Center for Medical Ethics and Health Policy Staff Publications
Publication Date
8-1-2022
Journal
Journal of Pediatric Hematology/Oncology
DOI
10.1097/MPH.0000000000002429
PMID
35137727
PMCID
PMC10026693
PubMedCentral® Posted Date
3-20-2023
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
Diagnostic Imaging, Humans, Neoplasm Recurrence, Local, Proportional Hazards Models, Retrospective Studies, Rhabdomyosarcoma, Rhabdomyosarcoma, Embryonal
Abstract
Background: We investigated whether surveillance imaging had an impact on post-relapse survival in patients with rhabdomyosarcoma (RMS). We hypothesized that relapse detected by imaging (group IM) would be associated with longer survival compared with relapse detected with a clinical sign or symptom (group SS).
Materials and methods: We performed an observational multi-institutional study in 127 patients with relapsed RMS comparing overall survival (OS) after relapse using Kaplan-Meier and Cox proportional hazards analyses.
Results: Relapse was detected in 60 (47%) group IM and 67 (53%) SS patients. Median follow-up in survivors was 4 years (range 1.0 to 16.7 y). Four-year OS rates were similar between group IM (28%, 95% confidence interval [CI]: 14%-40%) and SS (21%, 95% CI: 11%-31%) ( P =0.14). In multivariable analyses accounting for institution, age at diagnosis, time to relapse, risk group at diagnosis, and primary site, not receiving chemotherapy (hazard ratio [HR]: 6.8, 95% CI: 2.8-16.6), radiation (HR: 3, 95% CI: 1.7-5.3), or surgery (HR: 2.8, 95% CI: 1.6-4.8) after relapse were independently associated with poor OS.
Conclusion: These results on whether surveillance imaging provides survival benefit in patients with relapsed RMS are inconclusive. Larger studies are needed to justify current surveillance recommendations. Chemotherapy, radiotherapy and surgery to treat recurrence prolong OS.