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Wang T, Huang C, Wang J, Tang T, Li Q, Li Y, Song X. Multimodality Treatment Outcome in Adult Patients with Head and Neck Rhabdomyosarcoma. Laryngoscope 2025; 135:2022-2029. [PMID: 39707798 DOI: 10.1002/lary.31968] [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: 06/20/2024] [Revised: 09/25/2024] [Accepted: 11/27/2024] [Indexed: 12/23/2024]
Abstract
OBJECTIVE(S) Head and neck rhabdomyosarcoma (HNRMS) is a rare malignant tumor in adults. No standard treatment for adults with HNRMS currently exists. METHODS A retrospective study of 72 newly diagnosed consecutive adult patients with HNRMS was conducted at one institution between November 2010 and April 2023. The log-rank tests were used to compare the differences in survival between treatment groups, and overall survival (OS), local recurrence-free survival (LRFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) were calculated using the Kaplan-Meier method. We used restricted cubic spline models fitted for Cox proportional hazards models to determine the association between chemotherapy cycles/radiotherapy dose and mortality. RESULTS The 2-year OS, PFS, LRFS, and DMFS rates for the entire cohort were 51.0%, 39.2%, 44.3%, and 47.3%, respectively. Radiotherapy significantly improved the OS (p < 0.01), PFS (p < 0.01), LRFS (p < 0.01), and DMFS (p < 0.01). Surgery had no effect on OS (49.3% vs. 53.0%, p = 0.62), PFS (36.9% vs. 41.8%, p = 0.31), LRFS (41.6% vs. 47.4%, p = 0.27), or DMFS (44.4% vs. 50.2%, p = 0.43). The restricted cubic spline showed that eight (HR = 1.002, 95% CI: 0.996-1.007) cycles of chemotherapy and 62.5Gy radiation therapy resulted in the lowest mortality. CONCLUSION For HNRMS, eight cycles of chemotherapy and 62.5Gy of radiation might be sufficient. Poor response to chemotherapy predicted an extreme worse outcome. Surgery played a limited role in the treatment. LEVEL OF EVIDENCE 3 Laryngoscope, 135:2022-2029, 2025.
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Affiliation(s)
- Tian Wang
- Department of Radiation Oncology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai, China
| | - Chuang Huang
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
- Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, 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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Shoji MK, Meyer BI, Diklich N, Panneerselvam S, Camacho M, Clauss KD, Johnson TE, Tse DT, Tse BC. Adult and pediatric orbital rhabdomyosarcoma: comparison of characteristics and outcomes. Orbit 2025:1-12. [PMID: 39792629 DOI: 10.1080/01676830.2024.2445702] [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: 09/02/2024] [Accepted: 12/17/2024] [Indexed: 01/12/2025]
Abstract
INTRODUCTION Rhabdomyosarcoma (RMS) is a common pediatric orbital malignancy but is extremely rare in adults. This study assesses clinical and radiographic features, management, and outcomes in adult orbital RMS patients with comparison to pediatric patients. METHODS A retrospective chart review from 2000-2023 at Bascom Palmer Eye Institute was conducted evaluating patients aged 0 to 100-years-old with biopsy-confirmed orbital RMS. Medical records were reviewed for demographics, clinical features, imaging, histopathology, management, and outcomes. Statistical analysis was conducted with Mann-U Whitney and chi-squared testing. RESULTS Twenty-four patients were included, 15 children (mean age 6.4 ± 4.4 years) and 9 adults (35.7 ± 12.4 years). Patients in both groups presented with eyelid edema followed by proptosis with similar symptom duration (p = 0.31). Lesions were frequently located medially and inferiorly in both groups. At presentation, adults had significantly more metastatic disease in addition to bone, extraocular muscle, intracranial, and parameningeal involvement. The most common pediatric RMS subtype was embryonal (80%), whereas most adults were alveolar (77.8%, p = 0.001). Treatment in both groups frequently included chemoradiation. Both groups demonstrated similar local recurrence (p = 0.72), overall survival (p = 0.86), and ophthalmologic sequelae (p = 0.45), although pediatric follow-up duration was notably longer. CONCLUSIONS To our knowledge, this study is the largest report of adult orbital RMS from a single institution, highlights key comparisons in features and outcomes between adult and pediatric orbital RMS, and provides an updated literature review. While pediatric and adult orbital RMS clinical presentations are similar, adult disease more often demonstrates aggressive features, including alveolar subtype, local structure involvement, and lower disease-free survival.
