Presenter: S. S. Donaldson, MD Affiliation: The Intergroup Rhabdomyosarcoma Study
Hyperfractionated radiation therapy (HFRT) has the theoretical potential for improving efficacy without producing more late effects of children with rhabdomyosarcoma (RMS).
This analysis of the IRS experience in treating rhabdomyosarcomas with HFRT is the first phase III randomized trial of this therapy reported for children
Materials and Methods:
Children with Group III (gross residual tumor) rhabdomyosarcoma were randomized to receive either 50.4 Gy standard RT or 59.4 Gy in 1.1 Gy BID fractions HFRT, both beginning about week 9 post-resection and after initial chemotherapy
The dose of HFRT was predicted (based on alpha/beta model) to increase effective tumor dose by 10% without increasing the late toxicity
450 children were analyzed, 251 of whom received HFRT and 239 of whom received conventional RT
Compliance to radiation protocol was only 57% for patients <= 5 years of age, and 88% for older patients
Five year actuarial survival was 75%, and relapse-free survival was 70%
There was no significant difference in survival for the 2 groups
When analyzed by intent to treat, there was no significant difference on freedom-from-relapse for the 2 groups
Local failure rate was 12% for the conventional RT patients and 15% for the HFRT patients; this was not significantly different
Grade III and IV toxicity was 86% in the conventional RT group and 89% in the HFRT group; also not significantly different
HFRT as described above does not improve tumor control in these patients
Conventional RT remains the standard of care for children with Group III rhabdomyosarcoma
Feb 10, 2011 - The results of two phase 3, randomized controlled trials suggest that two therapies, sunitinib and everolimus, hold promise in the treatment of patients with advanced pancreatic neuroendocrine tumors; the findings of these trials have been published in the Feb. 10 issue of the New England Journal of Medicine.