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

Ralph P. Ermoian, John Breneman, David O. Walterhouse, Yueh Yun Chi, Jane Meza, James Anderson, Douglas S. Hawkins, Andrea A. Hayes-Jordan, David M. Parham, Torunn I. Yock, Sarah S. Donaldson, Suzanne L. Wolden

Research output: Contribution to journalArticle

Abstract

Background: Recent Children's Oncology Group (COG) trials tested the efficacy of reduced therapy in an effort to lessen late effects compared to the Intergroup Rhabdomyosarcoma Study (IRS) IV regimen with associated hematologic and hepatic toxicity, and infertility. Here, we analyze the efficacy of 45 Gray (Gy) local radiotherapy (RT) in patients with Group III orbital embryonal rhabdomyosarcoma (ERMS) enrolled on the COG low-risk study ARST0331. Procedure: Sixty-two patients with Group III orbital ERMS were treated on ARST0331 with four cycles of vincristine (VCR), dactinomycin (DACT), and cyclophosphamide (CPM; VAC, total cumulative CPM dose 4.8 g/m2) followed by four cycles of VCR and DACT over 22 weeks. Forty-five Gray of radiation was administered in 25 fractions beginning at week 13 of therapy. Results: Fifty-three patients were evaluable for this response analysis; seven had missing week 12 response evaluation data and two had progressive disease prior to starting RT. Median follow-up was 7.8 years. None of the 15 patients with radiographic complete response (CR) compared to 6 of the 38 patients with <CR after 12 weeks of VAC chemotherapy had local recurrences (P = 0.11). There was no difference in overall survival by response at week 12 (P = 0.52). Conclusions: For patients with Group III orbital ERMS achieving a CR following VAC chemotherapy that includes modest dose CPM, 45 Gy may be sufficient for durable failure-free survival. However, for those with <CR treated with the ARST0331 systemic therapy, a different local therapy approach may be needed to achieve the control rate of IRS-IV without its toxicity.

Original languageEnglish
JournalPediatric Blood and Cancer
DOIs
StateAccepted/In press - 2017

Fingerprint

Embryonal Rhabdomyosarcoma
Sarcoma
Radiotherapy
Drug Therapy
Rhabdomyosarcoma
Dactinomycin
Vincristine
Cyclophosphamide
Infertility
Radiation
Recurrence
Liver

Keywords

  • Orbital rhabdomyosarcoma
  • Radiotherapy
  • Response based

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

45 Gy is not sufficient radiotherapy dose for Group III orbital embryonal rhabdomyosarcoma after less than complete response to 12 weeks of ARST0331 chemotherapy : A report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group Ermoian et al. / Ermoian, Ralph P.; Breneman, John; Walterhouse, David O.; Chi, Yueh Yun; Meza, Jane; Anderson, James; Hawkins, Douglas S.; Hayes-Jordan, Andrea A.; Parham, David M.; Yock, Torunn I.; Donaldson, Sarah S.; Wolden, Suzanne L.

In: Pediatric Blood and Cancer, 2017.

Research output: Contribution to journalArticle

Ermoian, Ralph P.; Breneman, John; Walterhouse, David O.; Chi, Yueh Yun; Meza, Jane; Anderson, James; Hawkins, Douglas S.; Hayes-Jordan, Andrea A.; Parham, David M.; Yock, Torunn I.; Donaldson, Sarah S.; Wolden, Suzanne L. / 45 Gy is not sufficient radiotherapy dose for Group III orbital embryonal rhabdomyosarcoma after less than complete response to 12 weeks of ARST0331 chemotherapy : A report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group Ermoian et al.

In: Pediatric Blood and Cancer, 2017.

Research output: Contribution to journalArticle

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title = "45 Gy is not sufficient radiotherapy dose for Group III orbital embryonal rhabdomyosarcoma after less than complete response to 12 weeks of ARST0331 chemotherapy: A report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group Ermoian et al.",
abstract = "Background: Recent Children's Oncology Group (COG) trials tested the efficacy of reduced therapy in an effort to lessen late effects compared to the Intergroup Rhabdomyosarcoma Study (IRS) IV regimen with associated hematologic and hepatic toxicity, and infertility. Here, we analyze the efficacy of 45 Gray (Gy) local radiotherapy (RT) in patients with Group III orbital embryonal rhabdomyosarcoma (ERMS) enrolled on the COG low-risk study ARST0331. Procedure: Sixty-two patients with Group III orbital ERMS were treated on ARST0331 with four cycles of vincristine (VCR), dactinomycin (DACT), and cyclophosphamide (CPM; VAC, total cumulative CPM dose 4.8 g/m2) followed by four cycles of VCR and DACT over 22 weeks. Forty-five Gray of radiation was administered in 25 fractions beginning at week 13 of therapy. Results: Fifty-three patients were evaluable for this response analysis; seven had missing week 12 response evaluation data and two had progressive disease prior to starting RT. Median follow-up was 7.8 years. None of the 15 patients with radiographic complete response (CR) compared to 6 of the 38 patients with <CR after 12 weeks of VAC chemotherapy had local recurrences (P = 0.11). There was no difference in overall survival by response at week 12 (P = 0.52). Conclusions: For patients with Group III orbital ERMS achieving a CR following VAC chemotherapy that includes modest dose CPM, 45 Gy may be sufficient for durable failure-free survival. However, for those with <CR treated with the ARST0331 systemic therapy, a different local therapy approach may be needed to achieve the control rate of IRS-IV without its toxicity.",
keywords = "Orbital rhabdomyosarcoma, Radiotherapy, Response based",
author = "Ermoian, {Ralph P.} and John Breneman and Walterhouse, {David O.} and Chi, {Yueh Yun} and Jane Meza and James Anderson and Hawkins, {Douglas S.} and Hayes-Jordan, {Andrea A.} and Parham, {David M.} and Yock, {Torunn I.} and Donaldson, {Sarah S.} and Wolden, {Suzanne L.}",
year = "2017",
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journal = "Pediatric Blood and Cancer",
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T1 - 45 Gy is not sufficient radiotherapy dose for Group III orbital embryonal rhabdomyosarcoma after less than complete response to 12 weeks of ARST0331 chemotherapy

