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Bisogno G, Minard-Colin V, Jenney M, Ferrari A, Chisholm J, Di Carlo D, Hjalgrim LL, Orbach D, Merks JHM, Casanova M. Maintenance Chemotherapy for Patients with Rhabdomyosarcoma. Cancers (Basel) 2023; 15:4012. [PMID: 37568826 PMCID: PMC10417571 DOI: 10.3390/cancers15154012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Maintenance chemotherapy (MC) defines the administration of prolonged relatively low-intensity chemotherapy with the aim of "maintaining" tumor complete remission. This paper aims to report an update of the RMS2005 trial, which demonstrated better survival for patients with high-risk localized rhabdomyosarcoma (RMS) when MC with vinorelbine and low-dose cyclophosphamide was added to standard chemotherapy, and to discuss the published experience on MC in RMS. In the RMS2005 study, the outcome for patients receiving MC vs. those who stopped the treatment remains superior, with a 5-year disease-free survival of 78.1% vs. 70.1% (p = 0.056) and overall survival of 85.0% vs. 72.4% (p = 0.008), respectively. We found seven papers describing MC in RMS, but only one randomized trial that did not demonstrate any advantage when MC with eight courses of trofosfamide/idarubicine alternating with trofosfamide/etoposide has been employed in high-risk RMS. The use of MC showed better results in comparison to high-dose chemotherapy in non-randomized studies, including metastatic patients, and demonstrated feasibility and tolerability in relapsed RMS. Many aspects of MC in RMS need to be investigated, including the best drug combination and the optimal duration. The ongoing EpSSG trial will try to answer some of these questions.
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Affiliation(s)
- Gianni Bisogno
- Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy;
- Pediatric Hematology Oncology Division, University Hospital of Padua, 35128 Padua, Italy
| | - Veronique Minard-Colin
- Department of Pediatric and Adolescent Oncology, Institut Gustave-Roussy, Université Paris-Saclay, 94800 Villejuif, France;
| | - Meriel. Jenney
- Department of Paediatric Oncology, Children’s Hospital for Wales, Heath Park, Cardiff CF14 4XW, UK;
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (A.F.); (M.C.)
| | - Julia Chisholm
- Children and Young People’s Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton SM2 5PT, UK;
| | - Daniela Di Carlo
- Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy;
| | - Lisa Lyngsie Hjalgrim
- Department of Paediatric and Adolescent Medicine, University Hospital Copenhagen, 2100 Copenhagen, Denmark;
| | - Daniel Orbach
- SIREDO Oncology Centre (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris Sciences et Lettres L University, 75005 Paris, France;
| | - Johannes Hendrikus Maria Merks
- Princess Máxima Centre for Pediatric Oncology, 3584 CS Utrecht, The Netherlands;
- Division of Imaging and Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (A.F.); (M.C.)
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Bisogno G, Minard-Colin V, Zanetti I, Ferrari A, Gallego S, Dávila Fajardo R, Mandeville H, Kelsey A, Alaggio R, Orbach D, Terwisscha van Scheltinga S, Guillén Burrieza G, Ben-Arush M, Glosli H, Mudry P, Ferman S, Devalck C, Defachelles AS, Merks JHM, Jenney M. Nonmetastatic Rhabdomyosarcoma in Children and Adolescents: Overall Results of the European Pediatric Soft Tissue Sarcoma Study Group RMS2005 Study. J Clin Oncol 2023; 41:2342-2349. [PMID: 36848614 DOI: 10.1200/jco.22.02093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The RMS2005 study included two phase III randomized trials for high-risk (HR) and observational trials for low (LR), standard (SR), and very high-risk (VHR) patients who have been partially reported. Herein, we present a comprehensive report of results achieved for the complete unselected nonmetastatic cohort and analyze the evolution of treatment in comparison with previous European protocols. After a median follow-up of 73.1 months, the 5-year event-free survival (EFS) and overall survival (OS) of the 1,733 patients enrolled were 70.7% (95% CI, 68.5 to 72.8) and 80.4% (95% CI, 78.4 to 82.3), respectively. The results by subgroup: LR (80 patients) EFS 93.7% (95% CI, 85.5 to 97.3), OS 96.7% (95% CI, 87.2 to 99.2); SR (652 patients) EFS 77.4% (95% CI, 73.9 to 80.5), OS 90.6% (95% CI, 87.9 to 92.7); HR (851 patients) EFS 67.3% (95% CI, 64.0 to 70.4), OS 76.7% (95% CI, 73.6 to 79.4); and VHR (150 patients) EFS 48.8% (95% CI, 40.4 to 56.7), OS 49.7% (95% CI, 40.8 to 57.9). The RMS2005 study demonstrated that 80% of children with localized rhabdomyosarcoma could be long-term survivors. The study has established the standard of care across the European pediatric Soft tissue sarcoma Study Group countries with the confirmation of a 22-week vincristine/actinomycin D regimen for LR patients, the reduction of the cumulative ifosfamide dose in the SR group, and for HR disease, the omission of doxorubicin and the addition of maintenance chemotherapy.
