Pediatric Department of Beijing Tongren Hospital, Capital Medical University, 100730, 1# Dong Jiao Min Xiang, Dongcheng District, Beijing, China.
BMC Pediatr. 2020 May 29;20(1):265. doi: 10.1186/s12887-020-02165-y.
The purpose of this study is to analyze the influence of radiation therapy on survival in a historical cohort of 56 pediatric patients with head and neck rhabdomyosarcoma.
A historical cohort of 56 pediatric patients with head and neck rhabdomyosarcoma from June 1st, 2013 to June 30th, 2019 was chosen. Clinical data and follow up results were collected including all diagnosis, treatment and prognosis information. Overall survival (OS) and event free survival (EFS) as time-to-event distributions were estimated with Kaplan-Meier method, and univariate analysis was performed with log rank test to detect differences between groups. Multivariate analysis was performed to explore the risk factors for survival with Cox proportional hazard model.
The media follow up time of all 56 patients was 31.8 months (range 3.5-74.6 months). There were 26 events during follow up, including 14 disease progressions and 12 relapses. The estimated 5-year OS of all patients was 69.9%, and the estimated 5-year EFS was 48.8%. Patients with radiation therapy as a component of the initial treatment plan had better 5-year OS and EFS compared with those without radiation therapy (OS 80.3% vs. 49.7%, p = 0.003 and EFS 63.9% vs. 21.9%, p < 0.001). In patients with events, those who received salvage radiation therapy had better 5-year OS compared with those who didn't (OS 66.0% vs. 31.2%, p = 0.033). On multivariate analysis, tumor size > 5 cm and non-initial radiation therapy were independent risk factors for OS in all patients, non-initial radiation therapy was an independent risk factor for EFS in all patients, and tumor size > 5 cm was an independent risk factor for OS in patients with events.
Radiation therapy as a component of initial treatment can improve the OS and EFS in pediatric head and neck rhabdomyosarcoma patients by enhancing local control, and non-initial radiation therapy is an independent risk factor for OS and EFS. Salvage radiation therapy still can improve OS in patients with disease progression and relapse. Tumor size > 5 cm is an independent risk factor for OS in pediatric HNRMS patients with or without disease progression/relapse.
本研究旨在分析 56 例头颈横纹肌肉瘤患儿的历史队列中放射治疗对生存的影响。
选择 2013 年 6 月 1 日至 2019 年 6 月 30 日期间的头颈横纹肌肉瘤 56 例儿科患者的历史队列。收集包括所有诊断、治疗和预后信息的临床数据和随访结果。使用 Kaplan-Meier 方法估计总生存期（OS）和无事件生存期（EFS）作为时间事件分布，并使用对数秩检验进行单变量分析以检测组间差异。使用 Cox 比例风险模型进行多变量分析以探讨生存的危险因素。
所有 56 例患者的中位随访时间为 31.8 个月（范围 3.5-74.6 个月）。随访期间发生 26 例事件，包括 14 例疾病进展和 12 例复发。所有患者的 5 年 OS 估计为 69.9%，5 年 EFS 估计为 48.8%。接受放射治疗作为初始治疗方案一部分的患者 5 年 OS 和 EFS 优于未接受放射治疗的患者（OS：80.3% vs. 49.7%，p=0.003；EFS：63.9% vs. 21.9%，p<0.001）。在有事件的患者中，接受挽救性放射治疗的患者 5 年 OS 优于未接受者（OS：66.0% vs. 31.2%，p=0.033）。多变量分析显示，肿瘤大小>5cm 和非初始放射治疗是所有患者 OS 的独立危险因素，非初始放射治疗是所有患者 EFS 的独立危险因素，肿瘤大小>5cm 是有事件患者 OS 的独立危险因素。
作为初始治疗一部分的放射治疗可以通过提高局部控制来提高儿科头颈横纹肌肉瘤患者的 OS 和 EFS，非初始放射治疗是 OS 和 EFS 的独立危险因素。挽救性放射治疗仍可提高疾病进展和复发患者的 OS。肿瘤大小>5cm 是有或无疾病进展/复发的儿科 HNRMS 患者 OS 的独立危险因素。