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Affiliation(s)
- Marissa K Shoji
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
- Department of Oculofacial Plastic and Orbital Surgery, Shiley Eye Institute, University of California San Diego, San Diego, California, USA
| | - Benjamin I Meyer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Nina Diklich
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Sugi Panneerselvam
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Matthew Camacho
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Kevin D Clauss
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Thomas E Johnson
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - David T Tse
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Brian C Tse
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
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Lofgren DH, Gillette B, Knight BB, Succar E. Induction Chemotherapy Prior to Endoscopic Resection of Alveolar Rhabdomyosarcoma. Cureus 2023; 15:e48761. [PMID: 38098924 PMCID: PMC10719548 DOI: 10.7759/cureus.48761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 12/17/2023] Open
Abstract
Head and neck rhabdomyosarcoma (HNRMS) is a rare type of soft tissue tumor that affects both adults and children with an overall incidence of 0.041 per 100,000 people. Adults make up approximately 31.2% of all HNRMS diagnoses and have an overall survival rate between 20% and 40%. We present a case of a 46-year-old male who initially presented with nasal congestion and vision changes. Maxillofacial computed tomography and magnetic resonance imaging of the brain showed involvement of the orbital apex, abutment of the planum sphenoidale, and extension to the foramen rotundum (FR). Nasal endoscopy with biopsy confirmed the diagnosis of T2aN0M0 parameningeal HNRMS. The patient underwent induction chemotherapy, followed by endoscopic resection, which resulted in negative intraoperative margins. Subsequently, he underwent adjuvant concurrent chemotherapy and proton beam radiation after positive microscopic positive margins were found on the optic nerve. The patient did not experience any significant complications, and he is currently without radiographic or clinical recurrence 18 months after the treatment. He was able to maintain his vision throughout the treatment. In adults, HNRMS is usually treated with chemoradiotherapy based on pediatric protocols, since there are limited data available for adult treatment protocols and outcomes. Although surgery has been associated with positive outcomes in adult patients, there are no previous reports of its use with either neoadjuvant or adjuvant treatment. This type of treatment protocol has never been described for adult HNRMS. We hope that our report can add more data to the growing body of literature on HNRMS treatment protocols.
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Affiliation(s)
- Daniel H Lofgren
- Otolaryngology - Head and Neck Surgery, McLaren Oakland Hospital, Pontiac, USA
| | - Benjamin Gillette
- Otolaryngology - Head and Neck Surgery, McLaren Oakland Hospital, Pontiac, USA
| | - Brandon B Knight
- Otolaryngology - Head and Neck Surgery, McLaren Oakland Hospital, Pontiac, USA
| | - Eric Succar
- Otolaryngology - Head and Neck Surgery, St. Joseph Mercy Oakland Hospital, Pontiac, USA
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4
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Sarma A, Gadde JA. Post-treatment Evaluation of Pediatric Head and Neck. Semin Roentgenol 2023; 58:363-373. [PMID: 37507176 DOI: 10.1053/j.ro.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/03/2023] [Accepted: 03/22/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Asha Sarma
- Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, Nashville, TN
| | - Judith A Gadde
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
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5
