Treatment of adult rhabdomyosarcoma.
OBJECTIVE
Rhabdomyosarcoma is an exceedingly rare tumor in adults, and standard chemotherapy used for children is much less effective in adults. This study examines short-term outcomes using doxorubicin, ifosfamide, and vincristine for adult rhabdomyosarcoma.


METHODS
Pathology records were searched for adults (age, >18) with rhabdomyosarcoma treated at our musculoskeletal tumor center. Treatment involved surgical resection, radiation therapy, and chemotherapy with doxorubicin, ifosfamide, and vincristine. Eleven met inclusion criteria. Mean age was 49 (range: 19-72). Tumors sites included upper extremity (4 patients), lower extremity (6), and cervix (1). Subtypes were pleomorphic (7), alveolar (1), embryonal (1), and mixed alveolar/embryonal (2).


RESULTS
Of the 7 patients with nonmetastatic disease, 6 had no evidence of disease posttreatment, but 1 died of myelodysplastic syndrome after 51 months. Three patients who received neoadjuvant chemotherapy had 100% tumor necrosis. One patient with positive margins scheduled for adjuvant chemotherapy had local recurrence and metastasis within 2 weeks and died 5 months later. Of the 4 patients with metastatic disease on presentation, 1 had complete response, 2 had partial response with later progression and death at 8 and 24 months, and 1 had immediate progression and died at 12 months. Mean overall survival was 24 months with 6 of 11 (55%) alive at last follow-up. Mean disease-free survival was 17 months for all patients and 23 months for the 7 patients who had remission of all disease.


CONCLUSIONS
When combined with surgery and radiation therapy, chemotherapy using doxorubicin, ifosfamide, and vincristine yielded 55% overall and 64% disease-free survival at 2 years.
Ogilvie
Christian M
CM
Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA. christian.ogilvie@uphs.upenn.edu
Crawford
Eileen A
EA
Slotcavage
Rachel L
RL
King
Joseph J
JJ
Lackman
Richard D
RD
Hartner
Lee
L
Staddon
Arthur P
AP
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012208:Rhabdomyosarcoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
D014750:Vincristine; D004317:Doxorubicin; D007069:Ifosfamide