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Raze T, Lapouble E, Lacour B, Guissou S, Defachelles AS, Gaspar N, Delattre O, Pierron G, Desandes E. PAX-FOXO1 fusion status in children and adolescents with alveolar rhabdomyosarcoma: Impact on clinical, pathological, and survival features. Pediatr Blood Cancer 2023; 70:e30228. [PMID: 36722003 DOI: 10.1002/pbc.30228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Alveolar rhabdomyosarcoma (ARMS) is an aggressive pediatric cancer and cases with fusion PAX3-FOXO1 and PAX7-FOXO1 seem to have a poor prognosis. The aim is to evaluate whether PAX-FOXO1 alterations influence clinical outcome in childhood and adolescence population with ARMS. PROCEDURE A population-based study was conducted between 2011 and 2016 in patients less than 17 years with a diagnosis of ARMS. Overall survival (OS) depending on fusion status with clinical factors was analyzed. RESULTS Out of 111 ARMS patients recorded in the French National Childhood Cancer Registry during the 2011-2016 period, 61% expressed PAX3-FOXO1, 15% expressed PAX7-FOXO1, 13% were FOXO1 fusion-positive without PAX specification, and 7% were PAX-FOXO1 negative (n = 4 missing data). Compared to patients with PAX7-FOXO1 positive ARMS, those with PAX3-FOXO1 positive tumor were significantly older (10-17 years: 57.4% vs. 29.4%), and had more often a metastatic disease (54.4% vs. 23.5%). Poorer 5-year OS for patients with PAX3-FOXO1 and PAX not specified FOXO1-positive tumor were observed (44.0% [32.0-55.4] and 35.7% [13.1-59.4], respectively). After adjustment for stage at diagnosis, patients with positive tumor for PAX3-FOXO1 were 3.6-fold more likely to die than those with positive tumor for PAX7-FOXO1. CONCLUSION At the population level, PAX3-FOXO1 was associated with a significant higher risk of death compared to PAX7-FOXO1-positive and PAX-FOXO1-negative tumors, and could explain poorer 5-year OS observed in adolescence population diagnosed with ARMS. A continuous risk score derived from the combination of clinical parameters with PAX3-FOXO1 fusion status represents a robust approach to improving current risk-adapted therapy for ARMS.
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Affiliation(s)
- Thomas Raze
- Registre National des cancers de l'Enfant, Registre National des Tumeurs Solides de l'Enfant, CHRU Nancy, Vandœuvre-lès-Nancy, France
| | - Eve Lapouble
- Département de génétique, Unité de Génétique Somatique, Institut Curie, Paris, France
| | - Brigitte Lacour
- Registre National des cancers de l'Enfant, Registre National des Tumeurs Solides de l'Enfant, CHRU Nancy, Vandœuvre-lès-Nancy, France
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université Paris-Cité, Paris, France
| | - Sandra Guissou
- Registre National des cancers de l'Enfant, Registre National des Tumeurs Solides de l'Enfant, CHRU Nancy, Vandœuvre-lès-Nancy, France
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université Paris-Cité, Paris, France
| | | | - Nathalie Gaspar
- Département d'Oncologie Enfants et Adolescents, Centre du Cancer Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Olivier Delattre
- Département de génétique, Unité de Génétique Somatique, Institut Curie, Paris, France
- Diversity and Plasticity of Childhood Tumors Lab, INSERM U830, PSL Research University, SIREDO Oncology Center, Institut Curie Research Center, Paris, France
| | - Gaelle Pierron
- Département de génétique, Unité de Génétique Somatique, Institut Curie, Paris, France
| | - Emmanuel Desandes
- Registre National des cancers de l'Enfant, Registre National des Tumeurs Solides de l'Enfant, CHRU Nancy, Vandœuvre-lès-Nancy, France
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université Paris-Cité, Paris, France
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Fayolle H, Jehanno N, Lauwers-Cances V, Castex MP, Orbach D, Mognetti T, Nadège C, Payoux P, Hitzel A. PET metabolic tumor volume as a new prognostic factor in childhood rhabdomyosarcoma. PLoS One 2022; 17:e0261565. [PMID: 35030176 PMCID: PMC8759649 DOI: 10.1371/journal.pone.0261565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/04/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose Childhood RMS is a rare malignant disease in which evaluation of tumour spread at diagnosis is essential for therapeutic management. F-18 FDG-PET imaging is currently used for initial RMS disease staging. Materials and methods This multicentre retrospective study in six French university hospitals was designed to analyse the prognostic accuracy of MTV at diagnosis for patients with RMS between 1 January 2007 and 31 October 2017, for overall (OS) and progression-free survival (PFS). MTV was defined as the sum of the primitive tumour and the largest metastasis, where relevant, with a 40% threshold of the primary tumour SUVmax. Additional aims were to define the prognostic value of SUVmax, SUVpeak, and bone lysis at diagnosis. Results Participants were 101 patients with a median age of 7.4 years (IQR [4.0-12.5], 62 boys), with localized disease (35 cases), regional nodal spread (43 cases), or distant metastases (23). 44 patients had alveolar subtypes. In a univariate analysis, a MTV greater than 200 cm3 was associated with OS (HR = 3.47 [1.79;6.74], p<0.001) and PFS (HR = 3.03 [1.51;6.07], p = 0.002). SUVmax, SUVpeak, and bone lysis also influenced OS (respectively p = 0.005, p = 0.004 and p = 0.007) and PFS (p = 0.029, p = 0.019 and p = 0.015). In a multivariate analysis, a MTV greater than 200 cm3 was associated with OS (HR = 2.642 [1.272;5.486], p = 0.009) and PFS (HR = 2.707 [1.322;5.547], p = 0.006) after adjustment for confounding factors, including SUVmax, SUVpeak, and bone lysis. Conclusion A metabolic tumor volume greater than 200 cm3, SUVmax, SUVpeak, and bone lysis in the pre-treatment assessment were unfavourable for outcome.