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Hintze JM, Afshar S, Taghinia A, Labow B, Green M, Robson CD, Marcus K, Mack J, Perez-Atayde A, Rahbar R. A multi-disciplinary team approach to pediatric malignant mandibular tumors. Int J Pediatr Otorhinolaryngol 2023; 168:111547. [PMID: 37079945 DOI: 10.1016/j.ijporl.2023.111547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Mandibular tumors in the pediatric population are rare. These malignancies are variable in their histology, and combined with their rarity, has made it difficult to describe their clinical course, and treatment guidelines. The aim of this paper is to describe the experience of Boston Children's Hospital, a pediatric tertiary referral center, with treating malignant mandibular malignancies, as well as provide multi-disciplinary team approach in managing this clinical entity. METHODS A retrospective search was performed for mandibular malignancies in pediatric patients between 1995 and 2020 via the pathological database at Boston Children's Hospital. Only patients with malignant solid mandibular neoplasms were included, leaving 15 patients for final analysis. RESULTS The median age at presentation was 10.1 ± 10.3 years. Nine of 15 patients (60%) presented with jaw mass which was the most common clinical presentation. The most commonly identified histological diagnosis was rhabdomayosarcoma and osteosarcoma (n = 4, 26% each). A mandibulectomy was performed in 12 (80%) cases. Reconstruction of the mandible was performed using a fibular free flap in 6 (40%) cases, and a plate in 3 (20%) cases. Mean follow-up was 4.6 ± 4.9 years. CONCLUSION Malignant tumors most commonly present with a jaw mass, however asymptomatic and incidental presentations follow closely and pathologies can vary greatly. Surgical resection and reconstruction is often indicated, multidisciplinary tumor board review is required to determine when children are best treated with neo-/adjuvant treatment with chemo- and radiotherapy.
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Affiliation(s)
- Justin M Hintze
- Department of Otolaryngology and Communication Enhancement, USA; Harvard Medical School, Boston, MA, USA.
| | - Salim Afshar
- Department of Plastic and Oral Surgery, USA; Harvard Medical School, Boston, MA, USA
| | - Amir Taghinia
- Department of Plastic and Oral Surgery, USA; Harvard Medical School, Boston, MA, USA
| | - Brian Labow
- Department of Plastic and Oral Surgery, USA; Harvard Medical School, Boston, MA, USA
| | - Mark Green
- Department of Plastic and Oral Surgery, USA; Harvard Medical School, Boston, MA, USA
| | - Caroline D Robson
- Department of Neuroradiology, USA; Harvard Medical School, Boston, MA, USA
| | - Karen Marcus
- Department of Radiation Oncology, USA; Harvard Medical School, Boston, MA, USA
| | - Jennifer Mack
- Department of Hematology and Oncology, USA; Harvard Medical School, Boston, MA, USA
| | - Antonio Perez-Atayde
- Department of Pathology, Boston Children's Hospital, USA; Harvard Medical School, Boston, MA, USA
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement, USA; Harvard Medical School, Boston, MA, USA
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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: 9] [Impact Index Per Article: 3.0] [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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Long-term disease-free survival following salvage brachytherapy for recurrent pediatric rhabdomyosarcoma: Two case reports and review of relevant literature. Brachytherapy 2022; 21:494-500. [PMID: 35514002 DOI: 10.1016/j.brachy.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Rhabdomyosarcoma (RMS) is the most common pediatric soft-tissue sarcoma, mostly involving the genitourinary (GU) tract, head and neck, and extremities. This study reports the long-term outcome of two infants with recurrent GU-RMS who underwent combination therapy with chemotherapy (ChT) and salvage brachytherapy (BT). METHODS AND MATERIALS An 18-month-old girl with vaginal bleeding and a 7-month-old boy with urinary retention presented with a diagnosis of vaginal, and bladder/prostate embryonal RMS, respectively. Surgical resection and ChT were done for both patients. However, both developed local recurrences after one year and subsequently, underwent second-line ChT and salvage interstitial high dose rate BT. RESULTS The clinical target volumes for the first and second patients were treated to a totaldose of 32 Gy in 10 fractions and 35 Gy in 10 fractions, respectively, with two fractions delivered per day with a 6-h interval between fractions. After 9 years of follow-up, both patients are alive with natural growth and no late complication or evidence of recurrence. CONCLUSIONS Our report shows that BT (for patients with no prior history of irradiation) could result in long-term disease-free survival in well-selected pediatric patients with recurrent GU embryonal RMS without inflicting expected adverse effects of external beam radiotherapy.
