Is surveillance imaging in pediatric patients treated for localized rhabdomyosarcoma useful? The European experience

Abstract

BACKGROUND: After the completion of therapy, patients with localized rhabdomyosarcoma (RMS) are subjected to intensive radiological tumor surveillance. However, the clinical benefit of this surveillance is unclear. This study retrospectively analyzed the value of off-therapy surveillance by comparing the survival of patients in whom relapse was detected by routine imaging (the imaging group) and patients in whom relapse was first suspected by symptoms (the symptom group). METHODS: This study included patients with relapsed RMS after the completion of therapy for localized RMS who were treated in large pediatric oncology hospitals in France, the United Kingdom, Italy, and the Netherlands and who were enrolled in the International Society of Paediatric Oncology Malignant Mesenchymal Tumor 95 (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004) study, the Italian Paediatric Soft Tissue Sarcoma Committee Rhabdomyosarcoma 96 (1996-2004) study, or the European Paediatric Soft Tissue Sarcoma Study Group Rhabdomyosarcoma 2005 (2005-2013) study. The survival times after relapse were compared with a log-rank test between patients in the imaging group and patients in the symptom group. RESULTS: In total, 199 patients with relapsed RMS were included: 78 patients (39.2%) in the imaging group and 121 patients (60.8%) in the symptom group. The median follow-up time after relapse was 7.4 years (interquartile range, 3.9-11.5 years) for survivors (n = 86); the 3-year postrelapse survival rate was 50% (95% confidence interval [CI], 38%-61%) for the imaging group and 46% (95% CI, 37%-55%) for the symptom group (P = .7). CONCLUSIONS: Although systematic routine imaging is the standard of care after RMS therapy, the majority of relapses were detected as a result of clinical symptoms. This study found no survival advantage for patients whose relapse was detected before the emergence of clinical symptoms. These results show that the value of off-therapy surveillance is controversial, particularly because repeated imaging may also entail potential harm. Cancer 2020;126:823-831.

Radiation therapy is an important factor to improve survival in pediatric patients with head and neck rhabdomyosarcoma by enhancing local control: a historical cohort study from a single center

“…In our cohort during the follow up there were 26 events, of which 24 were local events. This result was consisted with other reports, that the most common treatment failure (including disease progression and relapse) was local failure, and maintaining local control would benefit prognosis substantially [7,8,22].…”

“…Clinical data during and after treatment were recorded. Frequency of off-therapy surveillance was every 3 months for the first year, every 4 months for the second and third year, and once a year for the fourth and fifth year [8]. Clinical physical examination, blood routine and biochemical tests, head and neck CT or MRI with or without contrast, and chest CT or chest X-ray were required for surveillance, and PET-CT was optional to replace all imaging examinations.…”

“…The prognosis of all RMS is strongly determined by the ability of achieving local control (control of the primary tumor site) [2,7]. The main pattern of treatment failure including disease progression and relapse is local failure, and maintaining local control is of crucial importance throughout the treatment plan [7,8]. The two major modalities of local control are surgery and RT, which could be used separately or combined [2,9].…”

Risk Factors for Disease Progression and Prognosis Analysis in Pediatric Head and Neck Rhabdomyosarcoma Patients: a Historical Cohort Study From a Single Center

“…We previously reported that the patterns of disease progression and relapse of this cohort were mainly local, which was consistent with other published reports [9,21]. A cure for RMS depends rstly on local control (eradication of the primary tumor by surgery and/or RT), then on systemic control (eradication of the micro and metastatic residual) [5].…”

Recent advances in understanding and managing pediatric rhabdomyosarcoma

“…To determine whether delayed diagnosis contributes to such poor outcomes in some patients, the EpSSG conducted a retrospective study comparing 78 patients who had imaging performed routinely to 121 patients who had imaging performed on the basis of symptoms alone. The patients who received routine imaging had their disease detected earlier than those who did not (8 versus 12 months); however, this did not improve survival, suggesting that the poor outcomes cannot be explained solely by delayed diagnosis 38 .…”