int J Radiat Oncol Biol Phys 2022; 113:907-910. [PMID: 35841914 DOI: 10.1016/j.ijrobp.2022.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Kilian E Salerno
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Christine Hill-Kayser
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Natia Esiashvili
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Ralph Ermoian
- Department of Radiation Oncology, University of Washington, Seattle, Washington.
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14
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Casey DL, Mandeville H, Bradley JA, Ter Horst SAJ, Sheyn A, Timmermann B, Wolden SL. Local control of parameningeal rhabdomyosarcoma: An expert consensus guideline from the International Soft Tissue Sarcoma Consortium (INSTRuCT). Pediatr Blood Cancer 2022; 69:e29751. [PMID: 35484997 DOI: 10.1002/pbc.29751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 12/19/2022]
Abstract
The International Soft Tissue Sarcoma Database Consortium (INSTRuCT) consists of a collaboration between the Children's Oncology Group (COG) Soft Tissue Sarcoma Committee, the European pediatric Soft Tissue Sarcoma Study Group (EpSSG), and the Cooperative Weichteilsarkom Studiengruppe (CWS). As part of the larger initiative of INSTRuCT to provide consensus expert opinions for clinical treatment of pediatric soft tissue sarcoma, we sought to provide updated, evidenced-based consensus guidelines for local treatment of parameningeal rhabdomyosarcoma using both existing literature as well as recommendations from the relevant cooperative group clinical trials. Overall, parameningeal rhabdomyosarcoma represents a distinctly challenging disease to treat, given its location near many critical structures in the head and neck, frequently advanced local presentation, and predilection for local failure. Definitive chemoradiation remains the standard treatment approach for parameningeal rhabdomyosarcoma, with surgery often limited to biopsy or salvage therapy for recurrent disease. In this consensus paper, we specifically discuss consensus guidelines and evidence for definitive local management with radiotherapy, with a focus on imaging for radiotherapy planning, dose and timing of radiation, approach for nodal irradiation, various radiation techniques, including proton therapy, and the limited role of surgical resection.
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Affiliation(s)
- Dana L Casey
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - Henry Mandeville
- Royal Marsden NHS Foundation Trust, London, UK.,Institute of Cancer Research, London, UK
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida, USA
| | - Simone A J Ter Horst
- Department of Radiology, University Medical Center Utrecht, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Anthony Sheyn
- Department of Surgery, Division of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Essen, Germany
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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15
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Nishida Y, Kawai A. Surgical treatment for extremity rhabdomyosarcoma: longitudinal national questionnaire survey in Japan. Jpn J Clin Oncol 2021; 52:362-369. [PMID: 34963137 DOI: 10.1093/jjco/hyab206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/08/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Extremity rhabdomyosarcoma differs from other soft tissue sarcomas, being highly sensitive to chemotherapy and radiotherapy and having a high rate of metastasis to lymph nodes. Therefore, the treatment modality differs from that of other soft tissue sarcomas. The purpose of this study was to conduct a longitudinal questionnaire survey of orthopedic oncologists in charge of surgical treatment for extremity rhabdomyosarcoma in Japan to determine whether the treatment modality chosen here is in line with the international and national treatment ones. METHODS Questionnaire surveys were conducted in 2012 and 2019 to orthopedic oncologists of Japanese Orthopaedic Association and Japanese Musculoskeletal Oncology Group. RESULTS Responses were obtained from 80 facilities and 76 facilities, respectively. Fewer than 50% of the facilities treated one or more patients a year in both years. Many facilities first performed diagnostic biopsy, but most did not perform pretreatment re-excision. The number of facilities that provided radiotherapy in addition to surgery increased significantly from 2012 to 2019 (P = 0.028), but it was still 21% in 2019. The number of facilities performing excision and lymph node dissection was 19% in both 2012 and 2019, which was a very low result without improvement. The departments responsible for follow-up have been changed to pediatrics and orthopedic oncology in tandem (P = 0.0004). CONCLUSIONS Radiotherapy and pathological evaluation of lymph nodes are important for improving the prognosis of patients with extremity rhabdomyosarcoma. It is necessary to continue and develop more efficient educational activities on the appropriate medical treatment modalities for extremity RMS.
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Affiliation(s)
- Yoshihiro Nishida
- Department of Rehabilitation Medicine, Nagoya University Hospital, Nagoya, Aichi, Japan.,Department of Orthopaedic Surgery, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, Tokyo, Japan
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16
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Fuchs J, Murtha-Lemekhova A, Kessler M, Günther P, Fichtner A, Pfeiffenberger J, Probst P, Hoffmann K. Biliary Rhabdomyosarcoma in Pediatric Patients: A Systematic Review and Meta-Analysis of Individual Patient Data. Front Oncol 2021; 11:701400. [PMID: 34660271 PMCID: PMC8515851 DOI: 10.3389/fonc.2021.701400] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The biliary tree is a rare location of pediatric rhabdomyosarcoma. Due to the low incidence, there is a lack of evidence concerning therapeutic guidelines for this tumor location. In particular, the impact of surgery is discussed controversially. PURPOSE Objective is to generate evidence-based treatment guidelines for pediatric biliary rhabdomyosarcoma (BRMS). All available published data on therapeutic regimens and important prognostic factors are investigated with a focus on the role of surgery. METHODS A systematic literature search of MEDLINE, Web of Science, and CENTRAL was performed. Patient data were entered individually. Data was pooled and qualitative and quantitative analyses of demographic data, therapy, postoperative/interventional outcomes, relapse, and survival were conducted. In an individual patient data analysis, cox regression was applied to identify key factors predicting the outcome of patients with BRMS. RESULTS 65 studies met the inclusion criteria, providing data on 176 patients with BRMS. Individual patient data analysis showed a 5-year overall survival and progression-free survival of 51% and 50% for the total study population. For patients treated after 2000, 5-year OS and PFS was 65% and 59%, respectively. Absence of surgical tumor resection was an independent risk factor for death (Hazard ratio 8.9, 95%-CI 1.8-43.6, p = 0.007) and significantly associated with recurrent disease and disease-related death. CONCLUSION This analysis provides comprehensive information on the largest number of patients hitherto reported in the literature. BRMS is still associated with high morbidity and mortality. Surgical tumor resection is essential for appropriate oncological treatment of BRMS. International cooperation studies are needed to enhance evidence and improve the outcome of this orphan disease. PROTOCOL REGISTRATION PROSPERO (CRD42021228911) https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021228911.
