title: Indications for radiotherapy and chemotherapy after complete resection in rhabdomyosarcoma: A report from the Intergroup Rhabdomyosarcoma Studies I to III.
abstract: OBJECTIVE
  To evaluate the outcome of patients with rhabdomyosarcoma (RMS) treated with complete surgical resection and multiagent chemotherapy, with or without local radiotherapy (RT).
  
  
  METHODS
  Four hundred thirty-nine patients with completely resected (ie, group I) RMS were further treated with chemotherapy (vincristine and actinomycin D +/- cyclophosphamide, doxorubicin, and cisplatin) on Intergroup Rhabdomyosarcoma Studies (IRS) I to III between 1972 and 1991. Eighty-three patients (19%) also received local RT as a component of initial treatment.
  
  
  RESULTS
  Eighty-six patients relapsed (10-year failure-free survival [FFS] 79%, overall survival 89%). Six percent of failure sites were local, 6% were regional, and 7% were distant. Poor prognostic factors were tumor size greater than 5 cm, alveolar or undifferentiated histology, primary tumor sites other than genitourinary, and treatment on IRS-I or II. For patients with embryonal RMS who were treated with RT, there was a trend for improved FFS but no difference in overall survival. On IRS-I and II, patients with alveolar or undifferentiated sarcoma who received RT compared with those who did not receive RT had greater 10-year FFS rates (73% v 44%, respectively; P =.03) and overall survival rates (82% v 52%, respectively; (P =.02). Such patients who received RT on IRS III also benefited more than those who did not receive RT (10-year FFS, 95% v 69%; P =.01; overall survival, 95% v 86%; P =.23).
  
  
  CONCLUSIONS
  Patients with group I embryonal RMS have an excellent prognosis when treated with adjuvant multiagent chemotherapy without RT. Patients with alveolar RMS or undifferentiated sarcoma fare worse; however, FFS and overall survival are substantially improved when RT is added to multiagent chemotherapy (IRS-I and II). The best outcome occurred in IRS-III, when RT was used in conjunction with intensified chemotherapy.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Wolden
authors.forename: J R
authors.initials: JR
authors.lastname: Anderson
authors.forename: W M
authors.initials: WM
authors.lastname: Crist
authors.forename: J C
authors.initials: JC
authors.lastname: Breneman
authors.forename: M D
authors.initials: MD
authors.lastname: Wharam
authors.forename: E S
authors.initials: ES
authors.lastname: Wiener
authors.forename: S J
authors.initials: SJ
authors.lastname: Qualman
authors.forename: S S
authors.initials: SS
authors.lastname: Donaldson
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D006801:Humans; D007223:Infant; D011379:Prognosis; D012208:Rhabdomyosarcoma / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis; D017211:Treatment Failure