UNLABELLED

Our present study is a retrospective analysis of the treatment results of new rhabdomyosarcoma pediatric patients who had attended the pediatric unit clinic of Kasr El-Aini Center of Radiation Oncology and Nuclear Medicine (NEMROCK) from January 1992 to January 2001).

PATIENTS AND METHODS

Fifty-five new cases of pediatric rhabdomyosarcoma attended the pediatric unit outpatient clinic of (NEMROCK) from the period of January 1992 until January 2001. Patients were divided into 4 stages and classified into low-risk patients and high-risk patients according to the extent of resection. Stage I, II orbital and stage I para-testicular embryonal rhabdomyosarcomas received 32 weeks of vincristine and actinomycin- D (vincristine 1.5 mg/m2 weekly, actinomycin-D 0.015 mg/Kg/day day 1 to day 5). Other pathologies, sites and stages received 52 weeks of chemotherapy. Chemotherapy regimens included VAC (vincristine 1.5 mg/m2 weekly, actinomycin-D 0.015 mg/Kg/day day 1 to day 5 and endoxan 2.2 gm/m2 I.V with mesna every 21 days), VAI (vincristine, actinomycin-D and ifosfamide 1.8 gm/m2 I.V day 1 to day 5 with mesna) or VIE (vincristine, ifosfamide and vepesid 100 mg/m2 I.V day 1 to day 5) [11,12]. Stages I and II received conventional fractionation radiotherapy 4140 cGy on week 13, stages III and IV received conventional fractionation radiation therapy 5040 cGy also, on week 13. The radiation volume included the tumor bed with a 2 cm safety margin at least. Relapsing cases received palliative radiation therapy and chemotherapy (cisplatinum I.V 100 mg/m2 divided over 2 days and vepesid 100 mg/m2 I.V day 1 to day 3 to be recycled every 21 days). Patients were followed-up for 5 years, with a median follow-up of 36 months. Overall survival, disease free survival, treatment response, and complications of treatment were assessed and statistically analyzed.

RESULTS

Fifty-five new cases of pediatric rhabdomyosarcoma attended the pediatric unit outpatient clinic of (NEMROCK) and were evaluated. Males constituted about 63.6% of the cases (35 cases) and females 36.4% (20 cases). The median age was 6 years and the ages of the patients ranged from 1 to 9 years. Most of the cases were in early stages (40/55 i.e. 72.7%) versus late stages (15/55, i.e. 27.3%). Pathologically, embryonal type was the commonest statistically (48/55, i.e. 87.3%) compared to the alveolar type (7/55, i.e. 12.7%). Concerning site of the primary tumor it was found to be highest in the head and neck (20/55, i.e. 36.4%) followed by abdominal site (23.6%) excluding the genitourinary system which was classified separately because it included pelvis and abdomen (13/55, i.e. 23.6%). The estimated 5-year Failure Free actuarial Survival (FFSR) for the entire study is 68% [n=55; 95% confidence interval (CI), 63% to 73%], and the estimated 5-year overall actuarial survival (OS) rate is 74% (95% CI, 69% to 79%). Twenty cases experienced relapse during the 5 years follow up (i.e. 36.4%). There was no lost follow-up in the selected group of children studied. In addition, only 3 cases showed distant metastasis at the onset of the study. Complete remission (CR) was achieved in 50.9% of the cases.

CONCLUSION

Despite the advances in the therapy of rhabdomyosarcoma. Nearly 30% of the pediatric cases with rhabdomyosarcoma experience progressive or relapsing disease, which has a fatal end. The factors determining the 5-year survival after relapse at the time of initial diagnosis include histological subtype, and disease cluster. These findings will form the basis of a multi-institutional risk adapted relapse protocol for childhood rhabdomyosarcoma patients.