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Leiser D, Dantonello T, Krcek R, Grawehr LV, Pica A, Vazquez M, Calaminus G, Weber DC. Long Term Clinical Outcome and Quality of Life of Children, Adolescents and Young Adults Treated with Pencil Beam Scanning Proton Therapy for Rhabdomyosarcoma. Int J Radiat Oncol Biol Phys 2023; 117:S77. [PMID: 37784572 DOI: 10.1016/j.ijrobp.2023.06.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To assess the long-term clinical outcomes of children, adolescents and young adults (CAYAs) with rhabdomyosarcoma (RMS) treated with pencil beam scanning proton therapy (pbsPT). MATERIALS/METHODS One hundred twenty-one RMS (embryonal, n = 102; 84.3%) patients treated between January 2000 and December 2020 were included in this analysis. The median age was 4.7 years (range, 0.1-35.3). All patients received systemic chemotherapy according to prospective protocols. The median total dose delivered was 54 Gy (RBE) (range, 41.4-74.0). RESULTS After a median follow-up time of 85.5 month (range,3.4-240.0), we observed 23 local/regional and 12 distant failures. The estimated 5-year local control (LC) and overall survival (OS) was 81.5% and 80%, respectively. For the subgroups of parameningeal (PM), orbital, urogenital and H&N non-PM the 5-year LC was 74.7%, 92%, 100% and 66.7%. The corresponding figures for OS were 68.8%, 100%, 100%, and 66.7, respectively. The 5-year non-ocular Grade 3 toxicity free survival was 78.9%. At the start of pbsPT children and their caregivers reported QoL significantly worse than the norm group. QoL improved however over the follow up period to normal values in nearly all domains. Median of PEDQOL PROXY reported QoL in Normgroup (children: 4- 18 yrs) and RMS patients (n = 27-42 answers per domain): CONCLUSION: Excellent clinical outcome was observed for CAYAs with RMS treated with pbsPT. Two thirds of treatment failures were local. High-grade late non-ocular toxicity was manageable. QoL improved towards normal scores in nearly all domains after therapy.
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Affiliation(s)
- D Leiser
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | | | - R Krcek
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - A Pica
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | | | - G Calaminus
- Zentrum für Kinderheilkunde Universitätsklinikum Bonn, Bonn, Germany
| | - D C Weber
- Paul Scherrer Institute, Villigen PSI, Switzerland; Department of Radiation Oncology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
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2
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Tramsen L, Bochennek K, Sparber-Sauer M, Salzmann-Manrique E, Scheer M, Dantonello T, Borkhardt A, Dirksen U, Thorwarth A, Greiner J, Ebinger M, Weclawek-Tompol J, Ladenstein R, Ljungman G, Hallmen E, Lehrnbecher T, Koscielniak E, Klingebiel T. Pediatric Patients with Stage IV Rhabdomyosarcoma Significantly Benefit from Long-Term Maintenance Therapy: Results of the CWS-IV 2002 and the CWS DOK IV 2004-Trials. Cancers (Basel) 2023; 15:cancers15072050. [PMID: 37046711 PMCID: PMC10093505 DOI: 10.3390/cancers15072050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma (STS) in childhood. Whereas more than 90% of patients with localized low-risk RMS can be cured, metastatic RMS have a dismal outcome, with survival rates of less than 30%. The HD CWS-96 trial showed an improved outcome for patients receiving maintenance therapy after completing intensive chemotherapy. Consequently, the international clinical trials CWS-IV 2002 and CWS DOK IV 2004 on metastatic disease of STS of the Cooperative Weichteilsarkom Studiengruppe (CWS) were designed in addition to the CWS-2002P trial for localized RMS disease. All patients received a multimodal intensive treatment regimen. To maintain remission, three options were compared: long-term maintenance therapy (LTMT) versus allogeneic hematopoietic stem cell transplantation (alloHSCT) versus high-dose chemotherapy (HDCT). A total of 176 pediatric patients with a histologically confirmed diagnosis of metastatic RMS or RMS-like tumor were included. A total of 89 patients receiving LTML showed a significantly better outcome, with an event-free survival (EFS) of 41% and an overall survival (OS) of 53%, than alloHSCT (n = 21, EFS 19%, p = 0.02, OS 24%, p = 0.002). The outcome of LTML was slightly improved compared to HDCT (n = 13, EFS 35%, OS 34%). In conclusion, our data suggest that in patients suffering from metastatic RMS, long-term maintenance therapy is a superior strategy in terms of EFS and OS compared to alloHSCT. EFS and OS of HDCT are similar in these strategies; however, the therapeutic burden of LTMT is much lower.
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Affiliation(s)
- Lars Tramsen
- Department of Pediatrics, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
- Department for Children and Adolescents, University Hospital, Goethe-University, 60590 Frankfurt, Germany
- Correspondence: ; Tel.: +49-431-500-20127
| | - Konrad Bochennek
- Department for Children and Adolescents, University Hospital, Goethe-University, 60590 Frankfurt, Germany
| | - Monika Sparber-Sauer
- Center for Pediatric, Adolescent and Women’s Medicine, Pediatric 5 (Oncology, Hematology, Immunology), Hospital of the State Capital Stuttgart, Olgahospital, Stuttgart Cancer Center, 70174 Stuttgart, Germany
- Faculty of Medicine, University Tuebingen, 72016 Tuebingen, Germany
| | - Emilia Salzmann-Manrique
- Department for Children and Adolescents, University Hospital, Goethe-University, 60590 Frankfurt, Germany
| | - Monika Scheer
- Department of Pediatric Oncology and Hematology, Charité–Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Tobias Dantonello
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich Heine University, 40225 Duesseldorf, Germany
| | - Uta Dirksen
- Pediatrics III, University Hospital Essen, West German Cancer Center, 45147 Essen, Germany
- German Cancer Consortium site Essen, National Center for Tumor Diseases (NCT) Site Essen, 45147 Essen, Germany
| | - Anne Thorwarth
- Department of Pediatric Oncology and Hematology, Charité–Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Jeanette Greiner
- Pediatric Oncology and Hematology, Children’s Hospital, Kantonsspital Aarau AG, CH-5001 Aarau, Switzerland
| | - Martin Ebinger
- Department of General Pediatrics and Pediatric Oncology and Hematology, University Children’s Hospital, 72076 Tuebingen, Germany
| | - Jadwiga Weclawek-Tompol
- Department of Bone Marrow Transplantation, Pediatric Oncology and Haematology, University of Medicine Wroclaw, 50556 Wroclaw, Poland
| | - Ruth Ladenstein
- St. Anna-Kinderspital, Children’s Cancer Research Institute (CCRI), 1090 Vienna, Austria
| | - Gustaf Ljungman
- Department of Women’s and Children’s Health, Pediatric Oncology, Uppsala University, 75185 Uppsala, Sweden
| | - Erika Hallmen
- Center for Pediatric, Adolescent and Women’s Medicine, Pediatric 5 (Oncology, Hematology, Immunology), Hospital of the State Capital Stuttgart, Olgahospital, Stuttgart Cancer Center, 70174 Stuttgart, Germany
| | - Thomas Lehrnbecher
- Department for Children and Adolescents, University Hospital, Goethe-University, 60590 Frankfurt, Germany
| | - Ewa Koscielniak
- Center for Pediatric, Adolescent and Women’s Medicine, Pediatric 5 (Oncology, Hematology, Immunology), Hospital of the State Capital Stuttgart, Olgahospital, Stuttgart Cancer Center, 70174 Stuttgart, Germany
- Faculty of Medicine, University Tuebingen, 72016 Tuebingen, Germany
| | - Thomas Klingebiel
- Department for Children and Adolescents, University Hospital, Goethe-University, 60590 Frankfurt, Germany
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3
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Liniger S, Dantonello T, Diepold M, Aebi C, Brodard J, Kremer Hovinga JA, Rössler JK, Kartal-Kaess M. Severe acquired purpura fulminans in a child. Arch Dis Child 2022; 107:300. [PMID: 34417189 DOI: 10.1136/archdischild-2021-322379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Sophia Liniger
- Department of Paediatrics, University of Bern, Bern, Switzerland
| | - Tobias Dantonello
- Department for BioMedical Research, University of Bern, Bern, Switzerland.,Division of Paediatric Haematology & Oncology, Department of Paediatrics, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Miriam Diepold
- Department for BioMedical Research, University of Bern, Bern, Switzerland.,Division of Paediatric Haematology & Oncology, Department of Paediatrics, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Aebi
- Department of Paediatrics, University of Bern, Bern, Switzerland
| | - Justine Brodard
- Department for BioMedical Research, University of Bern, Bern, Switzerland.,Department of Haematology and Central Haematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johanna A Kremer Hovinga
- Department for BioMedical Research, University of Bern, Bern, Switzerland.,Department of Haematology and Central Haematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jochen Karl Rössler
- Department for BioMedical Research, University of Bern, Bern, Switzerland.,Division of Paediatric Haematology & Oncology, Department of Paediatrics, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Mutlu Kartal-Kaess
- Department for BioMedical Research, University of Bern, Bern, Switzerland .,Division of Paediatric Haematology & Oncology, Department of Paediatrics, Inselspital, University Hospital, University of Bern, Bern, Switzerland
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4
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Kube S, Vokuhl C, Dantonello T, Scheer M, Hallmen E, Feuchtgruber S, Escherich G, Niggli F, Kuehnle I, von Kalle T, Bielack S, Klingebiel T, Koscielniak E. Inflammatory myofibroblastic tumors-A retrospective analysis of the Cooperative Weichteilsarkom Studiengruppe. Pediatr Blood Cancer 2018; 65:e27012. [PMID: 29480552 DOI: 10.1002/pbc.27012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 01/09/2018] [Accepted: 01/22/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Inflammatory myofibroblastic tumors (IMTs) are a rare subgroup of soft tissue tumors. The outcome of patients with IMT has been reported as favorable when the tumor is completely resected. If surgical resection is not possible, systemic therapy has to be considered. However, the best systemic treatment and response rates are currently unclear. METHODS Thirty-eight patients under the age of 21, who were registered between 2000 and 2014 with a primary diagnosis of IMT, were analyzed. RESULTS IMT was typically localized intra-abdominally or in the pelvis. In 20 patients, the tumor was resected without further therapy; 17 patients were in complete remission at last evaluation and two patients were in partial remission. Eighteen patients received systemic therapy, 15 of whom had macroscopically incomplete resection. Systemic therapy most commonly consisted of regimens with dactinomycin, ifosfamide or cyclophosphamide, and vincristine, with or without doxorubicin, and it seemed to reduce tumor extension in individual cases. Five-year event-free survival was 74 ± 14% and 5-year overall survival was 91 ± 10% for all patients. The patients who died due to the disease were those with incomplete resection (n = 3). CONCLUSIONS Surgery without further systemic therapy was a feasible and acceptable therapeutic option for every second patient with IMT. Standard chemotherapy for pediatric soft tissue sarcoma produced favorable results in individual cases and was able to shrink the tumor enough to enable resection. Superior efficacy of new targeted therapies such as anaplastic lymphoma kinase-inhibitors compared to standard chemotherapy has to be proven in the future.
