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Suzanne Wolden, Elizabeth Lyden, Carola Arndt, Douglas Hawkins,

Local Control for Intermediate Risk Rhabdomyosarcoma: Results from D9803 according to Histology, Group, Site and Size A Report from the Children’s Oncology Group. Suzanne Wolden, Elizabeth Lyden, Carola Arndt, Douglas Hawkins, James Anderson, David Rodeberg, Ken Brown, Sarah Donaldson .

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Suzanne Wolden, Elizabeth Lyden, Carola Arndt, Douglas Hawkins,

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  1. Local Control for Intermediate Risk Rhabdomyosarcoma: Results from D9803 according to Histology, Group, Site and Size A Report from the Children’s Oncology Group Suzanne Wolden, Elizabeth Lyden, Carola Arndt, Douglas Hawkins, James Anderson, David Rodeberg, Ken Brown, Sarah Donaldson

  2. D9803 background • Intermediate risk RMS 1999-2005 • Phase III: VAC vs VAC/VTC • 617 eligible patients enrolled • Local control analysis limited to nonmetastatic, centrally confirmed alveolar or embryonal RMS • Soft Tissue Sarcoma

  3. Patients • 423 eligible for local failure analysis • Alveolar histology, Group I/II 41 • Embryonal histology, Group III 280 • Alveolar histology, Group III 102 • Local failure defined as local progression as 1st event (+/- regional or distant failure) • Median follow-up 6.6 years • Soft Tissue Sarcoma

  4. Local failure: Alveolar Group I-II 10% local failure, n=41 All events at 5 years: 31% Soft Tissue Sarcoma

  5. EFS and local failure: Group III • 5-yr EFS: 70% Overall failure rate 30% • 5-yr local failure: 19% 63% of all failures are local Soft Tissue Sarcoma

  6. Local failure: Group III by histology ERMS 20% ARMS 17% p=0.97 Soft Tissue Sarcoma

  7. Local failure: Group III by primary site Retroperitoneal 33% Parameningeal 19% Everything else 14% Soft Tissue Sarcoma

  8. Local failure: Only tumors >5cm Retroperitoneal 33% Retroperitoneal 30% Parameningeal 24% Parameningeal 19% Extremity, B/P 19% Everything else 14% Soft Tissue Sarcoma

  9. Local failure: Group III by size >= 5 cm 25% < 5 cm 10% p=0.0004 Soft Tissue Sarcoma

  10. Local failure: Group III by nodal status N0 19% N1 17% p=0.69 Soft Tissue Sarcoma

  11. Comparison to IRS III & IV Soft Tissue Sarcoma

  12. Summary • Local control was excellent (90%) for Group I/II ARMS representing only 32% of all failures with strategy of postoperative RT • Local failure accounted for 63% of all failures in Group III patients & did not vary by histology or nodal status • Local failure was highest for RP primary tumors (33%) compared to all other sites (14-19%) • Local failure higher for tumors > 5cm (25% vs 10%) • Results are similar to IRS III Soft Tissue Sarcoma

  13. Future directions • Suggestions for next COG Intermediate Risk RMS study: • RT boost to 55.8 Gy (from 50.4) for tumors arising in retroperitoneal & parameningeal sites and all tumors >5cm. • Limit pre-chemotherapy volume to 30.6 Gy (from 36 Gy). • Reduce total dose for complete response or resection at week 12 to 30.6 Gy. • Study PET response related to local failure Soft Tissue Sarcoma

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