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Affiliation(s)
- Gianni Bisogno
- Pediatric Hematology Oncology Division, University Hospital of Padua, Padua, Italy
| | - Veronique Minard-Colin
- Department of Pediatric and Adolescent Oncology, Gustave-Roussy, Université Paris-Saclay, Villejuif, France
| | - Ilaria Zanetti
- Pediatric Hematology Oncology Division, University Hospital of Padua, Padua, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Soledad Gallego
- Department of Pediatric Oncology and Hematology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Raquel Dávila Fajardo
- Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Henry Mandeville
- Department of Radiotherapy, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, Surrey, United Kingdom
| | - Anna Kelsey
- Department of Paediatric Histopathology, Manchester University Foundation Trust, Manchester, United Kingdom
| | - Rita Alaggio
- Pathology Unit, Department of Laboratories, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy
| | - Daniel Orbach
- SIREDO Oncology Center, Institut Curie, PSL University, Paris, France
| | | | | | - Myriam Ben-Arush
- Rambam Medical Center, Joan and Sanford Weill Pediatric Hematology Oncology and Bone Marrow Transplantation Division, Ruth Rappaport Children's Hospital, Haifa, Israel
| | - Heidi Glosli
- Centre for Rare Disorders, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Peter Mudry
- Pediatric Oncology, Department University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Sima Ferman
- Pediatric Oncology Department, National Cancer Institute, Rio de Janeiro, Brazil
| | - Christine Devalck
- Pediatric Hematology and Oncology, Hôpital Universitaire des Enfants Reine Fabiola, HUDERF, ULB, HUB, Brussels, Belgium
| | | | - Johannes Hendrikus Maria Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Meriel Jenney
- Department of Paediatric Oncology, Children's Hospital for Wales, Heath Park, Cardiff, United Kingdom
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Vaarwerk B, Limperg PF, Naafs-Wilstra MC, Merks JHM, Grootenhuis MA. Getting control during follow-up visits: the views and experiences of parents on tumor surveillance after their children have completed therapy for rhabdomyosarcoma or Ewing sarcoma. Support Care Cancer 2019; 27:3841-3848. [PMID: 30747278 PMCID: PMC6726689 DOI: 10.1007/s00520-019-04678-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/28/2019] [Indexed: 11/24/2022]
Abstract
Purpose Patients treated for rhabdomyosarcoma (RMS) or Ewing sarcoma (ES) are subject to extensive follow-up after completion of therapy. The aim of this follow-up is to monitor treatment side effects and to detect relapse in an early phase to improve prognosis after relapse. Little is known about parental emotional experiences during this period. We assessed the views and experiences of parents of children treated for RMS or ES on the follow-up examinations after completion of therapy. Methods We conducted two focus group meetings and four semi-structured telephone interviews with parents of children treated for RMS or ES in Dutch pediatric oncology centers. Parents of children 0–5 years after end-of-therapy were invited via letters (response rate 31%) and via social media channels of “Dutch Childhood Association for Children and Parents” (VOKK). An inductive thematic approach was used to analyze the data. Results In total, 12 parents (fathers, n = 3; mothers, n = 9) of 12 patients treated for RMS (n = 6) or ES (n = 6) participated. Median age at diagnosis for their children was 7.9 years and median time after end-of-treatment was 37 months. Four major themes were identified: content of follow-up, distress and anxiety, search for reassurance and hope, and interaction with others. Parents of children treated for RMS or ES report experiencing significant distress after completion of treatment. They report that their distress was decreased by adequate communication about content, timing, and reasoning behind follow-up. Conclusion Physicians should pay attention to the needs of individual parents to reduce distress in the period after completion of therapy.
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Affiliation(s)
- B Vaarwerk
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. .,Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584 CS, Utrecht, The Netherlands.
| | - P F Limperg
- Paediatric Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - J H M Merks
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584 CS, Utrecht, The Netherlands
| | - M A Grootenhuis
- Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584 CS, Utrecht, The Netherlands.,Paediatric Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Verly IRN, van Kuilenburg ABP, Abeling NGGM, Goorden SMI, Fiocco M, Vaz FM, van Noesel MM, Zwaan CM, Kaspers GJL, Merks JHM, Caron HN, Tytgat GAM. 3-Methoxytyramine: An independent prognostic biomarker that associates with high-risk disease and poor clinical outcome in neuroblastoma patients. Eur J Cancer 2017; 90:102-110. [PMID: 29274926 DOI: 10.1016/j.ejca.2017.11.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/15/2017] [Accepted: 11/23/2017] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Prognosis of neuroblastoma patients is very diverse, indicating the need for more accurate prognostic parameters. The excretion of catecholamine metabolites by most neuroblastomas is used for diagnostic purposes, but their correlation with prognosis has hardly been investigated. Therefore, we performed an in-depth analysis of a panel of elevated urinary catecholamine metabolites at diagnosis and their correlation with prognosis. PATIENTS AND METHODS Retrospective study of eight urinary catecholamine metabolites in a test (n = 96) and validation (n = 205) cohort of patients with neuroblastoma (all stages) at diagnosis. RESULTS Multivariate analyses, including risk factors such as stage and MYCN amplification, revealed that 3-methoxytyramine (3MT) was an independent risk factor for event-free survival (EFS) and overall survival (OS). Furthermore, only 3MT appeared to be an independent risk factor for both EFS and OS in high-risk patients, which was independent of modern high-risk therapy and immunotherapy. Among high-risk patients, those with elevated 3MT and older than 18 months had an extremely poor prognosis compared to patients with non-elevated 3MT and younger than 18 months (5-year EFS of 14.3% ± 4% and 66.7% ± 18%, respectively, p = 0.001; 5-year OS of 21.8% ± 5% and 87.5% ± 12%, respectively, p < 0.001). CONCLUSIONS Elevated 3MT at diagnosis was associated with high-risk disease and poor prognosis. For high-risk patients, elevated 3MT at diagnosis was the only significant risk factor for EFS and OS. 3MT was also able to identify subgroups of high-risk patients with favourable and extremely poor prognosis.
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Affiliation(s)
- I R N Verly
- Department of Pediatric Oncology/Hematology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands; Laboratory Genetic Metabolic Diseases, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands; Princess Máxima Center for Pediatric Oncology/Hematology, Utrecht, The Netherlands
| | - A B P van Kuilenburg
- Laboratory Genetic Metabolic Diseases, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - N G G M Abeling
- Laboratory Genetic Metabolic Diseases, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - S M I Goorden
- Laboratory Genetic Metabolic Diseases, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - M Fiocco
- Mathematical Institute, Leiden University, Leiden, The Netherlands; Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - F M Vaz
- Laboratory Genetic Metabolic Diseases, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - M M van Noesel
- Princess Máxima Center for Pediatric Oncology/Hematology, Utrecht, The Netherlands; University Medical Center Utrecht, Utrecht, The Netherlands
| | - C M Zwaan
- Department of Pediatric Oncology/Hematology, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | - G J L Kaspers
- Princess Máxima Center for Pediatric Oncology/Hematology, Utrecht, The Netherlands; Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - J H M Merks
- Department of Pediatric Oncology/Hematology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands; Princess Máxima Center for Pediatric Oncology/Hematology, Utrecht, The Netherlands
| | - H N Caron
- Department of Pediatric Oncology/Hematology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - G A M Tytgat
- Department of Pediatric Oncology/Hematology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands; Princess Máxima Center for Pediatric Oncology/Hematology, Utrecht, The Netherlands.
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Pleunis N, Breunis WB, Merks JHM, Bouwma AE, van der Steeg JW. [A toddler with a vaginal mass and blood loss; the rhabdomyosarcoma]. Ned Tijdschr Geneeskd 2017; 161:D1674. [PMID: 28914211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The differential diagnosis of vaginal blood loss in childhood is broad, and includes irritation of the mucous membranes, trauma, tumours, foreign bodies and sexual abuse. Physical and additional examination is often initially difficult; however, prompt detection of a rhabdomyosarcoma, a soft-tissue tumour principally diagnosed in childhood, is vitally important. CASE DESCRIPTION A 3-year-old girl with a history of vaginal blood loss and an introital mass was referred to the gynaecologist. Treatment with oestriol and triamcinolone cream did not lead to healing. Pathological examination of a biopsy taken under general anaesthetic indicated an embryonic rhabdomyosarcoma. Chemotherapy, surgical resection and brachytherapy lead to persistent remission of the tumour. CONCLUSION Because rhabdomyosarcoma is rare and can present atypically, diagnosis can be delayed. Early recognition is, however, essential and this condition should be placed high in the differential diagnosis by vaginal blood loss or vaginal abnormality in childhood.
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Affiliation(s)
- N Pleunis
- Jeroen Bosch Ziekenhuis, afd. Obstetrie & Gynaecologie 's-Hertogenbosch
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Schoot RA, Theunissen EAR, Slater O, Lopez-Yurda M, Zuur CL, Gaze MN, Chang YC, Mandeville HC, Gains JE, Rajput K, Pieters BR, Davila Fajardo R, Talwar R, Caron HN, Balm AJM, Dreschler WA, Merks JHM. Hearing loss in survivors of childhood head and neck rhabdomyosarcoma: a long-term follow-up study. Clin Otolaryngol 2016; 41:276-83. [PMID: 26293165 DOI: 10.1111/coa.12527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the hearing status of survivors treated for head and neck rhabdomyosarcoma (HNRMS) at long-term follow-up. DESIGN Cross-sectional long-term follow-up study. SETTING Tertiary comprehensive cancer centre. PARTICIPANTS Survivors treated for HNRMS during childhood in two concurrent cohorts; survivors in London had been treated with external beam radiotherapy (EBRT-based local therapy); survivors in Amsterdam were treated with AMORE (Ablative surgery, MOuld technique afterloading brachytherapy and surgical REconstruction) if feasible, otherwise EBRT (AMORE-based local therapy). MAIN OUTCOME MEASURES We assessed hearing status of HNRMS survivors at long-term follow-up. Hearing thresholds were obtained by pure-tone audiometry. METHODS We assessed the hearing thresholds, the number of patients with clinically relevant hearing loss and hearing impairment graded according to the Common Terminology Criteria for Adverse Events version 4.0 (CTCAEv4) and Boston criteria. Furthermore, we compared hearing loss between survivors treated with EBRT-based local therapy (London) and AMORE-based local therapy (Amsterdam). RESULTS Seventy-three survivors were included (median follow-up 11 years). We found clinically relevant hearing loss at speech frequencies in 19% of survivors. Multivariable analysis showed that survivors treated with EBRT-based treatment and those with parameningeal tumours had significantly more hearing impairment, compared to survivors treated with AMORE-based treatment and non-parameningeal tumours. CONCLUSIONS One in five survivors of HNRMS developed clinically relevant hearing loss. AMORE-based treatment resulted in less hearing loss compared to EBRT-based treatment. As hearing loss was highly prevalent and also occurred in survivors with orbital primaries, we recommend systematic audiological follow-up in all HNRMS survivors.