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Affiliation(s)
- Helio Fayolle
- Nuclear Medicine Department, Toulouse Purpan University Hospital, Toulouse, France
- * E-mail:
| | - Nina Jehanno
- Nuclear Medicine Department, Curie Institute, PSL Research University, Paris, France
| | - Valerie Lauwers-Cances
- Epidemiology and Public Health Department, Faculty of Medicine, Toulouse University Hospital, Toulouse, France
| | - Marie-Pierre Castex
- Paediatric Haemato-Oncology Department, Toulouse Children’s Hospital, Toulouse University Hospital, Toulouse, France
| | - Daniel Orbach
- IREDO Oncology Centre, Curie Institute, PSL University, Paris, France
| | - Thomas Mognetti
- Nuclear Medicine Department, Léon Bérard Cancer Centre, Lyon, France
| | - Corradini Nadège
- Oncology and Clinical Research Departments, Léon Bérard Cancer Centre and Institute of Paediatric Haematology and Oncology, Lyon, France
| | - Pierre Payoux
- Toulouse NeuroImaging Centre, Toulouse Paul Sabatier University-INSERM, Toulouse, France
| | - Anne Hitzel
- Nuclear Medicine Department, Toulouse Purpan University Hospital, Toulouse, France
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Zhu Y, Zhu Z, Xiao Y, Zhu Z. Case Report: Paratesticular Rhabdomyosarcoma. Front Oncol 2021; 11:629878. [PMID: 33816267 PMCID: PMC8010692 DOI: 10.3389/fonc.2021.629878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/01/2021] [Indexed: 11/19/2022] Open
Abstract
Paratesticular rhabdomyosarcoma (RMS) accounts for only 7% of all the RMS cases. Due to the limited available data, there is no consensus on the diagnosis and management of the paratesticular tumors. Here, we interrogated two paratesticular RMS cases in 25 and 27-year-old men presenting with painless and rapidly growing mass in the scrotum. Whereas the data showed no upregulation of tumor markers such as β-human chorionic gonadotropin (β-HCG), alpha-fetoprotein (AFP), and lactate dehydrogenase (LDH), scrotal ultrasonography and magnetic resonance imaging indicated the existence of paratesticular and inguinal lesions respectively. There was local recurrence in one patient who underwent radical orchiectomy for the sarcoma one year ago. In addition, the CT scans showed no occurrence of distant metastasis. The two patients underwent radical inguinal orchiectomy or resection of the recurrent tumors with nerve-sparing retroperitoneal lymph node dissection. Histologic examination revealed embryonal RMS (eRMS) without lymph node metastasis. We highlight the importance of multi-disciplinary participation for paratesticular RMS detection and preoperative ultrasound-guided needle biopsy (UNB) for rapid confirmatory diagnosis. Complete surgical resection coupled with chemotherapy and radiotherapy is the main treatment option for the paratesticular RMS. In addition, sperm cryopreservation treatment and endocrine follow-up could increase the overall survival and quality of life of the patients.
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Affiliation(s)
- Yiyi Zhu
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ziwei Zhu
- Department of Urology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, China
| | - Yunyuan Xiao
- Department of Urology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, China
| | - Zaisheng Zhu
- Department of Urology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, China
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Bergamaschi L, Bertulli R, Casanova M, Provenzano S, Chiaravalli S, Gasparini P, Collini P, Sangalli C, Gandola L, Diletto B, Morosi C, Fiore M, Massimino M, Ferrari A. Rhabdomyosarcoma in adults: analysis of treatment modalities in a prospective single-center series. Med Oncol 2019; 36:59. [PMID: 31104202 DOI: 10.1007/s12032-019-1282-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/07/2019] [Indexed: 11/28/2022]
Abstract
Rhabdomyosarcoma (RMS) is rare in adults and it is generally characterized by poor outcome. In a previous retrospective study, we demonstrated a better prognosis in adults treated with multimodality approach resembling pediatric protocols. Thereafter, we developed specific recommendations based on the principles adopted in pediatric oncology. The present analysis reports the results in a subsequent prospective series. The study included 95 consecutive patients (age 18-77 years) treated from 2002 to 2015 for embryonal and alveolar RMS. As in the previous series, patients were stratified by the appropriateness of their treatment according to therapeutic guidelines for childhood RMS. The 5-year event-free survival (EFS) and overall survival (OS) rates were 33.6% and 40.3%, respectively. The 5-year EFS was 40.8% for patients with the highest treatment score, and 15% for those with lower score, while OS was 44.4% and 24.5%, respectively. The developing of specific recommendations enabled an increase in the number of patients treated with intensive multimodal treatment resembling pediatric strategy (69.7% vs. 39.1% in the retrospective series). This study reinforced the idea that adherence to the principles of pediatric protocols, improves adult RMS outcomes. However, treating adults with pediatric-type strategy is not enough to achieve the results obtained in children. Issues in compliance and a more aggressive biology of adult RMS might have a role in the different outcome according to age. Improving the collaboration between pediatric and adult oncologists in promoting specific clinical and biological research is crucial to improve the outcome for this patient population.
