Rhabdomyosarcoma medical therapy: Difference between revisions

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==Overview==
==Overview==
Treatment for rhabdomyosarcoma may consists of [[chemotherapy]], [[radiation therapy]] and surgery. Chemotherapy may be given as [[neoadjuvant chemotherapy]] or [[adjuvant chemotherapy]]. [[Radiation therapy]] may be used as local therapy.
Treatment for rhabdomyosarcoma may consists of [[chemotherapy]], [[radiation therapy]] and [[surgery]] and treatments depends on [[Cancer staging|staging]] [[classification]] and [[Risk stratification tools|risk stratification]]. Rhabdomyosarcoma [[chemotherapy]] depends on patient's risk groups. [[Vincristine]], [[actinomycin D]],and [[cyclophosphamide]] are the fundamental [[chemotherapy]] standard based on [[Children's Oncology Group]]. [[Ifosfamide]], [[vincristine]], and [[actinomycin D]] are the fundamental [[chemotherapy]] standard base on European [[Soft tissue]] [[Sarcoma]] Group. Patients's response to [[chemotherapy]] is classified to five groups as complete response, good response, poor response, objective response, and progressive disease. [[Radiation therapy]] may be used as local therapy and is usually initiated after 4 [[chemotherapy]] cycles. The only exception for starting [[radiotherapy]] from the first day is [[vision loss]] and [[spinal cord compression]]. [[Radiotherapy]] dosage is based on completeness of [[tumor]] [[resection]] before [[chemotherapy]] and completeness of a delayed primary [[tumor]] [[excision]] after [[adjuvant chemotherapy]].
==Medical Therapy==
==Medical Therapy==
* Rhabdomyosarcoma treatment include combination of surgery, radiotherapy, and chemotherapy.
* Rhabdomyosarcoma treatment include combination of [[surgery]], [[radiotherapy]], and [[chemotherapy]].<ref name="pmid24326270">{{cite journal| author=Hawkins DS, Gupta AA, Rudzinski ER| title=What is new in the biology and treatment of pediatric rhabdomyosarcoma? | journal=Curr Opin Pediatr | year= 2014 | volume= 26 | issue= 1 | pages= 50-6 | pmid=24326270 | doi=10.1097/MOP.0000000000000041 | pmc=4096484 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326270  }} </ref>
* Rhabdomyosarcoma treatments depends on staging classification and risk stratification. For more information [[Rhabdomyosarcoma staging|click here]].
* Rhabdomyosarcoma treatments depends on [[Cancer staging|staging]] [[classification]] and [[Risk stratification tools|risk stratification]]. For more information [[Rhabdomyosarcoma staging|click here]].
===Chemotherapy===
* Rhabdomyosarcoma [[chemotherapy]] depends on patient's risk groups.
Chemotherapy may be given as [[neoadjuvant chemotherapy]] or [[adjuvant chemotherapy]]. The most common drugs used to treat rhabdomyosarcoma are:<ref name="radiopaedia">{{Cite web | title =Rhabdomyosarcoma| url =http://radiopaedia.org/articles/rhabdomyosarcoma}}</ref>
* [[Vincristine]], [[actinomycin D]],and [[cyclophosphamide]] are the fundamental [[chemotherapy]] standard based on [[Children's Oncology Group]].
*[[Vincristine]]
* In low-risk [[patients]], [[cyclophosphamide]] [[dosage]] and [[chemotherapy]] duration can be decreased in order to decline [[chemotherapy]] [[toxicity]].
*[[Cyclophosphamide]]
* [[Ifosfamide]], [[vincristine]], and [[actinomycin D]] are the fundamental [[chemotherapy]] standard base on European [[Soft tissue]] [[Sarcoma]] Group.<ref name="pmid19224858">{{cite journal| author=Dantonello TM, Int-Veen C, Harms D, Leuschner I, Schmidt BF, Herbst M et al.| title=Cooperative trial CWS-91 for localized soft tissue sarcoma in children, adolescents, and young adults. | journal=J Clin Oncol | year= 2009 | volume= 27 | issue= 9 | pages= 1446-55 | pmid=19224858 | doi=10.1200/JCO.2007.15.0466 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19224858  }} </ref><ref name="pmid22665534">{{cite journal| author=Oberlin O, Rey A, Sanchez de Toledo J, Martelli H, Jenney ME, Scopinaro M et al.| title=Randomized comparison of intensified six-drug versus standard three-drug chemotherapy for high-risk nonmetastatic rhabdomyosarcoma and other chemotherapy-sensitive childhood soft tissue sarcomas: long-term results from the International Society of Pediatric Oncology MMT95 study. | journal=J Clin Oncol | year= 2012 | volume= 30 | issue= 20 | pages= 2457-65 | pmid=22665534 | doi=10.1200/JCO.2011.40.3287 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22665534  }} </ref>
*[[Dactinomycin]]
** [[Ifosfamide]] is used instead of [[cyclophosphamide]] to decrease [[gonadal]] [[toxicity]] amount.
*[[Adriamycin]]
* Patients's response to [[chemotherapy]] is classified to following groups:<ref name="pmid19224858" /><ref name="pmid25263634">{{cite journal| author=Dantonello TM, Stark M, Timmermann B, Fuchs J, Selle B, Linderkamp C et al.| title=Tumour volume reduction after neoadjuvant chemotherapy impacts outcome in localised embryonal rhabdomyosarcoma. | journal=Pediatr Blood Cancer | year= 2015 | volume= 62 | issue= 1 | pages= 16-23 | pmid=25263634 | doi=10.1002/pbc.25207 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25263634  }}</ref>
*[[Ifosfamide]]
{| class="wikitable"
*VP-16
|+
*[[Irinotecan]]
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Patients response
 
