Local control of parameningeal rhabdomyosarcoma: outcomes in non-complete responders to chemoradiation.
OBJECTIVE
To determine whether there is a role for surgery in Group III and IV patients with residual parameningeal rhabdomyosarcoma (PM-RMS) after radiotherapy (RT).


METHODS
From 1965 to 2000, 29 patients with PM-RMS (Group III 27, Group IV 2) were diagnosed and treated with RT at the University of Iowa. All patients received chemotherapy consisting of vincristine, dactinomycin, and cyclophosphamide (VAC) in 17 (59%), VAC + doxorubicin in six (21%), VC + doxorubicin in three (10%), and other in three. RT was given to the primary site. Median dose was 50.4 Gy (range, 41.4-65 Gy). Two had hyperfractionated RT (59.4 Gy in 54 fractions). Median follow-up time for surviving patients was 17.9 years (range, 1.5-31.5 years).


RESULTS
The 2- and 5-year overall survival rates were 78.9% and 45.7% while the 2- and 5-year freedom from local progression rates were 56.8% and 42.1%. For the 11 patients who did not achieve a complete response to chemoradiotherapy at the primary site, eight underwent surgical resection 1.5-7 months after RT. The 2- and 5-year survival rates for the eight who had a surgical salvage were 100% and 60%. None of the other three survived. Six of 18 patients (33%) relapsed at the primary site after a complete response to chemoradiation and all died.


CONCLUSIONS
Surgical salvage after an incomplete response to chemoradiation in PM-RMS is feasible and can be curative in some cases.
Paulino
Arnold C
AC
Department of Radiation Oncology, University of Iowa College of Medicine, Iowa City, Iowa, USA. arnold@radonc.emory.org
Bauman
Nancy
N
Simon
James H
JH
Nguyen
Thanh X
TX
Ritchie
Justine M
JM
Tannous
Raymond
R
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008577:Meningeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage
D000970:Antineoplastic Agents; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide