The impact of surgical excision in chest wall rhabdomyosarcoma: a report from the children's oncology group

Andrea Hayes-Jordan, Julie A. Stoner, James R. Anderson, David Rodeberg, Gene Weiner, William H. Meyer, Doug S. Hawkins, Carola A.S. Arndt, Charles Paidas

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Abstract

Aims: Rhabdomyosarcoma (RMS) is the most common soft tissue tumor of childhood. Patient age, size, histologic finding, and site of the tumor are primary determinants of prognosis in RMS. Chest wall RMS is a site in which the limitations of surgical excision are realized. We aim to determine the impact of surgical excision in chest wall RMS. Methods: A retrospective chart review was conducted of all 130 pediatric patients enrolled in the Intergroup Rhabdomyosarcoma Study (IRS) with chest wall rhabdomyosarcoma from the first (I) through fourth (IV) IRS with follow-up to June 2005. Median follow-up was 12.1 years (4.6-27.2 years). Results: There was a significant improvement in failure-free survival (FFS) and overall survival (OS) between the first IRS study, I, and IRS-IV. The estimated FFS and OS at 5 years in IRS I was 30% and 40%, respectively, compared to 68% and 78%, respectively, in IRS-IV (P = .03 and P = .05, respectively). There was no association between histologic finding or size and FFS or OS. However, all patients who presented without metastasis had an FFS and OS of 49% and 61%, respectively, compared with metastatic patients, 7% and 7%, respectively (P < .001). Five-year FFS of group I, II, and III patients was 52%, 52%, and 45%, respectively, and OS was 65%, 60%, and 59%, respectively. There was no significant difference in 5-year FFS or OS in patients who had a complete resection (group I), complete resection with positive microscopic margins (group II), or biopsy or partial resection only (group III). In groups I to III patients, the local and regional failure rate at 5 years is 25% and 6%, respectively. Conclusions: The most significant impact on outcome in chest wall RMS patients is metastatic disease at diagnosis. The locoregional failure rate is high but does not appear to impact survival. Alternative treatment strategies are needed for chest wall RMS, but aggressive surgical excision may not be necessary.

Original languageEnglish (US)
Pages (from-to)831-836
Number of pages6
JournalJournal of Pediatric Surgery
Volume43
Issue number5
DOIs
StatePublished - May 2008

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Rhabdomyosarcoma
Thoracic Wall
Survival
Neoplasms

Keywords

  • Chest wall
  • Childhood
  • Rhabdomyosarcoma

ASJC Scopus subject areas

  • Surgery

Cite this

Hayes-Jordan, A., Stoner, J. A., Anderson, J. R., Rodeberg, D., Weiner, G., Meyer, W. H., ... Paidas, C. (2008). The impact of surgical excision in chest wall rhabdomyosarcoma: a report from the children's oncology group. Journal of Pediatric Surgery, 43(5), 831-836. https://doi.org/10.1016/j.jpedsurg.2007.12.021

The impact of surgical excision in chest wall rhabdomyosarcoma : a report from the children's oncology group. / Hayes-Jordan, Andrea; Stoner, Julie A.; Anderson, James R.; Rodeberg, David; Weiner, Gene; Meyer, William H.; Hawkins, Doug S.; Arndt, Carola A.S.; Paidas, Charles.

In: Journal of Pediatric Surgery, Vol. 43, No. 5, 05.2008, p. 831-836.

Research output: Contribution to journalArticle

Hayes-Jordan, A, Stoner, JA, Anderson, JR, Rodeberg, D, Weiner, G, Meyer, WH, Hawkins, DS, Arndt, CAS & Paidas, C 2008, 'The impact of surgical excision in chest wall rhabdomyosarcoma: a report from the children's oncology group', Journal of Pediatric Surgery, vol. 43, no. 5, pp. 831-836. https://doi.org/10.1016/j.jpedsurg.2007.12.021
Hayes-Jordan, Andrea ; Stoner, Julie A. ; Anderson, James R. ; Rodeberg, David ; Weiner, Gene ; Meyer, William H. ; Hawkins, Doug S. ; Arndt, Carola A.S. ; Paidas, Charles. / The impact of surgical excision in chest wall rhabdomyosarcoma : a report from the children's oncology group. In: Journal of Pediatric Surgery. 2008 ; Vol. 43, No. 5. pp. 831-836.
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title = "The impact of surgical excision in chest wall rhabdomyosarcoma: a report from the children's oncology group",
abstract = "Aims: Rhabdomyosarcoma (RMS) is the most common soft tissue tumor of childhood. Patient age, size, histologic finding, and site of the tumor are primary determinants of prognosis in RMS. Chest wall RMS is a site in which the limitations of surgical excision are realized. We aim to determine the impact of surgical excision in chest wall RMS. Methods: A retrospective chart review was conducted of all 130 pediatric patients enrolled in the Intergroup Rhabdomyosarcoma Study (IRS) with chest wall rhabdomyosarcoma from the first (I) through fourth (IV) IRS with follow-up to June 2005. Median follow-up was 12.1 years (4.6-27.2 years). Results: There was a significant improvement in failure-free survival (FFS) and overall survival (OS) between the first IRS study, I, and IRS-IV. The estimated FFS and OS at 5 years in IRS I was 30{\%} and 40{\%}, respectively, compared to 68{\%} and 78{\%}, respectively, in IRS-IV (P = .03 and P = .05, respectively). There was no association between histologic finding or size and FFS or OS. However, all patients who presented without metastasis had an FFS and OS of 49{\%} and 61{\%}, respectively, compared with metastatic patients, 7{\%} and 7{\%}, respectively (P < .001). Five-year FFS of group I, II, and III patients was 52{\%}, 52{\%}, and 45{\%}, respectively, and OS was 65{\%}, 60{\%}, and 59{\%}, respectively. There was no significant difference in 5-year FFS or OS in patients who had a complete resection (group I), complete resection with positive microscopic margins (group II), or biopsy or partial resection only (group III). In groups I to III patients, the local and regional failure rate at 5 years is 25{\%} and 6{\%}, respectively. Conclusions: The most significant impact on outcome in chest wall RMS patients is metastatic disease at diagnosis. The locoregional failure rate is high but does not appear to impact survival. Alternative treatment strategies are needed for chest wall RMS, but aggressive surgical excision may not be necessary.",
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T1 - The impact of surgical excision in chest wall rhabdomyosarcoma

T2 - a report from the children's oncology group

AU - Hayes-Jordan, Andrea

AU - Stoner, Julie A.

AU - Anderson, James R.

AU - Rodeberg, David

AU - Weiner, Gene

AU - Meyer, William H.

AU - Hawkins, Doug S.

AU - Arndt, Carola A.S.

AU - Paidas, Charles

PY - 2008/5

Y1 - 2008/5

N2 - Aims: Rhabdomyosarcoma (RMS) is the most common soft tissue tumor of childhood. Patient age, size, histologic finding, and site of the tumor are primary determinants of prognosis in RMS. Chest wall RMS is a site in which the limitations of surgical excision are realized. We aim to determine the impact of surgical excision in chest wall RMS. Methods: A retrospective chart review was conducted of all 130 pediatric patients enrolled in the Intergroup Rhabdomyosarcoma Study (IRS) with chest wall rhabdomyosarcoma from the first (I) through fourth (IV) IRS with follow-up to June 2005. Median follow-up was 12.1 years (4.6-27.2 years). Results: There was a significant improvement in failure-free survival (FFS) and overall survival (OS) between the first IRS study, I, and IRS-IV. The estimated FFS and OS at 5 years in IRS I was 30% and 40%, respectively, compared to 68% and 78%, respectively, in IRS-IV (P = .03 and P = .05, respectively). There was no association between histologic finding or size and FFS or OS. However, all patients who presented without metastasis had an FFS and OS of 49% and 61%, respectively, compared with metastatic patients, 7% and 7%, respectively (P < .001). Five-year FFS of group I, II, and III patients was 52%, 52%, and 45%, respectively, and OS was 65%, 60%, and 59%, respectively. There was no significant difference in 5-year FFS or OS in patients who had a complete resection (group I), complete resection with positive microscopic margins (group II), or biopsy or partial resection only (group III). In groups I to III patients, the local and regional failure rate at 5 years is 25% and 6%, respectively. Conclusions: The most significant impact on outcome in chest wall RMS patients is metastatic disease at diagnosis. The locoregional failure rate is high but does not appear to impact survival. Alternative treatment strategies are needed for chest wall RMS, but aggressive surgical excision may not be necessary.

AB - Aims: Rhabdomyosarcoma (RMS) is the most common soft tissue tumor of childhood. Patient age, size, histologic finding, and site of the tumor are primary determinants of prognosis in RMS. Chest wall RMS is a site in which the limitations of surgical excision are realized. We aim to determine the impact of surgical excision in chest wall RMS. Methods: A retrospective chart review was conducted of all 130 pediatric patients enrolled in the Intergroup Rhabdomyosarcoma Study (IRS) with chest wall rhabdomyosarcoma from the first (I) through fourth (IV) IRS with follow-up to June 2005. Median follow-up was 12.1 years (4.6-27.2 years). Results: There was a significant improvement in failure-free survival (FFS) and overall survival (OS) between the first IRS study, I, and IRS-IV. The estimated FFS and OS at 5 years in IRS I was 30% and 40%, respectively, compared to 68% and 78%, respectively, in IRS-IV (P = .03 and P = .05, respectively). There was no association between histologic finding or size and FFS or OS. However, all patients who presented without metastasis had an FFS and OS of 49% and 61%, respectively, compared with metastatic patients, 7% and 7%, respectively (P < .001). Five-year FFS of group I, II, and III patients was 52%, 52%, and 45%, respectively, and OS was 65%, 60%, and 59%, respectively. There was no significant difference in 5-year FFS or OS in patients who had a complete resection (group I), complete resection with positive microscopic margins (group II), or biopsy or partial resection only (group III). In groups I to III patients, the local and regional failure rate at 5 years is 25% and 6%, respectively. Conclusions: The most significant impact on outcome in chest wall RMS patients is metastatic disease at diagnosis. The locoregional failure rate is high but does not appear to impact survival. Alternative treatment strategies are needed for chest wall RMS, but aggressive surgical excision may not be necessary.

KW - Chest wall

KW - Childhood

KW - Rhabdomyosarcoma

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