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, 103 (5), 1151-1157

Worse Outcomes for Head and Neck Rhabdomyosarcoma Secondary to Reduced-Dose Cyclophosphamide

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Worse Outcomes for Head and Neck Rhabdomyosarcoma Secondary to Reduced-Dose Cyclophosphamide

Dana L Casey et al. Int J Radiat Oncol Biol Phys.

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Abstract

Purpose: Recent trends, including the use of proton therapy and administration of reduced doses of cyclophosphamide, have been adapted in head and neck (HN) rhabdomyosarcoma (RMS) to reduce late morbidity. Our primary goal was to analyze local control and survival outcomes after photon versus proton irradiation in pediatric patients with HN-RMS, with the secondary goal of analyzing the effect of cyclophosphamide dose on disease outcomes.

Methods and materials: This single-institution cohort study comprised 76 pediatric HN-RMS patients treated with definitive chemoradiation from 2000 to 2018. Fifty-one patients (67%) received intensity modulated photon radiation therapy, and 25 (33%) received proton therapy.

Results: Local failure (LF) at 2 years was 12.5% for parameningeal RMS and 0% for orbital RMS and other head and neck sites (P = .24). Patients treated with protons were more likely to have received reduced-dose cyclophosphamide (P < .0001). The 2-year LF was 7.9% in the intensity modulated photon radiation therapy cohort versus 14.6% in the proton cohort (P = .07), with no difference in survival outcomes. Cumulative cyclophosphamide dose was significantly associated with 2-year LF: 0% for cumulative dose of >20 g/m2 versus 15.3% for ≤20 g/m2 (P = .04). In parameningeal RMS patients (n = 59), both cumulative cyclophosphamide dose and dose intensity were associated with LF (P = .01). There was a trend toward worse event-free survival for parameningeal RMS patients who received reduced-dose-intensity cyclophosphamide (59.2% vs 70.6%, P = .11).

Conclusions: Both dose-intensity and cumulative cyclophosphamide dose seem to play an important role in achieving local control for HN-RMS patients treated with either protons or photons. Longer follow-up is needed to further assess disease outcomes with proton therapy.

Conflict of interest statement

Conflict of interest: Dr. Wolden reports personal fees from YmAbs therapeutics, outside the submitted work.

Figures

Figure 1.
Figure 1.
Local failure by radiation modality (protons versus intensity-modulated radiation, therapy, IMRT)
Figure 2.
Figure 2.
Example of an in-field local failure in the high-dose region after proton therapy for a suprasellar rhabdomyosarcoma
Figure 3.
Figure 3.
Local failure among patients with parameningeal rhabdomyosarcoma by a) cumulative cyclophosphamide dose and b) cyclophosphamide dose-intensity
Figure 3.
Figure 3.
Local failure among patients with parameningeal rhabdomyosarcoma by a) cumulative cyclophosphamide dose and b) cyclophosphamide dose-intensity

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