title: Initial patient characteristics can predict pattern and risk of relapse in localized rhabdomyosarcoma.
abstract: OBJECTIVE
  Evaluation of primary tumor-, treatment-, and patient-related factors predicting relapse pattern, risk, and survival after relapse with the aim to design a risk-adapted, tumor-directed surveillance program for patients with localized rhabdomyosarcoma (RMS).
  
  
  METHODS
  One thousand one hundred sixty-four patients with nonmetastatic RMS achieved complete remission at the end of multimodal therapy in the consecutive trials of the Cooperative Weichteilsarkom Studiengruppe (CWS)-81, CWS-86, CWS-91, and CWS-96 between 1980 and 2002 (median follow-up, 5 years). Three hundred thirty-seven of these individuals developed either locoregional, metastatic, or combined relapses. Predictive factors for relapse, its pattern, and postrelapse survival were analyzed.
  
  
  RESULTS
  Age, histology, tumor size, tumor site, postsurgical stage, and omission of radiotherapy were identified as factors associated with an increased relapse risk in multivariate analyses. Relapse rates did not differ among the CWS trials. Median time to relapse was 1.43 years from first diagnosis (range, 0.13 to 13.5 years). There were 217 locoregional, 72 metastatic, and 48 combined recurrences. Only two patients developed metastases more than 4 years after diagnosis, and both had combined recurrences. Five-year postrelapse survival was 24%. Patient subsets with consistent relapse pattern, risk, and postrelapse survival rates were identified on the basis of histologic subtype and tumor size.
  
  
  CONCLUSIONS
  Initial patient and tumor characteristics predict pattern and risk of relapse and also correlate with postrelapse survival probabilities. In localized RMS, tumor-directed follow-up should focus on the primary site. Screening for metastatic relapse may not be necessary more than 4 years after diagnosis. The identification of subgroups with distinctive pattern and risk of relapse may be used to develop risk-adapted, tumor-directed guidance for detection of recurrent disease in localized RMS.
authors.affiliation: Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart, Bismarckstrasse 8, D-70176 Stuttgart, Germany. tobias.dantonello@olgahospital-stuttgart.de
authors.forename: Tobias M
authors.initials: TM
authors.lastname: Dantonello
authors.forename: Christoph
authors.initials: C
authors.lastname: Int-Veen
authors.forename: Peter
authors.initials: P
authors.lastname: Winkler
authors.forename: Ivo
authors.initials: I
authors.lastname: Leuschner
authors.forename: Andreas
authors.initials: A
authors.lastname: Schuck
authors.forename: Bernhard F
authors.initials: BF
authors.lastname: Schmidt
authors.forename: Helmut
authors.initials: H
authors.lastname: Lochbuehler
authors.forename: Sylvia
authors.initials: S
authors.lastname: Kirsch
authors.forename: Erika
authors.initials: E
authors.lastname: Hallmen
authors.forename: Iris
authors.initials: I
authors.lastname: Veit-Friedrich
authors.forename: Stefan S
authors.initials: SS
authors.lastname: Bielack
authors.forename: Felix
authors.initials: F
authors.lastname: Niggli
authors.forename: Bernarda
authors.initials: B
authors.lastname: Kazanowska
authors.forename: Ruth
authors.initials: R
authors.lastname: Ladenstein
authors.forename: Thomas
authors.initials: T
authors.lastname: Wiebe
authors.forename: Thomas
authors.initials: T
authors.lastname: Klingebiel
authors.forename: Joern
authors.initials: J
authors.lastname: Treuner
authors.forename: Ewa
authors.initials: E
authors.lastname: Koscielniak
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000209:etiology; D011379:Prognosis; D012208:Rhabdomyosarcoma / Q000473:pathology* / Q000628:therapy; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors