Relapse after non-metastatic rhabdomyosarcoma: The impact of routine surveillance imaging on early detection and post-relapse survival.
post-relapse survival
prognostic factors
radiological follow-up
relapse
rhabdomyosarcoma
surveillance imaging
symptoms
Journal
Pediatric blood & cancer
ISSN: 1545-5017
Titre abrégé: Pediatr Blood Cancer
Pays: United States
ID NLM: 101186624
Informations de publication
Date de publication:
02 2023
02 2023
Historique:
revised:
18
10
2022
received:
22
08
2022
accepted:
20
10
2022
pubmed:
22
11
2022
medline:
28
12
2022
entrez:
21
11
2022
Statut:
ppublish
Résumé
Patients with rhabdomyosarcoma (RMS) whose disease relapses have little chance of being cured, so front-line treatments are usually followed up with surveillance imaging in an effort to detect any recurrences as early as possible, and thereby improve post-relapse outcomes. The real benefit of such routine surveillance imaging in RMS remains to be demonstrated, however. This retrospective, single-center study examines how well surveillance imaging identifies recurrent tumors and its impact on post-relapse survival. The analysis concerned 79 patients <21 years old treated between 1985 and 2020 whose initially localized RMS relapsed. Clinical findings, treatment modalities, and survival were analyzed, comparing patients whose relapse was first suspected from symptoms they developed (clinical symptoms group) with those whose relapse was identified by radiological surveillance (routine imaging group). Tumor relapses came to light because of clinical symptoms in 42 cases, and on routine imaging in 37. The time to relapse was much the same in the two groups. The median overall survival (OS) and 5-year OS rate were, respectively, 10 months and 12.6% in the clinical symptoms group, and 11 months and 27.5% in the routine imaging group (p-value .327). Among patients with favorable prognostic scores, survival was better for those in the routine imaging group (5-year OS 75.0% vs. 33.0%, p-value .047). It remains doubtful whether surveillance imaging has any real impact on RMS relapse detection and patients' post-relapse survival. Further studies are needed to establish the most appropriate follow-up recommendations, taking the potentially negative effects of regular radiological exams into account.
Sections du résumé
BACKGROUND
Patients with rhabdomyosarcoma (RMS) whose disease relapses have little chance of being cured, so front-line treatments are usually followed up with surveillance imaging in an effort to detect any recurrences as early as possible, and thereby improve post-relapse outcomes. The real benefit of such routine surveillance imaging in RMS remains to be demonstrated, however. This retrospective, single-center study examines how well surveillance imaging identifies recurrent tumors and its impact on post-relapse survival.
METHODS
The analysis concerned 79 patients <21 years old treated between 1985 and 2020 whose initially localized RMS relapsed. Clinical findings, treatment modalities, and survival were analyzed, comparing patients whose relapse was first suspected from symptoms they developed (clinical symptoms group) with those whose relapse was identified by radiological surveillance (routine imaging group).
RESULTS
Tumor relapses came to light because of clinical symptoms in 42 cases, and on routine imaging in 37. The time to relapse was much the same in the two groups. The median overall survival (OS) and 5-year OS rate were, respectively, 10 months and 12.6% in the clinical symptoms group, and 11 months and 27.5% in the routine imaging group (p-value .327). Among patients with favorable prognostic scores, survival was better for those in the routine imaging group (5-year OS 75.0% vs. 33.0%, p-value .047).
CONCLUSION
It remains doubtful whether surveillance imaging has any real impact on RMS relapse detection and patients' post-relapse survival. Further studies are needed to establish the most appropriate follow-up recommendations, taking the potentially negative effects of regular radiological exams into account.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e30095Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Skapek S, Ferrari A, Gupta A, et al. Rhabdomyosarcoma. Nat Rev Dis Primers. 2019;5(1):1. https://doi.org/10.1038/s41572-018-0051-2
Hawkins DS, Chi YY, Anderson JR, et al. Addition of vincristine and irinotecan to vincristine, dactinomycin, and cyclophosphamide does not improve outcome for intermediate-risk rhabdomyosarcoma: a report from the Children's Oncology Group. J Clin Oncol. 2018;36:2770-2777.
Bisogno G, Jenney M, Bergeron C, et al. Addition of dose-intensified doxorubicin to standard chemotherapy for rhabdomyosarcoma (EpSSG RMS 2005): a multicentre, open-label, randomized controlled, phase 3 trial. Lancet Oncol. 2018;19:1061-1071.
Bisogno G, De Salvo GL, Bergeron C, et al. Vinorelbine and continuous low-dose cyclophosphamide as maintenance chemotherapy in patients with high-risk rhabdomyosarcoma (RMS 2005): a multicentre, open-label, randomized, phase 3 trial. Lancet Oncol. 2019;20:1566-1575.
Heske CM, Mascarenhas L. Relapsed rhabdomyosarcoma. J Clin Med. 2021;10:804.
Mazzoleni S, Bisogno G, Garaventa A, et al. Outcomes and prognostic factors after recurrence in children and adolescents with nonmetastatic rhabdomyosarcoma. Cancer. 2005;104:183-190.
Chisholm JC, Marandet J, Rey A, et al. Prognostic factors after relapse in non-metastatic rhabdomyosarcoma: a nomogram to better define patients who can be salvaged with further therapy. J Clin Oncol. 2011;29:1319-1325.
Pappo AS, Anderson JR, Crist WM, et al. Survival after relapse in children and adolescents with rhabdomyosarcoma: a report from the Intergroup Rhabdomyosarcoma Study Group. J Clin Oncol. 1999;17:3487-3493.
Dantonello TM, Int-Veen C, Winkler P, et al. Initial patient characteristics can predict pattern and risk of relapse in localized rhabdomyosarcoma. J Clin Oncol. 2008;26:406-413.
Mattke AC, Bailey EJ, Schuck A, et al. Does the time-point of relapse influence outcome in pediatric rhabdomyosarcomas? Pediatr Blood Cancer. 2009;52:772-776.
Affinita MC, Ferrari A, Chiaravalli S, et al. Defining the impact of prognostic factors at the time of relapse for nonmetastatic rhabdomyosarcoma. Pediatr Blood Cancer. 2020;67:e28674.
Raney RB, Crist WM, Maurer HM, Foulkes MA. Prognosis of children with soft tissue sarcoma who relapse after achieving a complete response. A report from the Intergroup Rhabdomyosarcoma Study I. Cancer. 1983;52:44-50.
Mascarenhas L, Lyden ER, Breitfeld PP, et al. Risk-based treatment for patients with first relapse or progression of rhabdomyosarcoma: a report from the Children's Oncology Group. Cancer. 2019;125:2602-2609.
Bergamaschi L, Chiaravalli S, Livellara V, et al. Relapse after non-metastatic rhabdomyosarcoma: salvage rates and prognostic variables. Pediatr Blood Cancer. 2022:e30050. https://doi.org/10.1002/pbc.30050
Lin JL, Guillerman RP, Russell HV, et al. Does routine imaging of patients for progression or relapse improve survival in rhabdomyosarcoma? Pediatr Blood Cancer. 2016;63:202-205
Mallebranche C, Carton M, Minard-Colin V, et al. Relapse after rhabdomyosarcoma in childhood and adolescence: impact of an early detection on survival. Bull Cancer. 2017;104:625-635.
Vaarwerk B, Mallebranche C, Affinita MC, et al. Is surveillance imaging in pediatric patients treated for localized rhabdomyosarcoma useful? The European experience. Cancer. 2020;126:823-831.
Fetzko S, Fonseca A, Wedekind MF, et al. Is detection of relapse by surveillance imaging associated with longer survival in patients with rhabdomyosarcoma? J Pediatr Hematol Oncol. 2022;44(6):305-312.
Postovsky S, Barzilai M, Meller I, et al. Does regular follow-up influence the survival of patients with sarcoma after recurrence? The Miri Shitrit pediatric oncology department experience. J Pediatr Hematol Oncol. 2008;30:189-195.
Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92(3):205e16.
Kaplan EL, Meier P. Non-parametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457e81.
Conover WJ. Practical Nonparametric Statistics. Wiley; 1980:153e69.
Amy Lee Chong AL, Grant RM, Ahmed BA, et al. Imaging in pediatric patients: time to think again about surveillance. Pediatr Blood Cancer. 2010;55:407-413.
McHugh K, Roebuck DJ. Pediatric oncology surveillance imaging: two recommendations. Abandon CT scanning, and randomize to imaging or solely clinical follow-up. Pediatr Blood Cancer. 2014;61:3-6.
Donnelly LF. Reducing radiation dose associated with pediatric CT by decreasing unnecessary examinations. AJR Am J Roentgenol. 2005;184:655-657.
Dauer LT, St Germain J, Meyers PA. Let's image gently: reducing excessive reliance on CT scans. Pediatr Blood Cancer. 2008;51:838, author reply 839-840.
Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176:289-296.
Kleinerman RA. Cancer risks following diagnostic and therapeutic radiation exposure in children. Pediatr Radiol. 2006;36(Suppl):121-125.
Robbins E. Radiation risks from imaging studies in children with cancer. Pediatr Blood Cancer. 2008;51(4):453-457.
Fazel R, Krumholz HM, Wang Y, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med. 2009;361:849-857.
Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380:499-505.
Meulepas JM, Ronckers CM, Smets A, et al. Radiation exposure from pediatric CT scans and subsequent cancer risk in the Netherlands. J Natl Cancer Inst. 2019;111:256-263.
McDonald RJ, Levine D, Weinreb J, et al. Gadolinium retention: a research roadmap from the 2018 NIH/ACR/RSNA workshop on gadolinium chelates. Radiology. 2018;289:517-534.
Metzner J, Domino KB. Risks of anesthesia or sedation outside the operating room: the role of the anesthesia care provider. Curr Opin Anaesthesiol. 2010;23:523-531.
Glatz P, Sandin RH, Pedersen NL, et al. Association of anesthesia and surgery during childhood with long-term academic performance. JAMA Pediatr. 2017;171:e163470.
Backeljauw B, Holland SK, Altaye M, Loepke AW. Cognition and brain structure following early childhood surgery with anesthesia. Pediatrics. 2015;136:e1-e12. https://doi.org/10.1542/peds.2014-3526
Norberg AL, Green A. Stressors in the daily life of parents after a child's successful cancer treatment. J Psychosoc Oncol. 2007;25:113-122.
Thompson CA, Charlson ME, Schenkein E, et al. Surveillance CT scans are a source of anxiety and fear of recurrence in long-term lymphoma survivors. Ann Oncol. 2010;21(11):2262-2266.
Vaarwerk B, Limperg PF, Naafs-Wilstra MC, et al. Getting control during follow-up visits: the views and experiences of parents on tumor surveillance after their children have completed therapy for rhabdomyosarcoma or Ewing sarcoma. Support Care Cancer. 2019;27(10):3841-3848.
McHugh K, Roebuck DJ. Pediatric oncology surveillance imaging: two recommendations. Abandon CT scanning, and randomize to imaging or solely clinical follow-up. Pediatr Blood Cancer. 2014;61:3e6.
van Ewijk R, Schoot RA, Sparber-Sauer M, et al. European guideline for imaging in paediatric and adolescent rhabdomyosarcoma--joint statement by the European Paediatric Soft Tissue Sarcoma Study Group, the Cooperative Weichteilsarkom Studiengruppe and the Oncology Task Force of the European Society of Paediatric Radiology. Pediatr Radiol. 2021;51:1940-1951.
Hettmer S, Linardic CM, Kelsey A, et al. Molecular testing of rhabdomyosarcoma in clinical trials to improve risk stratification and outcome: a consensus view from European paediatric Soft tissue sarcoma Study Group, Children's Oncology Group and Cooperative Weichteilsarkom-Studiengruppe. Eur J Cancer. 2022;172:367-386.
Tombolan L, Rossi E, Binatti A, et al. Clinical significance of circulating tumor cells and cell-free DNA in pediatric rhabdomyosarcoma. Mol Oncol. 2022;16(10):2071-2085.
Stegmaier S, Sparber-Sauer M, Aakcha-Rudel E, et al. Fusion transcripts as liquid biopsy markers in alveolar rhabdomyosarcoma and synovial sarcoma: a report of the Cooperative Weichteilsarkom Studiengruppe (CWS). Pediatr Blood Cancer. 2022;69(9):e29652.