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8
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Hassan MN, Wan Hitam WH, Masnon NA, Nadarajan C. Non-orbital Sclerosing Rhabdomyosarcoma Presented With Optic Neuropathy. Cureus 2022; 14:e21062. [PMID: 35155025 PMCID: PMC8826018 DOI: 10.7759/cureus.21062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 12/03/2022] Open
Abstract
Sclerosing rhabdomyosarcoma presentations are widely variable and non-specific initial features. We report a rare case of non-orbital sclerosing rhabdomyosarcoma presented with optic neuropathy. A 15-year-old female patient initially presented with upper gum swelling and pain for 3 months. It was associated with loosening of teeth. Subsequently, the patient developed recurrent epistaxis follow by left facial swelling and blurring of vision. Examination showed marked left facial swelling with mild proptosis. Visual acuity in the left eye was no perception of light with the presence of relative afferent pupillary defect. Fundoscopy showed left optic atrophy. Neuroimaging showed large aggressive soft tissue mass on the left infratemporal, masticator, and parapharyngeal space with a local extension to the sphenoid sinus. There was also an intracranial extension to the left temporal lobe with the base of skull bone destruction. Transnasal endoscopic biopsy revealed sclerosing rhabdomyosarcoma. Management was with chemotherapy. Sclerosing rhabdomyosarcoma may present with optic nerve involvement that may carry a guarded prognosis to the eyes.
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Abstract
BACKGROUND There are various options for the conservative treatment of the most frequent orbital tumors. These can delay, complement or be superior to the surgical approach, which is often prone to complications. OBJECTIVE This article gives a summary of the possible treatment options for the most common orbital tumors in childhood and adulthood. METHODS A literature search was carried out and the possible treatment pathways are presented. RESULTS 1. Frequent orbital tumors in childhood: a systemic treatment with noncardioselective beta blockers is the primary treatment for capillary orbital hemangiomas. In cases of no response, steroids, interferon alpha or cyclophosphamide are treatment options. Observation is a possible option for smaller dermoid cysts, in cases of progression excision can become necessary. Symptomatic optic nerve gliomas can also be observed and in cases of progression treated with chemotherapy, mTOR/MEK inhibitors or radiotherapy (children > 5 years). Rhabdomyosarcomas are biopsied and subsequently treated by radiotherapy and chemotherapy. 2. Frequent orbital tumors in adulthood: asymptomatic cases of cavernous hemangiomas of the orbit can just be observed. Symptomatic hemangiomas can be surgically excised or treated with radiotherapy. For meningiomas of the optic nerve sheath radiotherapy is a very effective treatment. Surgical excision should be reserved for cases with no prognosis of visual acuity. There is also the option to treat with antiprogesterone. Orbital lymphomas with purely orbital involvement can be treated with radiotherapy, chemotherapy or the application of rituximab. CONCLUSION There are now very effective conservative treatment options for many orbital tumors. In some cases a surgical procedure can be avoided and a good visual function can be retained.
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10
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Population-based survival of pediatric rhabdomyosarcoma of the head and neck over four decades. Int J Pediatr Otorhinolaryngol 2021; 142:110599. [PMID: 33422992 DOI: 10.1016/j.ijporl.2020.110599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/04/2020] [Accepted: 12/26/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Clinical trials have reported increases in the survival of pediatric rhabdomyosarcoma (RMS) from 25% in 1970 to 73% in 2001. The purpose of this study was to examine whether survival of pediatric patients with RMS of the head and neck improved at the US population level. METHODS A population-based cohort of patients with rhabdomyosarcoma of the head and neck aged 0-19 years in the Surveillance, Epidemiology, and End Results (SEER) registry from 1973 to 2013 was queried. The cumulative incidence competing risks (CICR) method was used to estimate risk and survival trends. RESULTS 718 cases were identified for analysis. Survival rates at 1-, 5-, and 10-years after diagnosis were 91.2%, 73.2%, and 69.4% respectively. Survival rates at 1 year after diagnosis increased from 82.6% to 93.1% during the study period. In the subdistributional hazard analysis, there was a significantly improved disease-specific risk of death in the first year after diagnosis. Overall risk of death did not improve significantly. Favorable prognostic factors included age <10 years at diagnosis, smaller tumor size, absence of distant metastasis, localized tumors, earlier stage at presentation, grossly complete surgical resection, and embryonal or botryoid histology. CONCLUSIONS Disease-specific survival in the first year following diagnosis improved, but the change in overall survival at the population level was not statistically significant. These findings should be interpreted in light of the inclusion of patients with distant metastasis at diagnosis, who have poor prognoses, together with the limited statistical power afforded in studies of rare diseases.
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11
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Perfect prognosis of a boy with alveolar rhabdomyosarcoma of the nasal wing treated with brachytherapy and chemotherapy. Chin Med J (Engl) 2020; 134:370-372. [PMID: 33522729 PMCID: PMC7846419 DOI: 10.1097/cm9.0000000000001188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ning Z, Liu X, Qin G, Wei L, Li X, Shen J. Evaluation of clinical efficacy of Chemotherapy for Rhabdomyosarcoma in children. Pak J Med Sci 2020; 36:1069-1074. [PMID: 32704291 PMCID: PMC7372667 DOI: 10.12669/pjms.36.5.1829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 06/10/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the clinical characteristics and treatment methods of rhabdomyosarcoma in children and the efficacy of the methods. METHODS The clinical data of 30 children with rhabdomyosarcoma who were admitted to our hospital from August 2013 to August 2017 were retrospectively analyzed. The clinical characteristics were summarized, and the curative effect and prognosis were evaluated. RESULTS Among all the children (N=30), there were 20 males and 10 females, with a median age of 3.5 years. As to the primary site, there were 13 cases of head and neck, 11 cases of trunk, three cases of urogenital system and three cases of limbs. There were 25 cases of embryonic type, 4 cases of alveolar type and one case of polymorphic type. As regards clinical stage, there were one case of stage I, 9 cases of stage II, 13 cases of stage III and 7 cases of stage IV. There were one case of low risk, 19 cases of medium risk and 10 cases of high risk. Eight cases received surgery alone, 22 cases received combined treatment of surgery and chemotherapy (the chemotherapeutics followed three schemes, low-risk group (VAC+VA), moderate risk group (VAC) and high risk group (alternating use of VDC and IE). Among all the cases (N=30), there were 14 cases of complete remission (CR), five cases of partial remission (PR), four cases of stable disease (SD), and 7 cases of progressive disease (PD). The CR rate was (N=14, 46.7%). The three-year overall survival (OS) rate was (N=19, 63.3%). The clinical efficacy and prognosis of children receiving surgery and chemotherapy were better than those of children receiving surgery alone, and the difference was statistically significant (P<0.05). CONCLUSION Rhabdomyosarcoma in children frequently happens in the head, neck and trunk. Embryonic type is the main pathological type of rhabdomyosarcoma. Comprehensive and standardized treatment based on surgery and chemotherapy is an important way to improve the curative effect in the treatment of rhabdomyosarcoma in children.