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Affiliation(s)
- Luca Bergamaschi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milan, Italy.
| | - Rossella Bertulli
- Adult Mesenchymal Tumor and Rare Cancer Medical Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milan, Italy
| | - Salvatore Provenzano
- Adult Mesenchymal Tumor and Rare Cancer Medical Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milan, Italy
| | - Patrizia Gasparini
- Tumor Genomics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Collini
- Histopathology And Pediatric Pathology Unit, Diagnostic Pathology and Laboratory Medicine Department, Soft Tissue And Bone Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Sangalli
- Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Lorenza Gandola
- Pediatric Radiotherapy Unit, Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Barbara Diletto
- Pediatric Radiotherapy Unit, Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133, Milan, Italy
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Ferrari A, Bleyer A, Patel S, Chiaravalli S, Gasparini P, Casanova M. The challenge of the management of adolescents and young adults with soft tissue sarcomas. Pediatr Blood Cancer 2018; 65:e27013. [PMID: 29493075 DOI: 10.1002/pbc.27013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/16/2018] [Accepted: 01/24/2018] [Indexed: 01/14/2023]
Abstract
Soft tissue sarcomas are relatively frequent in adolescents and young adults and their clinical management may be complex, partly due to tumor associated factors, but also because different approaches have been adopted by pediatric and adult medical oncologists dealing with the same disease. However, times are changing and in the last few years, management has tended to converge towards a common strategy. Continued and increased international collaboration between pediatric and adult sarcoma groups is of critical importance to improve the quality of treatment as well as research programs dedicated to young patients with soft tissue sarcomas.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Archie Bleyer
- Department of Radiation Medicine, Oregon Health and Sciences University, Portland, Oregon
| | - Shreyaskumar Patel
- Department of Sarcoma Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Patrizia Gasparini
- Tumor Genomics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Fu L, Jin Y, Jia C, Zhang J, Tai J, Li H, Chen F, Shi J, Guo Y, Ni X, He L. Detection of FOXO1 break-apart status by fluorescence in situ hybridization in atypical alveolar rhabdomyosarcoma. SCIENCE CHINA-LIFE SCIENCES 2017. [DOI: 10.1007/s11427-017-9082-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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van der Graaf WTA, Orbach D, Judson IR, Ferrari A. Soft tissue sarcomas in adolescents and young adults: a comparison with their paediatric and adult counterparts. Lancet Oncol 2017; 18:e166-e175. [PMID: 28271871 DOI: 10.1016/s1470-2045(17)30099-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/07/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Abstract
Survival outcomes for adolescent and young adult patients with soft tissue sarcomas lag behind those of children diagnosed with histologically similar tumours. To help understand these differences in outcomes, we discuss the following issues with regard to the management of these patients with soft tissue sarcomas: delays in diagnosis, trial availability and participation, aspects of the organisation of care (with an emphasis on age-specific needs), national centralisation of sarcoma care, international consortia, and factors related to tumour biology. Improved understanding of the causes of the survival gap between adolescents and young adults with sarcomas will help drive new initiatives to improve final health outcomes in these populations. In this Review, we specifically focus on embryonal and alveolar rhabdomyosarcoma, synovial sarcoma, and adult soft tissue sarcomas diagnosed in adolescents and young adults, and discuss the age-specific needs of these patients.
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Affiliation(s)
- Winette T A van der Graaf
- Division of Clinical Studies, Institute of Cancer Research, London, UK; Sarcoma Unit of the Royal Marsden NHS Foundation Trust, London, UK; Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Daniel Orbach
- Pediatric, Adolescent and Young Adult Oncology Department, Institut Curie, Paris, France
| | - Ian R Judson
- Division of Clinical Studies, Institute of Cancer Research, London, UK; Sarcoma Unit of the Royal Marsden NHS Foundation Trust, London, UK
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Kumar R, Kapoor R, Khosla D, Kumar N, Ghoshal S, Mandal AK, Radotra BD, Sharma SC. Paratesticular rhabdomyosarcoma in young adults: A tertiary care institute experience. Indian J Urol 2013; 29:110-3. [PMID: 23956511 PMCID: PMC3737665 DOI: 10.4103/0970-1591.114030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Introduction: Paratesticular rhabdomyosarcoma (RMS) is a rare tumor arising from the mesenchymal tissues of the spermatic cord, epididymis, testis and testicular tunics. It represents only 7% of all patients entered in the Intergroup Rhabdomyosarcoma Study (IRS) and 17% of all malignant intrascrotal tumors in children less than 15 years old. We present our experience in combined modality management of 10 successive patients of paratesticular RMS. Material and Methods: We retrospectively reviewed 10 patients of paratesticular RMS treated in our institute from July 2004 to December 2010. Clinical characteristics and treatment modality in form of surgery and chemotherapy (CCT) were noted. Statistical analysis was done with regards to progression-free survival (PFS) and overall survival (OS) using Kaplan-Meier survival analysis. Results: The median age of the patients was 16.5 years. The median duration of symptoms was 5 months. Five patients had retroperitoneal lymphadenopathy (RPLAP) while three had lung metastases and one had orbital metastases. All patients underwent high inguinal orchidectomy followed by systemic chemotherapy (CCT). Retroperitoneal node dissection was not a required staging procedure. Four patients had partial response to treatment while six had complete response. Mean duration of PFS was 48 months and mean OS was 56 months. Conclusions: Paratesticular RMS are rare neoplasms with aggressive growth patterns. Cure rates have dramatically improved and 60% of patients in our series had complete response. This success is due to development of multimodality and risk adapted treatment approaches.
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Affiliation(s)
- Ritesh Kumar
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ferrari A, Bisogno G, Meazza C, Vajna de Pava M, Sultan I, De Salvo GL, Clerici CA, Veneroni L, Casanova M. The challenge of access to care for soft tissue sarcomas bridging pediatric and adult age: the Italian pediatric oncology view. Expert Rev Anticancer Ther 2012; 12:243-54. [PMID: 22316372 DOI: 10.1586/era.11.209] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Synovial sarcoma and rhabdomyosarcoma are two high-grade soft tissue sarcoma subtypes that occur in adolescents and young adults. Managing these malignancies in patients in this age bracket poses various clinical problems, partly because different therapeutic approaches are sometimes adopted by pediatric and adult oncologists, even though they are dealing with the same condition. In this review, the doubts concerning how best to manage soft tissue sarcomas in patients between pediatric and adult ages lead up to a more general discussion of the issue of access to optimal cancer services for adolescents and young adults - a subset of patients acknowledged as being under-represented in clinical trials on therapies that may improve their outcome. The situation in Italy is described, along with action taken in an effort to bridge the gap and implement specific programs tailored to these patients.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori Via G Venezian, Milan 1-20133, Italy.
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Abstract
Pediatric soft tissue sarcomas (STS) are a heterogeneous group of malignant tumors constituting about 7% of all cancer cases. Rhabdomyosarcomas (RMS) constitute about half of all soft tissue sarcomas in children, the rest being constituted by non- rhabdomyosarcoma soft tissue sarcomas (NRSTS). Most RMS present in young children <6 y of age while the NRSTS occur in adolescents and young adults. The latter constitute a diverse group of tumors and are rare in children. The STS generally present as painless enlarging mass or with symptoms of compression/infiltration of adjacent organs or structures. Staging, risk stratification and multidisciplinary approach are needed for the treatment of STS and outcome depends on stage, site and histological type. Treatment of RMS has evolved systematically through various clinical trials. Chemotherapy remains the backbone of treatment for RMS and local control is achieved either with surgery or radiotherapy or both. Management of NRSTS is still a challenge as it is generally chemotherapy-resistant and surgery remains the mainstay of treatment. Outcome therefore depends on whether wide local excision with negative margins is possible. Local radiotherapy is reserved for recurrent, residual and large high grade NRST. The prognosis of metastatic as well as recurrent STS remains dismal.
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Van Gaal JC, De Bont ES, Kaal SE, Versleijen-Jonkers Y, van der Graaf WT. Building the bridge between rhabdomyosarcoma in children, adolescents and young adults: The road ahead. Crit Rev Oncol Hematol 2012; 82:259-79. [DOI: 10.1016/j.critrevonc.2011.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 06/29/2011] [Accepted: 06/30/2011] [Indexed: 01/02/2023] Open
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Arndt CAS, Rose PS, Folpe AL, Laack NN. Common musculoskeletal tumors of childhood and adolescence. Mayo Clin Proc 2012; 87:475-87. [PMID: 22560526 PMCID: PMC3538469 DOI: 10.1016/j.mayocp.2012.01.015] [Citation(s) in RCA: 205] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 01/07/2012] [Accepted: 01/16/2012] [Indexed: 11/23/2022]
Abstract
Osteosarcoma, Ewing sarcoma, and rhabdomyosarcoma are the most common malignant musculoskeletal tumors in children and adolescents. Today, most patients can be cured. Numerous factors have contributed to improved outcome for these patients over the past several decades. These include multidisciplinary care involving oncologists, radiation oncologists, surgeons, pathologists, and radiologists and enrollment of patients in clinical trials. Better understanding of molecular mechanisms of disease have resulted in studies using molecular targets in addition to standard chemotherapeutic agents, which hopefully will lead to better outcomes in the future. Moreover, new orthopedic techniques and devices as well as new technologies in radiation oncology hold promise for better local control of primary tumors and the potential for fewer late adverse effects. Despite this progress, patients must undergo lifelong follow-up for possible late effects of intense chemotherapy and radiation therapy. We review the diagnosis, prognosis, staging, multidisciplinary therapy, new directions in therapy, and long-term complications of treatment for these tumors. For this review, we searched MEDLINE using the terms rhabdomyosarcoma, osteosarcoma, Ewing sarcoma, biology, and humans and limited the search to articles from 2000 to September 2011. Additional references found in these articles were utilized as appropriate, as well as references from the background information in current therapeutic studies of the Children's Oncology Group. The same database and time frame were searched for articles written by leading authorities in the field.
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Key Words
- arms, alveolar rhabdomyosarcoma
- cog, children's oncology group
- efs, event-free survival
- erms, embryonal rhabdomyosarcoma
- es, ewing sarcoma
- fdg-pet, fluorodeoxyglucose positron emission tomography
- ie, ifosfamide and etoposide
- map, methotrexate, doxorubicin (adriamycin), and cisplatin
- os, osteosarcoma
- pnet, primitive neuroectodermal tumor
- rms, rhabdomyosarcoma
- vdc, vincristine, doxorubicin, and cyclophosphamide
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Affiliation(s)
- Carola A S Arndt
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Keskin S, Ekenel M, Basaran M, Kilicaslan I, Tunc M, Bavbek S. Clinicopathological characteristics and treatment outcomes of adult patients with paratesticular rhabdomyosarcoma (PRMS): A 10-year single-centre experience. Can Urol Assoc J 2012; 6:42-5. [PMID: 22396368 DOI: 10.5489/cuaj.11121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We report our experience with 8 consecutive adults treated for paratesticular rhabdomyosarcoma (RMS) at a single institution between 2000 and 2010. METHODS After primary surgical excision, 7 patients were classified into group I according to the Intergroup Rhabdomyosarcoma Study Group (IRSG) Postsurgical Grouping Classification, and 1 patient into group IIB. Retroperitoneal node dissection was not a required staging procedure. Adjuvant chemotherapy was administered to 7 of the 8 patients. No additional radiotherapy was administered. RESULTS The median age at diagnosis was 24 years (range: 18-60). Embryonal histology was the most common (75%) subtype. During follow-up, 3 patients experienced local relapse and 5 distant relapse. The median progression-free and overall survival times were 17.0 ± 9.9 months (range: 5-31) and 27.3 ± 1.3 months (range: 16-58), respectively. CONCLUSION Paratesticular RMS is an uncommon malignancy in adults. We confirm that patients with localized paratesticular RMS may have different prognoses. Retroperitoneal lymphadenectomy can be avoided as a treatment for paratesticular RMS after radical inguinal orchiectomy.
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Affiliation(s)
- Serkan Keskin
- Department of Medical Oncology, Institute of Oncology, University of Istanbul, Istanbul, Turkey
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Ferrari A, De Salvo GL, Oberlin O, Casanova M, De Paoli A, Rey A, Minard V, Orbach D, Carli M, Brennan B, Vannoesel MM, Morosi C, Stevens MC, Bisogno G. Synovial sarcoma in children and adolescents: a critical reappraisal of staging investigations in relation to the rate of metastatic involvement at diagnosis. Eur J Cancer 2012; 48:1370-5. [PMID: 22322070 DOI: 10.1016/j.ejca.2012.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 12/28/2011] [Accepted: 01/15/2012] [Indexed: 10/14/2022]
Abstract
BACKGROUND European protocols for paediatric synovial sarcoma (SS) require that all children routinely undergo chest computed tomography (CT) scanning and bone scanning as initial staging procedures. This study aims to determine the rate of initial metastases in paediatric SS based on specific clinical characteristics, thereby investigating whether these diagnostic procedures are really necessary in all patients. METHODS Data on 258 previously-untreated SS patients <21 years old were pooled from the databases of different European paediatric groups (study period 1988-2005) for this analysis, and the associations between patients' characteristics and any presence of metastasis were estimated. RESULTS Fifteen cases (5.8%) had distant metastases at diagnosis (86% pulmonary). The presence of metastases was unassociated with patients' gender or age, tumour grade or site, but it was influenced by T-status, and especially primary tumour size: the risk of metastases was 32 times higher in cases of tumour >5 cm than for tumours ≤ 5 cm. CONCLUSIONS Our findings suggest that tumour diameter can be used as a variable for identifying patients at greater risk of metastases and warranting more accurate radiological investigations. Chest CT scanning may improve the accuracy of pulmonary staging over X-ray, but requires different ionising radiation exposures that might have carcinogenic potential: it can be omitted for patients with tumours ≤ 5 cm. Given the very low risk of bone metastases, bone scans may be recommended only in cases with evidence of lung metastases.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy.
