Influence of noncompliance with radiation therapy protocol guidelines and operative bed recurrences for children with rhabdomyosarcoma and microscopic residual disease: a report from the Children's Oncology Group
Name:
Publisher version
View Source
Access full-text PDFOpen Access
View Source
Check access options
Check access options
Authors
Million, LynnAnderson, James
Breneman, John
Hawkins, Douglas S
Laurie, Fran
Michalski, Jeff
Wharam, Moody
Rodeberg, David A.
Wolden, Suzanne
Donaldson, Sarah S.
UMass Chan Affiliations
Department of Radiation OncologyDocument Type
Journal ArticlePublication Date
2011-06-01Keywords
AdolescentAge Factors
Child
Child, Preschool
Clinical Protocols
*Guideline Adherence
Humans
Infant
Neoplasm Recurrence, Local
Neoplasm, Residual
Radiotherapy Dosage
Rhabdomyosarcoma, Alveolar
Rhabdomyosarcoma, Embryonal
Tumor Burden
Neoplasms
Oncology
Metadata
Show full item recordAbstract
PURPOSE: Postoperative radiation therapy (RT) is recommended for patients with rhabdomyosarcoma having microscopic disease. Sometimes RT dose/volume is reduced or omitted in an attempt to avoid late effects, particularly in young children. We reviewed operative bed recurrences to determine if noncompliance with RT protocol guidelines influenced local-regional control. METHODS AND MATERIALS: All operative bed recurrences among 695 Group II rhabdomyosarcoma patients in Intergroup Rhabdomyosarcoma Study Group (IRS) I through IV were reviewed for deviation from RT protocol. Major/minor dose deviation was defined as >10% or 6-10% of the prescribed dose (40-60 Gy), respectively. Major/minor volume deviation was defined as tumor excluded from the RT field or treatment volume not covered by the specified margin (preoperative tumor volume and 2- to 5-cm margin), respectively. No RT was a major deviation. RESULTS: Forty-six of 83 (55%) patients with operative bed recurrences did not receive the intended RT (39 major and 7 minor deviations). RT omission was the most frequent RT protocol deviation (19/46, 41%), followed by dose (17/46, 37%), volume (9/46, 20%), and dose and volume deviation (1/46, 2%). Only 7 operative bed recurrences occurred in IRS IV (5% local-regional failure) with only 3 RT protocol deviations. Sixty-three (76%) patients with recurrence died of disease despite retrieval therapy, including 13 of 19 nonirradiated children. CONCLUSION: Over half of the operative bed recurrences were associated with noncompliance; omission of RT was the most common protocol deviation. Three fourths of children die when local-regional disease is not controlled, emphasizing the importance of RT in Group II rhabdomyosarcoma.Source
Int J Radiat Oncol Biol Phys. 2011 Jun 1;80(2):333-8. doi: 10.1016/j.ijrobp.2010.01.058. Epub 2010 Jun 18. Link to article on publisher's siteDOI
10.1016/j.ijrobp.2010.01.058Permanent Link to this Item
http://hdl.handle.net/20.500.14038/47943PubMed ID
20646841Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.ijrobp.2010.01.058