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Affiliation(s)
- Zhaohui Ning
- Zhaohui Ning, Department of Traditional Chinese Medicine, Taian City Central Hospital, Shandong, 271000, China
| | - Xiping Liu
- Xiping Liu, Department of Tumor Minimally Invasive, Taian City Central Hospital, Shandong, 271000, China
| | - Guang Qin
- Guang Qin, Department of Oncology, Taian City Central Hospital, Shandong, 271000, China
| | - Lei Wei
- Lei Wei, Department of Traditional Chinese Medicine, Taian City Central Hospital, Shandong, 271000, China
| | - Xia Li
- Xia Li, Department of Pediatric, Taian City Central Hospital, Shandong, 271000, China
| | - Jingjing Shen
- Jingjing Shen, Department of Pediatric, Taian City Central Hospital, Shandong, 271000, China
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13
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Rastatter JC, Sinard RN, Dilger A, Reichek J, Walterhouse DO, Patel U. Survival of Patients With Non-Rhabdomyosarcoma Soft Tissue Sarcomas of the Head and Neck. Laryngoscope 2020; 131:E500-E508. [PMID: 32531087 DOI: 10.1002/lary.28789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate factors associated with overall survival (OS) of patients with non-rhabdomyosarcoma soft tissue sarcomas of the head and neck. STUDY DESIGN Retrospective cohort study. METHODS The National Cancer Database was queried for cases of non-rhabdomyosarcoma soft tissue sarcomas of the head and neck between 2004 and 2014. Cases were categorized according to the World Health Organization classification of soft tissue tumors. A multivariable Cox proportional hazards model was used to evaluate associations with OS. RESULTS A total of 4,555 patients (63.6% male, 36.4% female, mean age 59.6 years) met inclusion criteria. The majority of tumors were classified as miscellaneous (35.9%), followed by vascular (20.1%), smooth muscle (13.5%), fibroblastic/myofibroblastic (12.1%), peripheral nerve (8.5%), adipocytic (7.4%), and undifferentiated (2.5%) sarcomas. The mean follow-up was 37.9 months, and overall mortality (MR) was 45.3%. The best prognosis was seen with fibroblastic/myofibroblastic sarcomas (MR = 20.6%, P < .001), whereas vascular sarcomas had the worst prognosis (MR = 67.6%, P < .001). Resection with clear margins had better OS than microscopically positive margins (hazard ratio [HR] = 1.43, P < .001) or grossly positive margins (HR = 2.97, P < .001). Radiation therapy was associated with better OS than no radiation (HR = 0.86, P = .001). CONCLUSION Non-rhabdomyosarcoma soft tissue sarcomas of the head and neck are associated with significant mortality. OS differs based on histologic subcategorization. Resection of the primary tumor with clear margins demonstrates improved OS for all histologies, suggesting this modality remains the preferred primary treatment when feasible. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E500-E508, 2021.
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Affiliation(s)
- Jeffrey C Rastatter
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Rebecca N Sinard
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Amanda Dilger
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Jennifer Reichek
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Division of Hematology, Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - David O Walterhouse
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Division of Hematology, Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Urjeet Patel
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
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李 笑, 彭 金, 刘 柱, 崔 哲, 张 普, 金 红. [Clinical analysis of 35 cases of adult rhabdomyosarcoma of nasal cavity and sinuses]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:223-226. [PMID: 32791587 PMCID: PMC10127844 DOI: 10.13201/j.issn.2096-7993.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Indexed: 11/12/2022]
Abstract
Objective:To investigate the clinical characteristics and prognostic factors of adult rhabdomyosarcoma(RMS) of nasal cavity and sinus. Method:There were 35 adult patients with RMS, including 22 with embryonal type and 13 with acinar type. Surgery + chemoradiotherapy(17 cases), surgery + radiotherapy(6 cases), surgery + chemotherapy(7 cases)(4 cases of seed implantation after surgery and chemotherapy); Five patients were treated with antitumor drugs instead of surgery. Result:The study follow-up 9-62 months, adult nasal sinuses RMS total 5 years survival rate was 2.9%, among them the IRS stage>Ⅱ period, the infiltration of the skull base tumor, local lymph node metastasis, tumor diameter of 5 cm or more, 50% or higher Ki-67 are poor prognosis factor. Conclusion:RMS in nasal cavity and sinus are mostly embryonal type in adults, and the 5-year overall survival rate is low, which is related to larger primary tumor volume, local lymph node metastasis, skull base infiltration and higher ki-67 ratio at the first diagnosis in adults.