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Affiliation(s)
- Stefanie Kube
- Pediatrics 5 (Oncology, Hematology, and Immunology), Stuttgart Cancer Center, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Christian Vokuhl
- Kiel Pediatric Tumor Registry, Department of Pediatric Pathology, University of Kiel, Kiel, Germany
| | - Tobias Dantonello
- Pediatrics 3 (Cardiology, Intensive Care Medicine, Pulmonology, and Allergology), Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Monika Scheer
- Pediatrics 5 (Oncology, Hematology, and Immunology), Stuttgart Cancer Center, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Erika Hallmen
- Pediatrics 5 (Oncology, Hematology, and Immunology), Stuttgart Cancer Center, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Simone Feuchtgruber
- Pediatrics 5 (Oncology, Hematology, and Immunology), Stuttgart Cancer Center, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Gabriele Escherich
- Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix Niggli
- Department of Pediatric Oncology, University Children's Hospital, Zürich, Switzerland
| | - Ingrid Kuehnle
- Department of Pediatric Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Thekla von Kalle
- Department of Pediatric Radiology, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Stefan Bielack
- Pediatrics 5 (Oncology, Hematology, and Immunology), Stuttgart Cancer Center, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Thomas Klingebiel
- Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt am Main, Germany
| | - Ewa Koscielniak
- Pediatrics 5 (Oncology, Hematology, and Immunology), Stuttgart Cancer Center, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
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5
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Sparber-Sauer M, von Kalle T, Seitz G, Dantonello T, Scheer M, Münter M, Fuchs J, Ladenstein R, Bielack SS, Klingebiel T, Koscielniak E. The prognostic value of early radiographic response in children and adolescents with embryonal rhabdomyosarcoma stage IV, metastases confined to the lungs: A report from the Cooperative Weichteilsarkom Studiengruppe (CWS). Pediatr Blood Cancer 2017; 64. [PMID: 28306214 DOI: 10.1002/pbc.26510] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/18/2017] [Accepted: 02/10/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Patients with metastatic rhabdomyosarcoma (RMS) have a poor prognosis apart from children with embryonal RMS whose metastases are confined to the lungs (PRME). The prognostic significance of response in patients with metastatic disease is still unknown and optimal treatment remains to be defined. METHODS Patient-, tumor- and treatment-related factors of patients with PRME treated on multiple prospective trials of the Cooperative Weichteilsarkom Studiengruppe (CWS) (1981-2013) were analyzed with a focus on response to induction chemotherapy. Response at week 7-10 was based on anatomic imaging and determined (1) for the primary tumor as complete response (CR), good response (GR), partial response (PR) and no response (NR) and (2) for pulmonary metastases as either complete lack of residual lesions (pCR) or no complete response (no-pCR). Event-free (EFS) and overall survival (OS) were the endpoints. RESULTS EFS and OS of all 53 eligible patients was 41% (±13 confidence interval [CI] 95%) and 52% (±11 CI 95%), respectively. pCR at week 7-10 and maintenance therapy (MT) were favorable prognostic factors. Interestingly, response of primary tumor at week 7-10 and number of metastases were not prognostic factors. The 5-year OS was 68% (±18 CI 95%) for 26 patients in pCR, but only 36% (±18 CI 95%) for 27 patients not in pCR at week 7-10 (P = 0.004) despite achieving pCR under continuation of chemotherapy or local therapy. CONCLUSION Achievement of pCR at week 7-10 by induction chemotherapy is a prognostic factor.