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15
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Ferrari A, Sultan I, Huang TT, -Galindo CR, Shehadeh A, Meazza C, Ness KK, Casanova M, Spunt SL. Soft tissue sarcoma across the age spectrum: a population-based study from the Surveillance Epidemiology and End Results database. Pediatr Blood Cancer 2011; 57:943-9. [PMID: 21793180 PMCID: PMC4261144 DOI: 10.1002/pbc.23252] [Citation(s) in RCA: 231] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 05/31/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Soft tissue sarcomas (STS) are a heterogeneous group of mesenchymal malignancies that occur throughout the lifespan. The impact of age on disease features and outcome is unclear. METHODS We analyzed the clinical features and outcome of all STS cases registered between 1973 and 2006 in the SEER database. RESULTS There were 48,012 cases that met the selection criteria. Individuals less than 20 years of age represented 5.6%, with rhabdomyosarcoma being the most common subtype. In adults, the most common types were Kaposi sarcoma, fibrohistiocytic tumors, and leiomyosarcoma. Rhabdomyosarcoma was the only entity with a median age <20 years. Male predominance (male/female of 1.5:1) was noticed for almost all types of STS, except for alveolar soft part sarcoma and leiomyosarcoma. Tumor stage was similar across different age groups. Younger patients (<50 years) had significantly better survival than older patients (88.8 ± 0.2% vs. 40 ± 0.3%, P < 0.001), but for most histologies the survival decline with advancing age was gradual and did not occur abruptly at the onset of adulthood. The decline in survival with advancing age was particularly significant for rhabdomyosarcoma. CONCLUSION With few exceptions, the clinical features of STS are similar in children and adults. However, individuals over 50 years of age have an inferior survival.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Istituto Nazionale Tumori, Milano, Italy
| | - Iyad Sultan
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan,Corresponding author: Iyad Sultan, MD, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman 11941, Jordan. , Telephone: +962-6-530-0460, Fax: +962-6-534-2567
| | - Tseng Tien Huang
- Department of Epidemiology & Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Carlos Rodriguez -Galindo
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmad Shehadeh
- Department of Surgery, Orthopedic Oncology Unit, King Hussein Cancer Center, Amman, Jordan
| | - Cristina Meazza
- Pediatric Oncology Unit, Istituto Nazionale Tumori, Milano, Italy
| | - Kirsten K. Ness
- Department of Epidemiology & Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Michela Casanova
- Pediatric Oncology Unit, Istituto Nazionale Tumori, Milano, Italy
| | - Sheri L. Spunt
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA and Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
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16
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Ferrari A, Meazza C, Vajna de Pava M, Clerici CA, Casanova M. Two Cases of Adolescents with Paratesticular Rhabdomyosarcoma Inadequately Treated: The Problem of Referral. J Adolesc Young Adult Oncol 2011; 1:152-154. [PMID: 23610735 DOI: 10.1089/jayao.2011.0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
This paper reports on two cases of adolescents with paratesticular embryonal rhabdomyosarcoma completely resected at diagnosis (a pediatric disease potentially curable in more than 90% of cases) and treated at adult facilities with a strategy used for adult soft tissue sarcomas. The final outcome of the two patients was dismal after they received a treatment inconsistent with pediatric protocols. The cases reported here give us a chance to turn the spotlight on a crucial issue-the referral of adolescents with pediatric-type tumors and their access to experienced centers and clinical trials.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy
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17
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Sultan I, Ferrari A. Selecting multimodal therapy for rhabdomyosarcoma. Expert Rev Anticancer Ther 2011; 10:1285-301. [PMID: 20735314 DOI: 10.1586/era.10.96] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rhabdomyosarcoma is a typical tumor of childhood, characterized by a high grade of malignancy, local invasiveness and a marked propensity to metastasize, but also a generally good response to chemotherapy and radiotherapy. Multimodal therapy is essential to cure rhabdomyosarcoma patients, but different uses of surgery, radiotherapy and chemotherapy, and their intensity, need to be selected and modulated to different patient risk groups. This article attempts to give an account of the current treatment options, the open and debated issues and the potential novel strategies for the near future.
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Affiliation(s)
- Iyad Sultan
- Department of Pediatric Oncology, King Hussein Cancer Center, Irbid, Hashemite Kingdom of Jordan
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18
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Casanova M, Ferrari A. Pharmacotherapy for pediatric soft-tissue sarcomas. Expert Opin Pharmacother 2011; 12:517-31. [DOI: 10.1517/14656566.2011.524926] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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19
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Favini F, Sultan I, Meazza C, Casanova M, Ferrari A. Prognostic role of tumor size in childhood cancer. Future Oncol 2010; 5:1605-13. [PMID: 20001798 DOI: 10.2217/fon.09.124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Identifying prognostic factors that influence outcome is a key point in pediatric oncology, as it enables risk stratification and helps us to fine-tune risk-adapted treatments, thereby hopefully improving the chances of survival for high-risk patients, and minimizing the burden of treatment for those whose outlook is good. Along with other clinical and biological variables, tumor size at onset has been identified as a crucial variable in several pediatric malignancies, and in soft-tissue sarcomas in particular. This review provides a critical reappraisal of the prognostic role of tumor size in pediatric soft-tissue sarcomas.
