- 作者：Beverly Raney ; Julie Stoner ; James Anderson ; Richard Andrassy ; Carola Arndt ; Ken Brown ; William Crist ; Harold Maurer ; Stephen Qualman ; Moody Wharam ; Eugene Wiener ; William Meyer ; Andrea Hayes-Jordan
- 关键词：Second-look procedures ; IRS-IV protocol ; Childhood rhabdomyosarcoma
- 刊名：Journal of Pediatric Surgery
- 出版年：2010
- 出版时间：November 2010
- 年：2010
- 卷：45
- 期：11
- 页码：2160-2168
- 全文大小：251 K
PurposesThe aims of the study were to compare results of clinical/radiographic studies before second-look procedures (SLP) with SLP specimens from patients with gross residual sarcoma at diagnosis and to relate tumor viability to outcome.Patients
Seventy-three patients underwent SLP before completing chemotherapy, with (n = 59) or without (n = 14) radiotherapy. Tumor sites were bladder/prostate (n = 27), head/orbit/parameningeal (n = 22), extremity/trunk (n = 14), and retroperitoneum/pelvis (n = 10).
Results
Of 14 patients, 1 (7 % ) with clinical/radiographic complete response (CR) had viable tumor. Of 59 patients, 35 (59 % ) without CR had viable tumor. Five-year failure-free survival (FFS) rates were 81 % in 37 patients without viable tumor and 53 % in 36 patients with viable tumor (Cox proportional hazards adjusted P = .05). Five-year FFS rates were 67 % in 15 patients with clear margins and 43 % in 21 patients with tumor-involved margins (n = 18) or viable gross tumor (n = 3) (Cox proportional hazards adjusted P = .04). Five-year survival was 78 % to 79 % among 73 patients with and 333 patients without SLP during treatment.
Conclusions
Second-look procedures can show whether viable tumor is present and may be beneficial in selected patients with rhabdomyosarcoma. Disappearance of tumor (CR) usually correlated with no viable tumor at SLP. However, 41 % of patients without CR had no viable tumor. Those without viable tumor had increased FFS but not survival compared to those with viable tumor.