Journal Article Ppublish
PubMed: 42490727 DOI: 10.1002/cncr.70530
The impact of whole lung irradiation in lung metastatic rhabdomyosarcoma: A pooled analysis of two European trials and one European registry.
Cancer 132(15):e70530
Authors: Amadeus T Heinz, Philip Heesen, Johannes H M Merks, Véronique Minard-Colin, Martin Ebinger, Alison L Cameron, Semi Harrabi, Henry Mandeville, Reineke A Schoot, Jörg Fuchs, Gabriela Guillen, Ewa Koscielniak, Julia C Chisholm, Monika Sparber-Sauer, Gianni Bisogno
Affiliations
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tuebingen, Tuebingen, Germany.
- Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin (Olgahospital), Pädiatrie 5 (Pädiatrische Onkologie, Hämatologie, Immunologie), Klinikum der Landeshauptstadt Stuttgart, Stuttgart, Germany.
- University Hospital USZ, University of Zurich, Zurich, Switzerland.
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
- Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
- Department of Radiooncology and Radiotherapy, Heidelberg University Hospital, Heidelberg, Germany.
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Institute of Cancer Research, Sutton, UK.
- Department of Pediatric Surgery and Urology, University Children's Hospital, Tuebingen, Germany.
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Medical Faculty, University Tuebingen, Tuebingen, Germany.
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Institute of Cancer Research, Sutton, UK.
- Department of Women's and Children's Health, University of Padua, Padua, Italy.
- Pediatric Hematology Oncology Division, University Hospital of Padua, Padua, Italy.
Abstract
BACKGROUND
Lung metastases in patients with metastatic rhabdomyosarcoma (RMS) have not been treated uniformly across Europe. This provides comparison of the impact of whole lung irradiation (WLI).
METHODS
Lung-metastatic patients included in the Cooperative Weichteilsarkom Studiengruppe-IV 2002, European Pediatric Soft Tissue Sarcoma Study Group MTS 2008 or the Soft Tissue Sarcoma Registry received four- or six-drug chemotherapy, surgery, and/or irradiation (radiotherapy) of the primary tumor. Treatment of lung lesions consisted of metastasectomy, WLI, or no local treatment according to protocols.
RESULTS
A total of 238 patients with lung-metastatic RMS were included. Half of these patients (n = 119/238) had lung metastases only (median age, 6.6 years), mainly classified as embryonal RMS (n = 93/119, 78%). Lung-only patients underwent metastasectomy (n = 17) and/or WLI (n = 31) or no local treatment of lung metastases (n = 71). Early complete response of lung metastases was associated with favorable 3-year overall survival (p = .009). A trend toward improved event-free survival after WLI could be identified in patients ≥10 years old (hazard ratio [HR], 2.7; 95% CI, 0.8-9.6), but not in patients under 10 years old (HR, 0.86; 95% CI, 0.44-1.66). Lung-relapse-free survival (lung-RFS) was not influenced by WLI or metastasectomy in the univariable and multivariable analyses. When analyzing all lung-metastatic patients (including those with metastases in other sites, n = 238), WLI in patients older than 10 years was a significant prognostic factor (HR, 2.2; 95% CI, 1.0-4.9).
CONCLUSIONS
The analysis failed to show a significant benefit of WLI in patients with lung-metastatic RMS, apart from the subgroup of patients older than 10 years. Lung-RFS was not influenced by WLI.
MeSH
Registries, Lung, Rhabdomyosarcoma, Neoplasms, Metastasectomy, Sarcoma, Neoplasm Metastasis, Therapeutics