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Affiliation(s)
- Francesca Favini
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milano, Italy
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20
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Abstract
The current standard in local treatment of soft tissue sarcomas has shifted from amputation and similar mutilating resections to more organ- and function-preserving surgery. This was possible through multidisciplinary treatment approaches, particularly those including adjuvant radiation therapy. Adjuvant radiation showed significant improvement in local tumour control after resection with tight margins and in high-risk sarcomas. Unfortunately adjuvant radiation failed to improve overall survival. Perioperative chemotherapies also have not contributed to improvement in the overall prognosis worldwide. Progress may occur when the pathogenesis and molecular profile of specific sarcoma subtypes are better understood, allowing more effective new drugs. One example is the treatment of advanced gastrointestinal stromal tumour with imatinib, a small molecular kinase inhibitor of the c-kit receptor. Presently the most effective measure to improve the prognosis with soft tissue sarcomas is early patient referral to expert centres, where diagnostic workup and therapy decisions are made on a multidisciplinary basis and updated according to the newest guidelines and study results.
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Affiliation(s)
- F Lordick
- Nationales Centrum für Tumorerkrankungen Medizinische Onkologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 350, Heidelberg, Germany.
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21
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Unique Case of Giant Adult Paratesticular Spindle Cell Rhabdomyosarcoma. Urology 2009; 73:500-2. [DOI: 10.1016/j.urology.2008.09.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 09/11/2008] [Accepted: 09/16/2008] [Indexed: 11/19/2022]
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22
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Molecular and phenotypic analysis of poorly differentiated sinonasal neoplasms: an integrated approach for early diagnosis and classification. Hum Pathol 2009; 40:283-92. [PMID: 19150107 PMCID: PMC4573623 DOI: 10.1016/j.humpath.2008.07.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 07/21/2008] [Accepted: 07/21/2008] [Indexed: 02/03/2023]
Abstract
Primary poorly differentiated (small round and non-small) sinonasal neoplasms comprise histogenetically and biologically diverse entities with overlapping morphologic features. Because of the limited initial biopsy tissue materials, differential diagnostic difficulties may arise and complicate timely management of some cases. We used immunohistochemical and molecular marker analyses in a large cohort of these tumors to optimize their early diagnosis and classification. Fifty-two tumors of the skull base and sinonasal regions and, for comparison, 19 poorly differentiated neoplasms of other head and neck sites were analyzed by a panel of immunohistochemical markers including those of epithelial, mesenchymal, melanocytic, and neuroectodermal origin using tissue microarray. Reverse transcriptase-polymerase chain reaction analysis of messenger RNA for EWS-FLI1 and PAX-FKHR fusion transcripts and the human achaete-scute homolog-1 gene was performed on 24 of the 52 sinonasal tumors and the 19 tumors of other sites for comparison. The immunohistochemical results substantiated the phenotypic assessment and the initial diagnosis in 49 of the 52 tumors. In 4 instances the integrated markers and phenotypic analyses led to reclassification of 3 tumors and confirmed the histogenesis of a mesenchymal tumor with aberrant cytokeratin expression. Molecular analysis of the EWS-FLI1 fusion gene transcript revealed 4 (9.3%) of the 43 tumors to be positive; all were Ewing sarcomas. The human achaete-scute homolog-1 gene transcript was identified in 10 (23.8%) of 42 tumors: 3 of 6 neuroblastomas, all 4 neuroendocrine carcinomas, and 1 each in sinonasal undifferentiated carcinoma, rhabdomyosarcoma, and melanoma. The PAX-FKHR fusion transcript was not detected in any tumors. We conclude that (1) an integrated morphologic and biomarker algorithm may better optimize the early diagnosis of poorly differentiated sinonasal and skull-base tumors; (2) molecular analysis may assist in future biological stratification of certain classes of these tumors; and (3) the human achaete-scute homolog-1 gene transcript is a nonspecific marker for the diagnosis of neuroblastoma.