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Affiliation(s)
- R A Schoot
- Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands
| | - E A R Theunissen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - O Slater
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M Lopez-Yurda
- Department of Epidemiology and Biostatistics, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - C L Zuur
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M N Gaze
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Y-C Chang
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - H C Mandeville
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - J E Gains
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - K Rajput
- Department of Audiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - B R Pieters
- Department of Radiation Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - R Davila Fajardo
- Department of Radiation Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - R Talwar
- Department of Otorhinolaryngology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - H N Caron
- Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands
| | - A J M Balm
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - W A Dreschler
- Department of Audiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - J H M Merks
- Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands
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Ferrari A, De Salvo GL, Brennan B, van Noesel MM, De Paoli A, Casanova M, Francotte N, Kelsey A, Alaggio R, Oberlin O, Carli M, Ben-Arush M, Bergeron C, Merks JHM, Jenney M, Stevens MC, Bisogno G, Orbach D. Synovial sarcoma in children and adolescents: the European Pediatric Soft Tissue Sarcoma Study Group prospective trial (EpSSG NRSTS 2005). Ann Oncol 2014; 26:567-72. [PMID: 25488687 DOI: 10.1093/annonc/mdu562] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To report the results of the first European prospective nonrandomized trial dedicated to pediatric synovial sarcoma. PATIENTS AND METHODS From August 2005 to August 2012, 138 patients <21 years old with nonmetastatic synovial sarcoma were registered in 9 different countries (and 60 centers). Patients were treated with a multimodal therapy including ifosfamide-doxorubicin chemotherapy and radiotherapy, according to a risk stratification based on surgical stage, tumor size and site, and nodal involvement. RESULTS With a median follow-up of 52.1 months (range 13.8-104.4 months), event-free survival (EFS) was 81.9% and 80.7%, and overall survival (OS) was 97.2% and 90.7%, at 3 and 5 years, respectively. The only significant prognostic variable at univariate analysis was the risk group: 3-year EFS was 91.7% for low-risk, 91.2% for intermediate-risk, and 74.4% for high-risk cases. In 24 low-risk patients (completely resected tumor ≤5 cm in size) treated with surgery alone, there were two local relapses and no metastatic recurrences. Among 67 high-risk patients (unresected, or axial tumor or nodal involvement), 66 underwent surgery after neoadjuvant chemotherapy. Response to chemotherapy was 55.2%, including 22.4% cases with complete or major partial remissions, and 32.8% with minor partial remissions. CONCLUSION This study demonstrates that collaborative prospective studies on rare pediatric sarcomas are feasible even on a European scale, with excellent treatment compliance. The overall results of treatment were satisfactory, with higher survival rates than those previously published by pediatric groups. Nonetheless, larger, international projects are needed, based on a cooperative effort of pediatric and adult oncologists. CLINICAL TRIALS NUMBER European Union Drug Regulating Authorities Clinical Trials No. 2005-001139-31.