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Affiliation(s)
- Juri Fuchs
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Anastasia Murtha-Lemekhova
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Kessler
- Department of General, Visceral and Transplantation Surgery, Division of Pediatric Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrick Günther
- Department of General, Visceral and Transplantation Surgery, Division of Pediatric Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Fichtner
- Department of Pediatrics I, Division of Pediatric Gastroenterology, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Jan Pfeiffenberger
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Pascal Probst
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
- Study Center of the German Surgical Society (SDGC), University of Heidelberg, Heidelberg, Germany
| | - Katrin Hoffmann
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Radiation Therapy in the Treatment of Head and Neck Rhabdomyosarcoma. Cancers (Basel) 2021; 13:cancers13143567. [PMID: 34298780 PMCID: PMC8305800 DOI: 10.3390/cancers13143567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 12/27/2022] Open
Abstract
The use of radiation therapy is an important part of multimodality treatment for rhabdomyosarcoma. The specific doses, treatment volumes, and techniques used in radiation therapy can vary dramatically based upon a number of factors including location, tumor size, and molecular characteristics, resulting in complex decisions in treatment planning. This article reviews the principles of evaluation and management for head and neck rhabdomyosarcoma including a summary of the historical studies upon which current management is based.
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Welmant J, Helfre S, Carton M, Bolle S, Minard-Colin V, Corradini N, Pannier S, Rome A, Mansuy L, Vérité C, Castex MP, Kerr C, Defachelles AS, Bernier V, Orbach D. Pattern of relapse in pediatric localized extremity rhabdomyosarcomas correlated with locoregional therapies administered. Strahlenther Onkol 2021; 197:690-699. [PMID: 33914102 DOI: 10.1007/s00066-021-01780-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Treatment of extremity rhabdomyosarcomas (RMS) includes chemotherapy, surgery, and radiotherapy. Lymph node irradiation is recommended in the presence of regional node involvement at diagnosis. The aim of this study was to analyze the correlation between the pattern of relapse of non-metastatic extremity RMS and the initial therapies delivered. METHODS All patients with localized extremity RMS prospectively treated in France in the MMT-95 and RMS-05 protocols were selected. Extent of disease and pattern of relapse were evaluated by clinical examination and imaging. RESULTS We identified 59 patients with clinical characteristics corresponding to unfavorable prognostic factors. Twenty patients (34%) were considered to have lymph node involvement at diagnosis. Regional node biopsy was performed in 32 patients (54%) and modified the lymph node stage in 8 of the 59 patients (14%). Seventy-three percent of patients received radiotherapy. Fifty-two patients achieved first remission. Overall, 26 patients underwent complete tumor resection, 17 had R1 margins, and 5 were not operated due to early tumor progression. With a median follow-up of 82 months (range: 5-287), 18 relapses had occurred, at least locoregional in 12 cases. The 5‑year local and nodal control rates were 73% (63-86%) and 86% (77-95%), respectively. Five-year progression-free and overall survival were 57% (95%CI [45-72%]) and 70% (95%CI [58-84%]), respectively. CONCLUSION The main sites of extremity RMS relapse are locoregional. Nodal failures in non-irradiated fields are not uncommon. We recommend systematic biopsy of in-transit nodes, especially in alveolar RMS and/or RMS with regional positive nodes at diagnosis to ensure their negativity.
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Affiliation(s)
- Julien Welmant
- Department of Radiation Oncology and Physics, Institut du Cancer de Montpellier, Montpellier, France
| | - Sylvie Helfre
- Radiotherapy Department, Institut Curie, Paris, France
| | - Matthieu Carton
- PSL Research University, DRCI, Biométrie, Institut Curie, Saint-Cloud, France
| | - Stéphanie Bolle
- Department of Radiotherapy Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Véronique Minard-Colin
- Department of Oncology for Children and Adolescents, Gustave Roussy Cancer Campus, Villejuif, France
| | - Nadège Corradini
- Department of Paediatric Haematology and Oncology, Centre Léon Bérard, Lyon, France
| | - Stéphanie Pannier
- Department of Orthopaedic Paediatrics, Necker-Enfants-Malades Hospital, Paris, France
| | - Angélique Rome
- Department of Paediatric Oncology, CHU de Marseille, Hôpital de la Timone, Marseille, France
| | - Ludovic Mansuy
- Oncology Surgery Department, Institute of Cancerology of Lorraine, Nancy, France
| | - Cécile Vérité
- Paediatric Hematology Unit, Groupe Hospitalier Pellegrin, Bordeaux, France
| | | | - Christine Kerr
- Department of Radiation Oncology and Physics, Institut du Cancer de Montpellier, Montpellier, France
| | | | - Valérie Bernier
- Department of Radiotherapy Oncology, Institute of Cancerology of Lorraine, Nancy, France
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation, and research for children and AYA with cancer), PSL Research University, Institut Curie, Paris, France. .,French Pediatric Rare Tumor group (Fracture group), Institut Curie, 26, rue d'Ulm, 75005, Paris, France.
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