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23
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Antillon F, Castellanos M, Valverde P, Luna-Fineman S, Garrido C, Serrato T, Rodriguez-Galindo C, Casanova M, Ferrari A. Treating Pediatric soft tissue sarcomas in a country with limited resources: the experience of the Unidad Nacional de Oncologia Pediatrica in Guatemala. Pediatr Blood Cancer 2008; 51:760-4. [PMID: 18680154 DOI: 10.1002/pbc.21699] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND About 250-300 children with newly diagnosed cancer are treated each year at the Unidad Nacional de Oncologia Pediatrica in Guatemala City; less than 5% of them have soft tissue sarcomas (STS). The aim of the article was to evaluate whether the therapeutic standards achieved in STS in developed countries could be reproduced in a low-income country. PATIENTS AND METHODS We reviewed the clinical data, treatment and outcome of 80 patients, 47 cases of rhabdomyosarcoma (RMS) and 33 of non-rhabdomyosarcoma soft tissue sarcoma (NRSTS), treated between January 2000 and October 2007. RESULTS Most of the RMS patients had advanced disease at diagnosis (87% groups III-IV). Their 3-year event-free survival rate (EFS) was 26.4% if abandoning the treatment was considered as an event, or 32.4% if it was censored (14 patients abandoned the treatment), and the 3-year overall survival rate (OS) was 43.5%. Local progression/relapse was the main cause of treatment failure. Among the patients with NRSTS, the EFS at 3 years was 36.4% (when abandoning the treatment was considered as an event) or 43.3% (when it was censored), and the OS was 44.2%. Outcome was satisfactory for synovial sarcoma patients, those with tumors < or =5 cm, and those with localized disease. CONCLUSIONS Overall results were unsatisfactory compared to results reported from developed countries. Late diagnosis and the consequently high proportion of cases of advanced disease at diagnosis, the large number of patients failing to complete the treatment, and the poor quality of local control (in RMS) adversely influence outcome.
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Ferrari A, Grosso F, Stacchiotti S, Meazza C, Zaffignani E, Marchianò A, Casanova M. Response to vinorelbine and low-dose cyclophosphamide chemotherapy in two patients with desmoplastic small round cell tumor. Pediatr Blood Cancer 2007; 49:864-6. [PMID: 16302215 DOI: 10.1002/pbc.20682] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report two cases of abdominal desmoplastic small round cell tumor (DSRCT) that showed a clinical response to the vinorelbine/low-dose cyclophosphamide combination that has been claimed to be effective for rhabdomyosarcoma. This observation may prompt further investigation into the activity of such a regimen in DSRCT patients with recurrent or refractory disease, with a view to a possible future role as maintenance therapy in controlling minimal residual disease in patients who achieve complete remission with intensive induction multimodality therapy.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy.
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25
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Driscoll K, Isakoff M, Ferrer F. Update on pediatric genitourinary oncology. Curr Opin Urol 2007; 17:281-6. [PMID: 17558273 DOI: 10.1097/mou.0b013e3281de72df] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Results of collaborative studies and advances in our understanding of the molecular biologic events involved in children's genitourinary cancers continue to advance treatment. Simultaneously, newly released reports analyze the long-term risks of treatment. We review the most significant recent developments in the field. RECENT FINDINGS New basic research findings are making molecular staging a reality for children with cancer. Patients with adverse biologic features can now be stratified to receive intensified therapy while others may safely be considered for diminished adjunctive treatment. Collaborative trials continue to accrue experience and refine current strategies. Studies of survivors suggest that the long-term risk of adverse effects associated with current chemotherapeutic and radiation regimens are significant. SUMMARY Continued progress from collaborative trials along with advancing knowledge of the molecular biology of children's cancers promise to improve outcomes. Novel therapies are needed as emerging data suggest significant treatment-associated morbidity exists from current therapy.
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Affiliation(s)
- Karen Driscoll
- Department of Pediatric Urology and Oncology, Connecticut Children's Medical Center and University of Connecticut, Hartford, Connecticut 06106, USA
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26
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Morgenstern DA, Anderson J. MYCN deregulation as a potential target for novel therapies in rhabdomyosarcoma. Expert Rev Anticancer Ther 2006; 6:217-24. [PMID: 16445374 DOI: 10.1586/14737140.6.2.217] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rhabdomyosarcoma is the most common soft-tissue sarcoma of childhood. Treatment requires a multimodality approach combining chemotherapy with surgery and radiotherapy. Although overall outcomes have improved considerably, the outlook for patients with high-risk disease, particularly the alveolar subtype, remains bleak and there is a clear need for new chemotherapeutic strategies. This review focuses on the possibilities for interventions targeting myc myelocytomatosis viral related oncogene, neuroblastoma derived (MYCN). The importance of aberrant expression of this oncogene is well established in neuroblastoma and recent data indicate that MYCN deregulation also occurs in up to a quarter of alveolar subtype cases. A range of possible approaches to target MYCN is discussed, including nucleic acid-based and immunotherapy strategies.
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Haga K, Kashiwagi A, Nagamori S, Yamashiro K. Adult paratesticular rhabdomyosarcoma. ACTA ACUST UNITED AC 2005; 2:398-402; quiz 403. [PMID: 16474737 DOI: 10.1038/ncpuro0257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2005] [Accepted: 07/07/2005] [Indexed: 11/09/2022]
Abstract
BACKGROUND A 29-year-old male patient presented with a history of painless enlargement of the left hemiscrotum. INVESTIGATIONS Laboratory tests for beta-human chorionic gonadotrophin, alpha-fetoprotein, and lactate dehydrogenase, physical examination, and CT of the chest, abdomen and pelvis. Histologic examination, nerve-sparing retroperitoneal lymph-node dissection. DIAGNOSIS Paratesticular rhabdomyosarcoma with lymph node metastasis. MANAGEMENT Inguinal radical orchiectomy and adjuvant chemotherapy for 48 weeks. Radiotherapy and additional chemotherapy were administered following local recurrence.
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