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Affiliation(s)
- 笑秋 李
- 郑州大学第一附属医院鼻科(郑州,450052)Department of Rhinology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - 金林 彭
- 郑州大学第一附属医院鼻科(郑州,450052)Department of Rhinology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - 柱 刘
- 郑州市中心医院耳鼻咽喉科Department of Otolaryngology, Zhengzhou Central Hospital
| | - 哲卿 崔
- 郑州大学第一附属医院鼻科(郑州,450052)Department of Rhinology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - 普文 张
- 郑州大学第一附属医院鼻科(郑州,450052)Department of Rhinology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - 红军 金
- 郑州大学第一附属医院鼻科(郑州,450052)Department of Rhinology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
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15
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Li W, Lu H, Wang D. Therapeutic outcome and prognostic factors in sinonasal rhabdomyosarcoma: a single-institution case series. J Cancer Res Clin Oncol 2019; 145:2793-2802. [PMID: 31444550 DOI: 10.1007/s00432-019-03009-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/19/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this study was to explore the demographics, multimodality therapeutic outcomes*** and prognostic factors in sinonasal rhabdomyosarcoma (SNRMS). METHODS We conducted a retrospective analysis of 40 patients who underwent treatment of SNRMS from March 2007 to March 2018. The Kaplan-Meier method and the log-rank test were used to assess survival rates. The Cox regression model was used for multivariate survival analysis. RESULTS In total, 25 males and 15 females were included in the study; the median age was 33 years (range, 2-67 years). All patients underwent surgical resection, and surgery prior to or after adjuvant therapy (chemotherapy and radiotherapy) was performed in 91.4% of the patients. The overall 1-, 3- and 5-year survival rates were 77.0%, 46.5% and 46.5%, respectively, during a mean follow-up time of 27.9 (range, 2-128) months in all patients. The log-rank test showed Intergroup Rhabdomyosarcoma Study (IRS) group and infiltration of the skull base influenced overall survival (p = 0.001; p = 0.022). Advanced IRS stage, lymph node metastasis and tumor size ≥ 5 cm were also associated with an unfavorable outcome on overall survival (p = 0.01; p = 0.035; p = 0.02). The results of multivariate regression analysis showed patients with IRS group I were associated with better prognosis outcome on overall survival. CONCLUSION Patients with SNRMS have poor 5-year overall survival, and IRS group is the independent prognostic factor for overall survival.
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Affiliation(s)
- Wanpeng Li
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, 83 Fen Yang Road, Shanghai, 200031, China
| | - Hanyu Lu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, 83 Fen Yang Road, Shanghai, 200031, China
| | - Dehui Wang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, 83 Fen Yang Road, Shanghai, 200031, China.
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Casey DL, Wexler LH, Wolden SL. Worse Outcomes for Head and Neck Rhabdomyosarcoma Secondary to Reduced-Dose Cyclophosphamide. Int J Radiat Oncol Biol Phys 2019; 103:1151-1157. [PMID: 30508617 PMCID: PMC6441953 DOI: 10.1016/j.ijrobp.2018.11.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Recent trends, including the use of proton therapy and administration of reduced doses of cyclophosphamide, have been adapted in head and neck (HN) rhabdomyosarcoma (RMS) to reduce late morbidity. Our primary goal was to analyze local control and survival outcomes after photon versus proton irradiation in pediatric patients with HN-RMS, with the secondary goal of analyzing the effect of cyclophosphamide dose on disease outcomes. METHODS AND MATERIALS This single-institution cohort study comprised 76 pediatric HN-RMS patients treated with definitive chemoradiation from 2000 to 2018. Fifty-one patients (67%) received intensity modulated photon radiation therapy, and 25 (33%) received proton therapy. RESULTS Local failure (LF) at 2 years was 12.5% for parameningeal RMS and 0% for orbital RMS and other head and neck sites (P = .24). Patients treated with protons were more likely to have received reduced-dose cyclophosphamide (P < .0001). The 2-year LF was 7.9% in the intensity modulated photon radiation therapy cohort versus 14.6% in the proton cohort (P = .07), with no difference in survival outcomes. Cumulative cyclophosphamide dose was significantly associated with 2-year LF: 0% for cumulative dose of >20 g/m2 versus 15.3% for ≤20 g/m2 (P = .04). In parameningeal RMS patients (n = 59), both cumulative cyclophosphamide dose and dose intensity were associated with LF (P = .01). There was a trend toward worse event-free survival for parameningeal RMS patients who received reduced-dose-intensity cyclophosphamide (59.2% vs 70.6%, P = .11). CONCLUSIONS Both dose-intensity and cumulative cyclophosphamide dose seem to play an important role in achieving local control for HN-RMS patients treated with either protons or photons. Longer follow-up is needed to further assess disease outcomes with proton therapy.
