The effect of radiation timing on patients with high-risk features of parameningeal rhabdomyosarcoma: an analysis of IRS-IV and D9803

UMMS Affiliation

Department of Radiation Oncology; Quality Assurance Review Center



Document Type


Medical Subject Headings

Brain Neoplasms; Child; Child, Preschool; Cranial Nerve Diseases; Female; Follow-Up Studies; Humans; Infant; Male; Meningeal Neoplasms; Neoplasm Invasiveness; Neoplasm Staging; Neoplasm, Residual; Radiotherapy Dosage; Rhabdomyosarcoma; Rhabdomyosarcoma, Alveolar; Rhabdomyosarcoma, Embryonal; Time Factors


Neoplasms | Oncology | Pediatrics | Radiology | Therapeutics


PURPOSE: Radiation therapy remains an essential treatment for patients with parameningeal rhabdomyosarcoma (PMRMS), and early radiation therapy may improve local control for patients with intracranial extension (ICE).

METHODS AND MATERIALS: To address the role of radiation therapy timing in PMRMS in the current era, we reviewed the outcome from 2 recent clinical trials for intermediate-risk RMS: Intergroup Rhabdomyosarcoma Study (IRS)-IV and Children's Oncology Group (COG) D9803. The PMRMS patients on IRS-IV with any high-risk features (cranial nerve palsy [CNP], cranial base bony erosion [CBBE], or ICE) were treated immediately at day 0, and PMRMS patients without any of these 3 features received week 6-9 radiation therapy. The D9803 PMRMS patients with ICE received day 0 X-Ray Therapy (XRT) as well; however, those with either CNP or CBBE had XRT at week 12.

RESULTS: Compared with the 198 PMRMS patients from IRS-IV, the 192 PMRMS patients from D9803 had no difference (P < .05) in 5-year local failure (19% vs 19%), failure-free-survival (70% vs 67%), or overall survival (75% vs 73%) in aggregate. The 5-year local failure rates by subset did not differ when patients were classified as having no risk features (None, 15% vs 19%, P = .25), cranial nerve palsy/cranial base of skull erosion (CNP/CBBE, 15% vs 28%, P = .22), or intracranial extension (ICE, 21% vs 15%, P = .27). The D9083 patients were more likely to have received initial staging by magnetic resonance imaging (71% vs 53%).

CONCLUSIONS: These data support that a delay in radiation therapy for high-risk PMRMS features of CNP/CBBE does not compromise clinical outcomes.

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Citation: Spalding AC, Hawkins DS, Donaldson SS, Anderson JR, Lyden E, Laurie F, Wolden SL, Arndt CA, Michalski JM. The effect of radiation timing on patients with high-risk features of parameningeal rhabdomyosarcoma: an analysis of IRS-IV and D9803. Int J Radiat Oncol Biol Phys. 2013 Nov 1;87(3):512-6. doi:10.1016/j.ijrobp.2013.07.003. PubMed PMID: 24074925; PubMed Central PMCID:PMC4524335. Link to article on publisher's site


This study was supported in part by Grant CA-29511 from the National Cancer Institute for the IROC Rhode Island (QARC), a quality assurance vehicle and data management service for diagnostic imaging and radiation oncology for the National Cancer Institute Clinical Trials Program. QARC is a research program within the University of Massachusetts Medical School led by Dr. Thomas (TJ) FitzGerald of the Department of Radiation Oncology.

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