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Affiliation(s)
- Monika Sparber-Sauer
- Olgahospital, Pediatrics 5 (Pediatric Oncology, Hematology, Immunology), Zentrum für Kinder-, Jugend- und Frauenmedizin, Klinikum Stuttgart, Stuttgart, Germany
| | - Thekla von Kalle
- Olgahospital, Institute of Radiology, Zentrum für Kinder-, Jugend- und Frauenmedizin, Klinikum Stuttgart, Stuttgart, Germany
| | - Guido Seitz
- Department of Pediatric Surgery, University Children's Hospital, Marburg, Germany
| | - Tobias Dantonello
- Olgahospital, Pediatrics 5 (Pediatric Oncology, Hematology, Immunology), Zentrum für Kinder-, Jugend- und Frauenmedizin, Klinikum Stuttgart, Stuttgart, Germany
| | - Monika Scheer
- Olgahospital, Pediatrics 5 (Pediatric Oncology, Hematology, Immunology), Zentrum für Kinder-, Jugend- und Frauenmedizin, Klinikum Stuttgart, Stuttgart, Germany
| | - Marc Münter
- Department of Radiotherapy, Klinikum Stuttgart, Stuttgart, Germany
| | - Joerg Fuchs
- Department of Pediatric Surgery and Urology, University Children's Hospital, Tuebingen, Germany
| | - Ruth Ladenstein
- Department of Pediatric Hematology and Oncology, St. Anna Kinderspital Wien, Wien, Austria
| | - Stefan S Bielack
- Olgahospital, Pediatrics 5 (Pediatric Oncology, Hematology, Immunology), Zentrum für Kinder-, Jugend- und Frauenmedizin, Klinikum Stuttgart, Stuttgart, Germany
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Thomas Klingebiel
- Hospital for Children and Adolescents, University of Frankfurt, Frankfurt/Main, Germany
| | - Ewa Koscielniak
- Olgahospital, Pediatrics 5 (Pediatric Oncology, Hematology, Immunology), Zentrum für Kinder-, Jugend- und Frauenmedizin, Klinikum Stuttgart, Stuttgart, Germany
- Department of Pediatric Oncology, University Children's Hospital, Tuebingen, Germany
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6
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Scheer M, Dantonello T, Hallmen E, Blank B, Sparber-Sauer M, Vokuhl C, Leuschner I, Münter MW, von Kalle T, Bielack SS, Klingebiel T, Koscielniak E. Synovial Sarcoma Recurrence in Children and Young Adults. Ann Surg Oncol 2016; 23:618-626. [PMID: 27638676 DOI: 10.1245/s10434-016-5535-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recurrence of synovial sarcoma (SS) has been associated with poor prognosis. Optimal treatment is unknown due to heterogeneous primary therapies with or without chemotherapy. METHODS Data of patients treated in consecutive prospective European Cooperative Weichteilsarkom Studiengruppe trials 1981-2010 with primary localized SS less than 21 years were analyzed. Chemotherapy had been recommended for all SS patients during primary therapy. RESULTS Of 220 patients, 52 experienced recurrence a median of 2.5 years (range, 0.3-11.6 years) after their initial diagnosis. Recurrence was local in 22 (42 %), metastatic in 24 (46 %), and combined in 6 (12 %) of the 52 patients. If present, metastases involved the lungs in more than 90 % of the patients. Second remission was achieved by 39 (75 %) of the 52 patients, whereas only 12 (23 %) of the 39 patients maintained it. The median follow-up period for 17 survivors was 6.7 years (range, 3.2-19.6 years). The 5-year post-relapse event-free survival probability was 26 %, and the overall survival probability was 40 %. In the univariable analyses, initial tumor smaller than 3 cm, 2.5 years or longer to recurrence, local relapse only, and R0/R1 resection at relapse correlated with improved survival expectancies. In the multivariable analysis, the only factor retaining significance was R0/R1 resection of the recurrence. No difference between R0 and R1 resections was evident. For the patients with metastatic relapse, maintenance therapy seemed to prolong the time to subsequent recurrences. CONCLUSION Although 75 % of the patients with first SS recurrence achieved a second remission, only a minority became long-term, disease-free survivors. They had small tumors at initial diagnosis, local relapse as the only site of involvement, and complete resection of their recurrence. Because the majority of patients relapse subsequently, quality-of-life-based treatment approaches prolonging disease-free intervals are needed.
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Affiliation(s)
- Monika Scheer
- Pediatrics 5 (Oncology, Hematology, Immunology), Olgahospital, Klinikum Stuttgart, Stuttgart, Germany.
| | - Tobias Dantonello
- Pediatrics 5 (Oncology, Hematology, Immunology), Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Erika Hallmen
- Pediatrics 5 (Oncology, Hematology, Immunology), Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Bernd Blank
- Pediatrics 5 (Oncology, Hematology, Immunology), Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Monika Sparber-Sauer
- Pediatrics 5 (Oncology, Hematology, Immunology), Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Christian Vokuhl
- Kiel Pediatric Tumor Registry, Department of Pediatric Pathology, University Hospital Kiel, Kiel, Germany
| | - Ivo Leuschner
- Kiel Pediatric Tumor Registry, Department of Pediatric Pathology, University Hospital Kiel, Kiel, Germany
| | - Marc W Münter
- Department of Radiation Oncology, Klinikum Stuttgart, Stuttgart, Germany
| | - Thekla von Kalle
- Pediatric Radiology, Radiologisches Institut, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Stefan S Bielack
- Pediatrics 5 (Oncology, Hematology, Immunology), Olgahospital, Klinikum Stuttgart, Stuttgart, Germany.,Department of Pediatric Hematology and Oncology, University Children's Hospital, Münster, Germany
| | - Thomas Klingebiel
- Hospital for Children and Adolescents, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Ewa Koscielniak
- Pediatrics 5 (Oncology, Hematology, Immunology), Olgahospital, Klinikum Stuttgart, Stuttgart, Germany.,Department of Pediatric Oncology, University of Tübingen, Tübingen, Germany
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7
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Scheer M, Dantonello T, Hallmen E, Vokuhl C, Leuschner I, Sparber-Sauer M, Kazanowska B, Niggli F, Ladenstein R, Bielack SS, Klingebiel T, Koscielniak E. Primary Metastatic Synovial Sarcoma: Experience of the CWS Study Group. Pediatr Blood Cancer 2016; 63:1198-206. [PMID: 27003095 DOI: 10.1002/pbc.25973] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/07/2016] [Accepted: 02/20/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Prognostic factors for localized synovial sarcoma are well defined. However, few data exist regarding patients with metastases at diagnosis. Poor outcome is described but the optimal therapeutic regimen remains unclear. Our aim was to assess the outcome, identify prognostic factors, and analyze treatment strategies. METHODS Patients <21 years with synovial sarcoma and primary distant metastases treated in the consecutive prospective European Cooperative Weichteilsarkom Studiengruppe trials 1980-2010 were analyzed. RESULTS Twenty-nine of 296 patients had primary metastases. Twenty-seven could be included. Median age was 16.7 years. Primaries were mainly located in the limbs (78%) and 74% were ≥10 cm. Metastases involved the lungs in all patients. Two patients presented with synchronous bone metastases. Sixty-three percent of patients achieved a first remission, whereas only 26% maintained it. Relapses were metastatic with pulmonary metastases in nearly all patients. Five-year event-free survival and overall survival (OS) rates were 26% and 30%, respectively. Prognosis was best for patients with oligometastatic lung metastases (5-year OS probability 85%). Prognosis was worse for patients with multiple bilateral lung metastases (5-year OS 13%) and even poorer for those with concurrent bone metastases. Treatment elements associated with superior survival were adequate local therapy of the primary tumor and, if feasible, for metastases, chemotherapy with an ifosfamide/doxorubicin-based regimen. The use of whole lung irradiation was not correlated with better outcomes. CONCLUSIONS The overall prognosis of primary metastatic synovial sarcoma is poor. However, individuals with oligometastatic lung metastases had very good chance for long-term survival when treated with adequate multimodal therapy.
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Affiliation(s)
- Monika Scheer
- Pediatrics 5, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | | | - Erika Hallmen
- Pediatrics 5, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Christian Vokuhl
- Department of Pediatric Pathology, Kiel Pediatric Tumor Registry, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Ivo Leuschner
- Department of Pediatric Pathology, Kiel Pediatric Tumor Registry, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | | | - Bernarda Kazanowska
- Department of Pediatric Hematology/Oncology and BMT, University of Wroclaw, Wroclaw, Poland
| | - Felix Niggli
- Department of Pediatric Oncology, University of Zurich, Zurich, Switzerland
| | - Ruth Ladenstein
- St. Anna Kinderspital and St. Anna Kinderkrebsforschung e.V, Vienna, Austria
| | - Stefan S Bielack
- Pediatrics 5, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany.,Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Münster, Germany
| | - Thomas Klingebiel
- Hospital for Children and Adolescents, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Ewa Koscielniak
- Pediatrics 5, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany.,Department of Pediatric Oncology, University of Tuebingen, Tuebingen, Germany
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8
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Bochennek K, Dantonello T, Koscielniak E, Claviez A, Dirksen U, Sauerbrey A, Beilken A, Klingebiel T. Response of Children with Stage IV Soft Tissue Sarcoma to Topotecan and Carboplatin: A Phase II Window Trial of the Cooperative Soft Tissue Sarcoma Group. Klin Padiatr 2013; 225:309-14. [DOI: 10.1055/s-0033-1341489] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- K. Bochennek