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MESH Headings
- Adolescent
- Antineoplastic Agents, Alkylating/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child
- Child, Preschool
- Combined Modality Therapy/methods
- Cyclophosphamide/administration & dosage
- Female
- Head and Neck Neoplasms/drug therapy
- Head and Neck Neoplasms/mortality
- Head and Neck Neoplasms/radiotherapy
- Head and Neck Neoplasms/surgery
- Humans
- Male
- Neoplasm Recurrence, Local
- Proton Therapy/adverse effects
- Proton Therapy/methods
- Proton Therapy/statistics & numerical data
- Radiotherapy Dosage
- Radiotherapy, Adjuvant/methods
- Radiotherapy, Intensity-Modulated/adverse effects
- Radiotherapy, Intensity-Modulated/methods
- Radiotherapy, Intensity-Modulated/statistics & numerical data
- Relative Biological Effectiveness
- Rhabdomyosarcoma, Alveolar/drug therapy
- Rhabdomyosarcoma, Alveolar/mortality
- Rhabdomyosarcoma, Alveolar/radiotherapy
- Rhabdomyosarcoma, Alveolar/surgery
- Rhabdomyosarcoma, Embryonal/drug therapy
- Rhabdomyosarcoma, Embryonal/mortality
- Rhabdomyosarcoma, Embryonal/radiotherapy
- Rhabdomyosarcoma, Embryonal/surgery
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Dana L Casey
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Leonard H Wexler
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
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Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and represents a high-grade neoplasm of skeletal myoblast-like cells. Decades of clinical and basic research have gradually improved our understanding of the pathophysiology of RMS and helped to optimize clinical care. The two major subtypes of RMS, originally characterized on the basis of light microscopic features, are driven by fundamentally different molecular mechanisms and pose distinct clinical challenges. Curative therapy depends on control of the primary tumour, which can arise at many distinct anatomical sites, as well as controlling disseminated disease that is known or assumed to be present in every case. Sophisticated risk stratification for children with RMS incorporates various clinical, pathological and molecular features, and that information is used to guide the application of multifaceted therapy. Such therapy has historically included cytotoxic chemotherapy as well as surgery, ionizing radiation or both. This Primer describes our current understanding of RMS epidemiology, disease susceptibility factors, disease mechanisms and elements of clinical care, including diagnostics, risk-based care of newly diagnosed and relapsed disease and the prevention and management of late effects in survivors. We also outline potential opportunities to further translate new biological insights into improved clinical outcomes.
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Affiliation(s)
- Stephen X Skapek
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Abha A Gupta
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Erin Butler
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Janet Shipley
- Divisions of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, Belmont, UK
| | - Frederic G Barr
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Douglas S Hawkins
- Seattle Children's Hospital, University of Washington, and Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Embryonal Rhabdomyosarcoma (Botryoid Subtype) Affecting the Buccal Mucosa. Head Neck Pathol 2018; 13:671-676. [PMID: 30094776 PMCID: PMC6854166 DOI: 10.1007/s12105-018-0957-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
Rhabdomyosarcoma (RMS) is a rare oral malignant soft tissue tumor whose pathological features may influence the clinical behavior, treatment and prognosis of the lesion. We report a case of a 13-year-old female patient, presenting an asymptomatic polypoid swelling in the left buccal mucosa that was approximately 2.5 cm in diameter and 3 months evolution. The presumptive diagnosis was fibrous hyperplasia and an excisional biopsy was carried out. Pathologic analysis revealed proliferation of predominantly ovoid cells, with eosinophilic cytoplasm and pleomorphic nuclei, arranged in subepithelial cambium layer. The mucosal surface presented a papillary-verrucous appearance. Immunohistochemical analysis revealed intense positivity for desmin, myogenin and Ki-67. The diagnosis was of embryonal RMS (botryoid variant). The patient was subjected to complementary chemotherapy and radiotherapy, with no evidence of recurrence or metastatic disease after 12 months follow-up. A discussion on the clinical, histopathological, immunohistochemical and therapeutic aspects of botryoid RMS will be provided.
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