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Affiliation(s)
- A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - G L De Salvo
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - B Brennan
- Department of Pediatric Oncology, Royal Manchester Children's Hospital, Manchester, UK
| | - M M van Noesel
- Department of Pediatric Oncology-Hematology, Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - A De Paoli
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - M Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - N Francotte
- Department of Pediatrics, CHC-Clin Espérance, Montegnée, Belgium
| | - A Kelsey
- Department of Diagnostic Paediatric Histopathology, Royal Manchester Children's Hospital, Manchester, UK
| | - R Alaggio
- Department of Pathology, Padova University, Padova, Italy
| | - O Oberlin
- Department of Pediatrics, Institut Gustave Roussy, Villejuif, France
| | - M Carli
- Division of Pediatric Hematology and Oncology, Padova University, Padova, Italy
| | - M Ben-Arush
- Department of Pediatric Hematology Oncology, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - C Bergeron
- Department of Pediatric Oncology, Institut D'Hematologie et D'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - J H M Merks
- Department of Pediatric Oncology, Emma Children's Hospital-Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M Jenney
- Department of Pediatric Oncology, Children's Hospital for Wales, Heath Park, Cardiff
| | - M C Stevens
- Department of Pediatric Oncology, Royal Hospital for Children, University of Bristol, Bristol, UK
| | - G Bisogno
- Division of Pediatric Hematology and Oncology, Padova University, Padova, Italy
| | - D Orbach
- Department of Pediatric, Adolescent and Young Adult Oncology, Institut Curie, Paris, France
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8
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Merks JHM, De Salvo GL, Bergeron C, Bisogno G, De Paoli A, Ferrari A, Rey A, Oberlin O, Stevens MCG, Kelsey A, Michalski J, Hawkins DS, Anderson JR. Parameningeal rhabdomyosarcoma in pediatric age: results of a pooled analysis from North American and European cooperative groups. Ann Oncol 2014; 25:231-6. [PMID: 24356633 DOI: 10.1093/annonc/mdt426] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Parameningeal (PM) site is a well-known adverse prognostic factor in children with localized rhabdomyosarcoma (RMS). To identify risk factors associated with outcome at this site, we pooled data from 1105 patients treated in 10 studies conducted by European and North American cooperative groups between 1984 and 2004. PATIENTS AND METHODS Clinical factors including age, histology, size, invasiveness, nodal involvement, Intergroup Rhabdomyosarcoma Study (IRS) clinical group, site, risk factors for meningeal involvement (MI), study group, and application of radiotherapy (RT) were studied for their impact on event-free and overall survival (EFS and OS). RESULTS Ten-year EFS and OS were 62.6 and 66.1% for the whole group. Patients without initial RT showed worse survival (10-year OS 40.8% versus 68.5% for RT treated patients). Multivariate analysis focusing on 862 patients who received RT as part of their initial treatment revealed four unfavorable prognostic factors: age <3 or >10 years, signs of MI, unfavorable site, and tumor size. Utilizing these prognostic factors, patients could be classified into different risk groups with 10-year OS ranging between 51.1 and 80.9%. CONCLUSIONS While, in general, PM localization is regarded as an adverse prognostic factor, the current analysis differentiates those with good prognosis (36% patients with 0-1 risk factor: 10-year OS 80.9%) from high-risk PM patients (28% with 3-4 factors: 10-year OS 51.1%). Furthermore, this analysis reinforces the necessity for RT in PM RMS.
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Affiliation(s)
- J H M Merks
- Department of Pediatric Oncology, Emma Children's Hospital-Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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van den Berg H, Merks JHM. Incidence and grading of cranio-facial osteosarcomas. Int J Oral Maxillofac Surg 2013; 43:7-12. [PMID: 24035127 DOI: 10.1016/j.ijom.2013.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/30/2013] [Accepted: 06/03/2013] [Indexed: 11/27/2022]
Abstract
Osteosarcoma of the cranio-facial structures and skull is rare. In children, only 5.6% of cases are localized in these areas. It is claimed that the mean age at presentation is at least 10-15 years higher than for osteosarcomas in other parts of the body. However these reports are based on data from single institutions or compiled from several registries. It is further claimed that tumours in the mandible and maxilla are less malignant, as based on observations of a better prognosis and lower incidence of metastatic spread as compared with osteosarcomas arising elsewhere. We report all histologically proven cranio-facial osteosarcomas in The Netherlands occurring over a 20-year period, based on the national registration covering all Dutch pathology laboratories (PALGA). The age-corrected incidence of primary osteosarcoma ranged from 0.33 to 0.41 per million across the age ranges. The mandible was the most frequent site of involvement. Only 61% had a high malignant histological grading. Our data indicate that the age-corrected incidence of primary osteosarcomas is similar across all age ranges. In respect to histology, a lower grade of malignancy is more frequent. Maxillary lesions significantly more often have a lower histological grade of malignancy.