T2 - Pediatric Blood and Cancer

AU - Ermoian,Ralph P.

AU - Breneman,John

AU - Walterhouse,David O.

AU - Chi,Yueh Yun

AU - Meza,Jane

AU - Anderson,James

AU - Hawkins,Douglas S.

AU - Hayes-Jordan,Andrea A.

AU - Parham,David M.

AU - Yock,Torunn I.

AU - Donaldson,Sarah S.

AU - Wolden,Suzanne L.

PY - 2017

Y1 - 2017

N2 - Background: Recent Children's Oncology Group (COG) trials tested the efficacy of reduced therapy in an effort to lessen late effects compared to the Intergroup Rhabdomyosarcoma Study (IRS) IV regimen with associated hematologic and hepatic toxicity, and infertility. Here, we analyze the efficacy of 45 Gray (Gy) local radiotherapy (RT) in patients with Group III orbital embryonal rhabdomyosarcoma (ERMS) enrolled on the COG low-risk study ARST0331. Procedure: Sixty-two patients with Group III orbital ERMS were treated on ARST0331 with four cycles of vincristine (VCR), dactinomycin (DACT), and cyclophosphamide (CPM; VAC, total cumulative CPM dose 4.8 g/m2) followed by four cycles of VCR and DACT over 22 weeks. Forty-five Gray of radiation was administered in 25 fractions beginning at week 13 of therapy. Results: Fifty-three patients were evaluable for this response analysis; seven had missing week 12 response evaluation data and two had progressive disease prior to starting RT. Median follow-up was 7.8 years. None of the 15 patients with radiographic complete response (CR) compared to 6 of the 38 patients with <CR after 12 weeks of VAC chemotherapy had local recurrences (P = 0.11). There was no difference in overall survival by response at week 12 (P = 0.52). Conclusions: For patients with Group III orbital ERMS achieving a CR following VAC chemotherapy that includes modest dose CPM, 45 Gy may be sufficient for durable failure-free survival. However, for those with <CR treated with the ARST0331 systemic therapy, a different local therapy approach may be needed to achieve the control rate of IRS-IV without its toxicity.

AB - Background: Recent Children's Oncology Group (COG) trials tested the efficacy of reduced therapy in an effort to lessen late effects compared to the Intergroup Rhabdomyosarcoma Study (IRS) IV regimen with associated hematologic and hepatic toxicity, and infertility. Here, we analyze the efficacy of 45 Gray (Gy) local radiotherapy (RT) in patients with Group III orbital embryonal rhabdomyosarcoma (ERMS) enrolled on the COG low-risk study ARST0331. Procedure: Sixty-two patients with Group III orbital ERMS were treated on ARST0331 with four cycles of vincristine (VCR), dactinomycin (DACT), and cyclophosphamide (CPM; VAC, total cumulative CPM dose 4.8 g/m2) followed by four cycles of VCR and DACT over 22 weeks. Forty-five Gray of radiation was administered in 25 fractions beginning at week 13 of therapy. Results: Fifty-three patients were evaluable for this response analysis; seven had missing week 12 response evaluation data and two had progressive disease prior to starting RT. Median follow-up was 7.8 years. None of the 15 patients with radiographic complete response (CR) compared to 6 of the 38 patients with <CR after 12 weeks of VAC chemotherapy had local recurrences (P = 0.11). There was no difference in overall survival by response at week 12 (P = 0.52). Conclusions: For patients with Group III orbital ERMS achieving a CR following VAC chemotherapy that includes modest dose CPM, 45 Gy may be sufficient for durable failure-free survival. However, for those with <CR treated with the ARST0331 systemic therapy, a different local therapy approach may be needed to achieve the control rate of IRS-IV without its toxicity.

KW - Orbital rhabdomyosarcoma

KW - Radiotherapy

KW - Response based

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U2 - 10.1002/pbc.26540

DO - 10.1002/pbc.26540

M3 - Article

JO - Pediatric Blood and Cancer

JF - Pediatric Blood and Cancer

SN - 1545-5009

ER -