title: Intergroup rhabdomyosarcoma study-IV: results for patients with nonmetastatic disease.
abstract: OBJECTIVE
  The study goal was to improve outcome in children with rhabdomyosarcoma by comparing risk-based regimens of surgery, radiotherapy (RT) and chemotherapy.
  
  
  METHODS
  Eight hundred eighty-three previously untreated eligible patients with nonmetastatic rhabdomyosarcoma entered the Intergroup Rhabdomyosarcoma Study-IV (IRS-IV) (1991 to 1997) after surgery and were randomized treatment by primary tumor site, group (1 to 3), and stage (I to III). Failure-free survival (FFS) rates and survival were the end points used in comparisons between randomized groups and between patient subgroups treated on IRS-III and IRS-IV. Most patients were randomized to receive vincristine and dactinomycin (VA) and cyclophosphamide (VAC, n = 235), or VA and ifosfamide (VAI, n = 222), or vincristine, ifosfamide, and etoposide (VIE, n = 236). Patients with group 3 tumors were randomized to receive conventional RT (C-RT) versus hyperfractionated RT (HF-RT).
  
  
  RESULTS
  Overall 3-year FFS and survival were 77% and 86%, respectively. Three-year FFS rates with VAC, VAI, and VIE were 75%, 77%, and 77%, respectively (P =.42). No significant difference in outcome was noted with HF-RT versus C-RT (P =.85 and P =.90, respectively). Overall, patients with embryonal tumors benefited from intensive three-drug chemotherapy in IRS-IV (3-year FFS, 83%). The improvement was seen for patients with stage I or stage II/III, group 1/2 disease, many of whom received VA chemotherapy on IRS-III. Patients with stage 2/3, group 3 disease had similar outcomes on IRS-III and IRS-IV. Three-year FFS for the nonrandomized patient subsets was 75% with renal abnormalities; 81% for paratesticular, group 1 cases; and 91% for group 1/2 orbit or eyelid tumors. Patients with paratesticular primaries had poorer outcomes if they were more than 10 years old (3-year FFS, 63% v 90%). Myelosuppression occurred in most patients, but toxic deaths occurred in less than 1%.
  
  
  CONCLUSIONS
  VAC and VAI or VIE with surgery (with or without RT), are equally effective for patients with local or regional rhabdomyosarcoma and are more effective for embryonal tumors than therapies used previously. Younger patients with group 1 paratesticular embryonal tumors and all patients with group 1/2 orbit or eyelid tumors can usually be cured with VA chemotherapy along with postoperative RT for group 2 disease.
authors.affiliation: Intergroup Rhabdomyosarcoma Study Group (IRSG) representing the Children's Cancer Group, the Pediatric Oncology Group, and the Intergroup Rhabdomyosarcoma Statistical Office, and the Quality Assurance Review Center, Arcadia, CA, USA.
authors.forename: W M
authors.initials: WM
authors.lastname: Crist
authors.forename: J R
authors.initials: JR
authors.lastname: Anderson
authors.forename: J L
authors.initials: JL
authors.lastname: Meza
authors.forename: C
authors.initials: C
authors.lastname: Fryer
authors.forename: R B
authors.initials: RB
authors.lastname: Raney
authors.forename: F B
authors.initials: FB
authors.lastname: Ruymann
authors.forename: J
authors.initials: J
authors.lastname: Breneman
authors.forename: S J
authors.initials: SJ
authors.lastname: Qualman
authors.forename: E
authors.initials: E
authors.lastname: Wiener
authors.forename: M
authors.initials: M
authors.lastname: Wharam
authors.forename: T
authors.initials: T
authors.lastname: Lobe
authors.forename: B
authors.initials: B
authors.lastname: Webber
authors.forename: H M
authors.initials: HM
authors.lastname: Maurer
authors.forename: S S
authors.initials: SS
authors.lastname: Donaldson
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005142:Eyelid Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009918:Orbital Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D011878:Radiotherapy / Q000379:methods*; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy