Local Therapy for Rhabdomyosarcoma of the Hands and Feet: Is Amputation Necessary? A Report From the Children's Oncology Group

Journal Article · Sun May 01 04:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2010.01.053· OSTI ID:21491730

La, Trang H ^[1]; Wolden, Suzanne L ^[2]; Zheng, Su ^[1]; Linardic, Corinne ^[3]; Randall, R Lor ^[4]; Hawkins, Douglas S ^[5]

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1. Department of Radiation Oncology, Stanford University, Stanford, CA (United States)
2. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
3. Department of Pediatric Hematology/Oncology, Duke University, Durham, NC (United States)
4. Department of Orthopedics, University of Utah, Salt Lake City, UT (United States)
5. Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, WA (United States)

Purpose: To evaluate the outcome of children with rhabdomyosarcoma (RMS) of the hand or foot treated with surgery and/or local radiotherapy (RT). Methods and Materials: Forty-eight patients with nonmetastatic RMS of the hand or foot were enrolled on Intergroup Rhabdomyosarcoma Study III, IV-Pilot, and IV. Patients received multiagent chemotherapy with surgery and/or RT. Twenty-four patients (50%) underwent surgery without local RT, of whom 4 had complete resection and 20 had an amputation. The remaining 24 patients (50%) underwent local RT, of whom 2 required RT for microscopic residual disease after prior amputation. Median follow-up for surviving patients was 9.7 years. Results: Actuarial 10-year local control was 100%; 10-year event-free survival and overall survival rates were 62% and 63%, respectively. Poor prognostic factors for recurrence included gross residual (Group III) disease and nodal involvement (p = 0.01 and 0.05, respectively). More patients in the RT group had alveolar histology, Group III disease, and nodal involvement, as compared with the surgery group. There was no difference in 10-year event-free survival (57% vs. 66%) or overall survival (63% vs. 63%) between patients who underwent surgery or local RT. Among relapsing patients, there were no long-term survivors. No secondary malignancies have been observed. Conclusions: Despite having high-risk features, patients treated with local RT achieved excellent local control. Complete surgical resection without amputation is difficult to achieve in the hand or foot. Therefore, we recommend either definitive RT or surgical resection that maintains form and function as primary local therapy rather than amputation in patients with hand or foot RMS.

• OSTI ID: 21491730
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 80; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
AGE GROUPS
ANIMALS
ARMS
BODY
CHEMOTHERAPY
CHILDREN
CONTROL
DISEASES
FEET
HANDS
LEGS
LIMBS
MAMMALS
MAN
MEDICINE
MYOSARCOMAS
NEOPLASMS
NUCLEAR MEDICINE
PRIMATES
RADIOLOGY
RADIOTHERAPY
RHABDOMYOSARCOMAS
SARCOMAS
SURGERY
THERAPY
VERTEBRATES