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The impact of surgical excision in chest wall rhabdomyosarcoma: a report from the Children's Oncology Group |
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| Authors: | Hayes-Jordan Andrea,Stoner Julie A,Anderson James R,Rodeberg David,Weiner Gene,Meyer William H,Hawkins Doug S,Arndt Carola A S,Paidas Charles Children's Oncology Group |
| Affiliation: | a University of Texas MD Anderson Cancer Center, Box 87, Houston, TX 77030, USA b Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA c Department of Pediatric Surgery, University of Pittsburgh, Pittsburgh, PA, USA d Pediatric Hematology Oncology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA e Pediatric Hematology Oncology, Seattle Children's Hospital, Seattle, WA, USA f Pediatric Hematology Oncology, Mayo Clinic, Rochester, MN, USA g Department of Pediatric Surgery, Tampa Bay, Tampa, FL, USA |
| Abstract: | AimsRhabdomyosarcoma (RMS) is the most common soft tissue tumor of childhood. Patient age, size, histologic finding, and site of the tumor are primary determinants of prognosis in RMS. Chest wall RMS is a site in which the limitations of surgical excision are realized. We aim to determine the impact of surgical excision in chest wall RMS.MethodsA retrospective chart review was conducted of all 130 pediatric patients enrolled in the Intergroup Rhabdomyosarcoma Study (IRS) with chest wall rhabdomyosarcoma from the first (I) through fourth (IV) IRS with follow-up to June 2005. Median follow-up was 12.1 years (4.6-27.2 years).ResultsThere was a significant improvement in failure-free survival (FFS) and overall survival (OS) between the first IRS study, I, and IRS-IV. The estimated FFS and OS at 5 years in IRS I was 30% and 40%, respectively, compared to 68% and 78%, respectively, in IRS-IV (P = .03 and P = .05, respectively). There was no association between histologic finding or size and FFS or OS. However, all patients who presented without metastasis had an FFS and OS of 49% and 61%, respectively, compared with metastatic patients, 7% and 7%, respectively (P < .001). Five-year FFS of group I, II, and III patients was 52%, 52%, and 45%, respectively, and OS was 65%, 60%, and 59%, respectively. There was no significant difference in 5-year FFS or OS in patients who had a complete resection (group I), complete resection with positive microscopic margins (group II), or biopsy or partial resection only (group III). In groups I to III patients, the local and regional failure rate at 5 years is 25% and 6%, respectively.ConclusionsThe most significant impact on outcome in chest wall RMS patients is metastatic disease at diagnosis. The locoregional failure rate is high but does not appear to impact survival. Alternative treatment strategies are needed for chest wall RMS, but aggressive surgical excision may not be necessary. |
| Keywords: | Rhabdomyosarcoma Childhood Chest wall |
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