- Pediatric Hematology and Oncology, University Hospital of J. W. Goethe University, Frankfurt/Main, Germany
| | - T. Dantonello
- Clinic of Pediatrics, Department 5, Klinikum Stuttgart – Olga Hospital, Stuttgart, Germany
| | - E. Koscielniak
- Clinic of Pediatrics, Department 5, Klinikum Stuttgart – Olga Hospital, Stuttgart, Germany
| | - A. Claviez
- Department of Pediatrics, M1 Oncology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - U. Dirksen
- Clinic and Outpatient Department of Pediatrics, Pediatric Hematology and Oncology, University Hospital Münster, Germany
| | - A. Sauerbrey
- Department of Pediatrics, Helios-Klinikum Erfurt, Germany
| | - A. Beilken
- Pediatric Hematology and Oncology, Medical University of Hannover, Germany
| | - T. Klingebiel
- Pediatric Hematology and Oncology, University Hospital of J. W. Goethe University, Frankfurt/Main, Germany
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Benesch M, von Bueren AO, Dantonello T, von Hoff K, Pietsch T, Leuschner I, Claviez A, Bierbach U, Kropshofer G, Korinthenberg R, Graf N, Suttorp M, Kortmann RD, Friedrich C, von der Weid N, Kaatsch P, Klingebiel T, Koscielniak E, Rutkowski S. Primary intracranial soft tissue sarcoma in children and adolescents: a cooperative analysis of the European CWS and HIT study groups. J Neurooncol 2012; 111:337-45. [DOI: 10.1007/s11060-012-1020-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 12/01/2012] [Indexed: 10/27/2022]
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Kiyotani C, Uno T, Ogiwara H, Morota N, Nakazawa A, Tsutsumi Y, Masaki H, Mori T, Sanz JAS, Guibelalde M, Tavera A, Herandez I, Ibanez J, Brell M, Mas A, Muller HL, Gebhardt U, Warmuth-Metz M, Pietsch T, Sorensen N, Kortmann RD, Stapleton S, Gonzalez I, Steinbrueck S, Rodriguez L, Tuite G, Krzyzankova M, Mertsch S, Jeibmann A, Kordes U, Wolff J, Paulus W, Hasselblatt M, Nonaka Y, Hara S, Fukazawa S, Shimizu K, Ben-Arush M, Postovsky S, Toledano H, Peretz-Nahum M, Fujimura J, Sakaguchi S, Kondo A, Saito Y, Shimoji K, Ohara Y, Arakawa A, Saito M, Shimizu T, Benesch M, von Bueren AO, Dantonello T, von Hoff K, Pietsch T, Leuschner I, Claviez A, Bierbach U, Kropshofer G, Korinthenberg R, Graf N, Suttorp M, Kortmann RD, Friedrich C, Klingebiel T, Koscielniak E, Rutkowski S, Mesa M, Sanchez M, Mejia J, Pena G, Dussan R, Cabeza M, Storino A, Dincer F, Roffidal T, Powell M, Berrak S, Wolff JE, Fouyssac F, Delaunay C, Vignaud JM, Schmitt E, Klein O, Mansuy L, Chastagner P, Cruz O, Guillen A, Garcia G, Alamar M, Candela S, Roussos I, Garzon M, Sunol M, Muchart J, Rebollo M, Mora J, Wolff J, Diez B, Muggeri A, Arakaki N, Meli F, Sevlever G, Tsitouras V, Pettorini B, Fellows G, Blair J, Didi M, Daousi C, Steele C, Javadpour M, Sinha A, Hishii M, Kondo A, Fujimura J, Sakaguchi S, Ishii H, Shimoji K, Miyajima M, Arai H, Dvir R, Sayar D, Levin D, Ben-Sirah L, Constantini S, Elhasid R, Gertsch E, Foreman N, Valera ET, Brassesco MS, Machado HR, Oliveira RS, Santos AC, Terra VC, Barros MV, Scrideli CA, Tone LG, Merino D, Pienkowska M, Shlien A, Tabori U, Gilbertson R, Malkin D, Jeeva I, Chang B, Long V, Picton S, Burton D, Clark S, Kwok C, Mokete B, Rafiq O, Simmons I, Shing MMK, Li CK, Chan GCF, Ha SY, Yuen HL, Luk CW, Li CK, Ling SC, Li RCH, Yoon JH, Park HJ, Shin HJ, Park BK, Kim JY, Jung HL, Ra YS, Ghim TT, Wolff J, Hasselblatt M, Hartung S, Powell M, Garami M, Traunecker H, Thall P, Mahajan A, Kordes U, Sumerauer D, Grillner P, Orrego A, Mosskin M, Gustavsson B, Holm S, Peters N, Rogers M, Chowdry S, Selman W, Mitchell A, Bangert B, Ahuja S, Laschinger K, Gold D, Stearns D, Wright K, Gupta K, Klimo P, Ellison D, Keating G, Eckel L, Giannini C, Wetjen N, Patton A, Zaky W, McComb G, Finlay J, Grimm J, Wong K, Dhall G, Zaky W, Gilles F, Grimm J, Dhall G, Finlay J, Ormandy D, Alston R, Estlin E, Gattamaneni R, Birch J, Kamaly-Asl I, Hemenway M, Foreman N, Rush S, Reginald YA, Nicolin G, Bartel U, Buncic JR, Aguilera D, Flamini R, Mazewski C, Schniederjan M, Hayes L, Boydston W, MacDonald T, Fleming A, Jabado N, Saint-Martin C, Albrecht S, Ramsay DA, Farmer JP, Bendel A, Hansen M, Dugan S, Mendelsohn N. RARE TUMORS. Neuro Oncol 2012; 14:i148-i156. [PMCID: PMC3483354 DOI: 10.1093/neuonc/nos108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
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Siepermann M, Koscielniak E, Dantonello T, Klee D, Boos J, Krefeld B, Borkhardt A, Hoehn T, Asea A, Wessalowski R. Oral low-dose chemotherapy: successful treatment of an alveolar rhabdomyosarcoma during pregnancy. Pediatr Blood Cancer 2012; 58:104-6. [PMID: 22076833 PMCID: PMC3138827 DOI: 10.1002/pbc.22934] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 11/02/2010] [Indexed: 11/10/2022]
Abstract
We report for the first time the impact of neoadjuvant oral low-dose chemotherapy consisting of oral trofosfamide, idarubicin, and etoposide (O-TIE) in the case of alveolar rhabdomyosarcoma (RMS) in the lower jaw of an 18-year-old woman at 27 weeks of gestation, without fetal complications and a highly efficient anti-tumor response. Our study suggests the possible application of O-TIE treatment in a neoadjuvant setting during pregnancy and recommends a schedule that can be considered for the treatment of patients with high-risk sarcomas who cannot be treated with intensive chemotherapy for various reasons.
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Affiliation(s)
- Meinolf Siepermann
- Clinic of Pediatric Hematology, Oncology and Clinical Immunology, Heinrich Heine University, Duesseldorf, Germany
| | - Ewa Koscielniak
- Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart, Germany
| | - Tobias Dantonello
- Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart, Germany
| | - Dirk Klee
- Department of Diagnostic Radiology, Heinrich Heine University, Duesseldorf, Germany
| | - Joachim Boos
- Department of Experimental Pediatric Oncology, Westfalian Wilhelms-University Muenster, University Children’s Hospital, Germany
| | - Barbara Krefeld
- Department of Experimental Pediatric Oncology, Westfalian Wilhelms-University Muenster, University Children’s Hospital, Germany
| | - Arndt Borkhardt
- Clinic of Pediatric Hematology, Oncology and Clinical Immunology, Heinrich Heine University, Duesseldorf, Germany
| | - Thomas Hoehn
- Department of Neonatology and Pediatric Intensive Care Medicine, Clinic of General Pediatrics, Heinrich-Heine-University, Duesseldorf, Germany
| | - Alexzander Asea
- Department of Pathology, Scott & White Hospital and Clinic and the Texas A&M Health Science Center College of Medicine, Temple, Texas, USA
| | - Rüdiger Wessalowski
- Clinic of Pediatric Hematology, Oncology and Clinical Immunology, Heinrich Heine University, Duesseldorf, Germany,Corresponding to: PD Dr. Rudiger Wessalowski, Department of Pediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, Heinrich Heine University, Moorenstr. 5, 40225 Duesseldorf, Germany.
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Bien E, Kazanowska B, Dantonello T, Adamkiewicz-Drozynska E, Balcerska A, Madziara W, Rybczynska A, Nurzynska-Flak J, Solarz E, Kurylak A, Zalewska-Szewczyk B, Krawczyk M, Izycka-Swieszewska E, Rapala M, Koscielniak E. Factors Predicting Survival in Childhood Malignant and Intermediate Vascular Tumors. Ann Surg Oncol 2010; 17:1878-89. [DOI: 10.1245/s10434-010-0991-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Indexed: 12/27/2022]
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Mattke AC, Bailey EJ, Schuck A, Dantonello T, Leuschner I, Klingebiel T, Treuner J, Koscielniak E. Does the time-point of relapse influence outcome in pediatric rhabdomyosarcomas? Pediatr Blood Cancer 2009; 52:772-6. [PMID: 19165889 DOI: 10.1002/pbc.21906] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Childhood rhabdomyosarcoma (RMS), a soft tissue malignant tumor of skeletal muscle origin, accounts for approximately 3.5% of the cases of cancer among children 0-14 years and 2% of the cases among adolescents and young adults 15-19 years of age. PROCEDURE We evaluated survival (SUR) after first relapse depending on the time to relapse (TTR) in RMSs of childhood and adolescence. Early, intermediate, and late relapsing patients were evaluated for prognostic risk factors. RESULTS Two hundred thirty-four patients with RMS enrolled in the German sarcoma trial CWS-81, CWS-86, CWS-91, and CWS-96 met selection criteria. Of the 234 patients, 35%, 32%, and 33% relapsed within 6 (early), 6-12 (intermediate), and more than 12 (late) months respectively after the end of primary therapy. Four-year SUR was 12%, 21%, and 41% for early, intermediate, and late relapse respectively (P < 0.001). Four-year SUR after local relapse was 18% (early), 38% (intermediate), and 49% (late). Embryonal RMS showed four year SUR of 16%, 30%, and 46% (P < 0.001) whereas alveolar histology showed four year SUR of 8%, 6%, and 23% (P < 0.01) for early, intermediate, and late relapse respectively. CONCLUSION TTR has significant influence on prognosis in relapsed RMS. It influences SUR independent of other features such as type of relapse, histology, tumor site, primary treatment time or irradiation in primary treatment.
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Affiliation(s)
- Adrian C Mattke
- Royal Children's Hospital, Department for Paediatric Intensive Care Medicine, Herston, QLD, Australia.
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Winkler P, Dantonello T. Bildgebung bei der Cooperativen Weichteilsarkomstudie (CWS) – MRT Diagnostik. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1220988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Klingebiel T, Boos J, Beske F, Hallmen E, Int-Veen C, Dantonello T, Treuner J, Gadner H, Marky I, Kazanowska B, Koscielniak E. Treatment of children with metastatic soft tissue sarcoma with oral maintenance compared to high dose chemotherapy: report of the HD CWS-96 trial. Pediatr Blood Cancer 2008; 50:739-45. [PMID: 18286501 DOI: 10.1002/pbc.21494] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE We prospectively studied the efficacy of high dose therapy (HDT) versus an oral maintenance treatment (OMT) in patients with stage IV soft tissue sarcoma (STS). PATIENTS AND METHODS Both groups were pretreated with the CEVAIE combination consisting of carboplatin, etoposide, vincristine, actinomycin D, ifosfamide, and epirubicin. HDT consisted of a tandem cycle of thiotepa (600 mg/m(2)) plus cyclophosphamide (4,500 mg/m(2)) and melphalan (120 mg/m(2)) plus etoposide (1,800 mg/m(2)). This treatment was compared with OMT, consisting of four cycles trofosfamide (10 days 2 x 75 mg/m(2)/day) plus etoposide (10 days 2 x 25 mg/m(2)/day), and 4 cycles trofosfamide (10 days 2 x 75 mg/m(2)/day) plus idarubicin (10 days 4 x 5 mg/m(2)). Eligibility criteria were: diagnosis confirmed by reference pathology, primary stage IV, below 22 years of age, and having completed the study therapy. RESULTS From 96 patients 45 were treated with HDT and 51 with OMT. The main risk parameters were equally distributed in both arms. After a median follow-up of 57.4 months, 11/45 (24.4%) patients in the HDT-arm and 26/51 (57.8%) patients in OMT-arm were alive. Kaplan-Meier analysis demonstrated an overall survival for the whole group of 0.27 (OMT group: 0.52, HDT group 0.27, log rank P = 0.03). The proportional hazard analysis for patients with rhabdomyosarcoma (RMS) or "RMS-like" tumors (77.1% of all patients) demonstrated an independent benefit of OMT on outcome. CONCLUSION Oral maintenance therapy seems to be a promising option for patients with RMS-like stage IV tumors.
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Affiliation(s)
- Thomas Klingebiel
- Children's Hospital of Frankfurt University Hospital, Frankfurt, Germany.
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Weihkopf T, Blettner M, Dantonello T, Jung I, Klingebiel T, Koscielniak E, Lückel M, Spix C, Kaatsch P. Incidence and time trends of soft tissue sarcomas in German children 1985–2004 – A report from the population-based German Childhood Cancer Registry. Eur J Cancer 2008; 44:432-40. [DOI: 10.1016/j.ejca.2007.11.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Revised: 10/15/2007] [Accepted: 11/07/2007] [Indexed: 10/22/2022]
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Ferrari A, Brecht IB, Koscielniak E, Casanova M, Scagnellato A, Bisogno G, Alaggio R, Cecchetto G, Catania S, Meazza C, Int-Veen C, Kirsch S, Dantonello T, Carli M, Treuner J. The role of adjuvant chemotherapy in children and adolescents with surgically resected, high-risk adult-type soft tissue sarcomas. Pediatr Blood Cancer 2005; 45:128-34. [PMID: 15852434 DOI: 10.1002/pbc.20376] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This analysis evaluates whether adjuvant chemotherapy can be recommended for high-risk, surgically-resected, adult-type non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) within the new European Pediatric Soft Tissue Sarcoma Study Group (EpSSG) protocol. The Italian and German Cooperative Groups reviewed their data-bases, analyzing patients classified as group I-II, with high-grade tumor (G3) larger than 5 cm in size. METHODS The analysis included 36 patients, and compared the clinical features and outcome of the group of 21 patients who received chemotherapy versus the group of 15 patients treated with local therapies only. RESULTS For the series as a whole, 5-year event-free survival (EFS), metastasis-free survival (MFS), and overall survival (OS) were 26.2%, 34.0%, and 37.5%, respectively. In patients treated with chemotherapy, MFS and OS were 49.5% and 41.5% (median time to relapse: 13 months). In patients who did not receive chemotherapy, MFS and OS were 0% and 23.8% (median time to relapse: 3 months). CONCLUSION The role of adjuvant chemotherapy in NRSTS is still uncertain, however, the current retrospective analysis showed that: (1) despite the globally good prognosis of grossly-resected cases, patients with G3 and large-size have a high-risk of metastatic spread, and (2) MFS appears to be better in patients who had chemotherapy. Based in part on these results, and in accordance with recent suggestions coming from the literature on adult sarcomas, the EpSSG NRSTS protocol will recommend adjuvant chemotherapy in high-risk surgically-resected patients.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Istituto Nazionale Tumori, Milano, Italy.
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