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Affiliation(s)
- H van den Berg
- Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, The Netherlands.
| | - J H M Merks
- Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, The Netherlands
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Faridpooya K, Mulder MMS, Merks JHM, de Smet MD, Pals ST, Saeed P. Precursor B lymphoblastic lymphoma of the orbit in a child: an unusual presentation of a non-Hodgkin lymphoma. Orbit 2006; 25:153-7. [PMID: 16754229 DOI: 10.1080/01676830600575501] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The majority of ocular adnexal lymphomas are marginal zone lymphomas, which occur rarely in children. This case report describes a 6 years old child with a precursor B lymphoblastic lymphoma presenting in the ocular adnexa. The combination of multi-agent chemotherapy with adjuvant radiotherapy seems to be necessary in order to achieve a complete remission of this subtype of lymphoma's in ocular adnexa. DESIGN Retrospective case study. METHOD A review of the clinical, pathological, radiological findings and follow-up in a patient from the files available at our center, which were reviewed between the years 1974 and 2004.
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Affiliation(s)
- K Faridpooya
- Department of Ophthalmology, Orbital Centre, Academic Medical Centre, Amsterdam, Holland.
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Buwalda J, Blank LECM, Schouwenburg PF, Copper MP, Strackee SD, Voûte PA, Merks JHM, Caron HN. The AMORE protocol as salvage treatment for non-orbital head and neck rhabdomyosarcoma in children. Eur J Surg Oncol 2005; 30:884-92. [PMID: 15336736 DOI: 10.1016/j.ejso.2004.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2004] [Indexed: 10/01/2022] Open
Abstract
AIM To investigate the feasibility and outcome of the AMORE protocol as salvage treatment in paediatric head and neck rhabdomyosarcoma (HNRMS). METHODS The AMORE protocol is a local treatment regimen, consisting of Ablative surgery, Moulage technique brachytherapy and surgical Reconstruction, scheduled in 1 week. Patients with recurrent or residual non-orbital HNRMS were eligible for AMORE salvage treatment. RESULTS The procedure was feasible in nine out of 11 eligible patients. Five patients were treated for recurrent or residual parameningeal RMS after prior chemoradiation. Local complete remission was achieved in all five patients and maintained in four. Three patients are without evidence of RMS with a follow-up duration of 4-10 years. Two patients developed a distant relapse, together with a local recurrence in one. Both patients died of their disease. Four patients were included for recurrent non-parameningeal HNRMS. Long-term local control at the site of recurrence was obtained in all four patients (follow-up 5-10 years). CONCLUSIONS The AMORE protocol is a feasible salvage strategy for non-orbital HNRMS even after external beam radiotherapy. The local salvage rate in this series is promising.
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Affiliation(s)
- J Buwalda
- Department of Otorhinolaryngology and Head and Neck Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
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Buwalda J, Schouwenburg PF, Blank LECM, Merks JHM, Copper MP, Strackee SD, Voûte PA, Caron HN. A novel local treatment strategy for advanced stage head and neck rhabdomyosarcomas in children: results of the AMORE protocol. Eur J Cancer 2003; 39:1594-602. [PMID: 12855267 DOI: 10.1016/s0959-8049(03)00363-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The AMORE protocol is a local treatment regimen for head and neck rhabdomyosarcomas (HNRMS), consisting of Ablative surgery, Moulage technique brachytherapy and surgical Reconstruction. The aim of AMORE is to intensify local treatment for children with HNRMS and to avoid external beam radiation therapy (EBRT) and its long-term sequelae. All children with primary irresectable, non-orbital HNRMS in whom EBRT was indicated, were evaluated for the feasibility of AMORE. In 20 children, AMORE was performed (15 with parameningeal disease and five with non-parameningeal disease). Complete remission was achieved in all 20 patients. Local complications were limited. 5 patients experienced a local relapse and 1 patient developed distant metastases. Estimated 5-year OS and EFS were 67.5 and 64.1% for the entire group, and 64.2 and 60.0% for the parameningeal subgroup. We conclude that the AMORE protocol is a feasible strategy, with a good local control rate. Long-term sequelae of EBRT might be avoided although, to date, the follow-up is too short for definitive conclusions regarding these sequelae.
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Affiliation(s)
- J Buwalda
- Department of Otolaryngology and Head and Neck Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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