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Tumor volume reduction
===Radiotherapy===
*[[Radiation therapy]] may be used as local therapy. [[Radiation|External beam radiation]] is used in some cases of rhabdomyosarcoma.
 
The treatment for rhabdomyosarcoma varies depending upon the location of tumor:<ref>{{Cite web | title =Surgery for Rhabdomyosarcoma| url = http://www.cancer.ca/en/cancer-information/cancer-type/rhabdomyosarcoma/treatment/surgery/?region=bc }}</ref>
 
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Treatment for rhabdomyosarcoma'''
! style="background: #4682B4; color:#FFF;" | Location
! style="background: #4682B4; color:#FFF;" | Symptoms
|-
|-
| style="padding: 5px 5px; background: #e4e4e4;" | Head and neck
| style="background:#DCDCDC;" align="center" + |Complete response
| style="padding: 5px 5px; background: #e4e4e4;" | Wide local excision; chemotherapy +/- radiation therapy
| style="background:#F5F5F5;" + |No measurable [[tumor]] [[volume]] as compared to initial one
|-
|-
| style="padding: 5px 5px; background: #e4e4e4;" | Bone around the eye
| style="background:#DCDCDC;" align="center" + |Good response
| style="padding: 5px 5px; background: #e4e4e4;" | Biopsy; chemotherapy + radiation therapy
| style="background:#F5F5F5;" + |[[Volume]] [[reduction]] of > 2/3 [[tumor]] as compared to initial one
|-
|-
| style="padding: 5px 5px; background: #e4e4e4;" | Extremities
| style="background:#DCDCDC;" align="center" + |Poor response
| style="padding: 5px 5px; background: #e4e4e4;" | Wide local excision; resection of nearby lymph nodes; amputation for extensive tumors
| style="background:#F5F5F5;" + |[[Volume]] [[reduction]] of > 1/3 and < 2/3 as compared to initial one
|-
|-
| style="padding: 5px 5px; background: #e4e4e4;" | Abdomen or pelvis
| style="background:#DCDCDC;" align="center" + |Objective response
| style="padding: 5px 5px; background: #e4e4e4;" | Neoadjvant therapy with chemotherapy and radiotherapy; wide local excision
| style="background:#F5F5F5;" + |[[Volume]] [[reduction]] of > 1/3 as compared to initial one
|-
|-
| style="padding: 5px 5px; background: #e4e4e4;" | Paratesticular region
| style="background:#DCDCDC;" align="center" + |Progressive disease
| style="padding: 5px 5px; background: #e4e4e4;" | Removal of testes and spermatic cord; ipsilateral retroperitoneal lymphnode resection
| style="background:#F5F5F5;" + |[[Volume]] increase of > 1/3 or new [[lesion]] [[development]]
|}
|}
* [[Radiotherapy]] indication in patient's with [[rhabdomyosarcoma]]:<ref name="pmid9240649">{{cite journal| author=Wharam MD, Hanfelt JJ, Tefft MC, Johnston J, Ensign LG, Breneman J et al.| title=Radiation therapy for rhabdomyosarcoma: local failure risk for Clinical Group III patients on Intergroup Rhabdomyosarcoma Study II. | journal=Int J Radiat Oncol Biol Phys | year= 1997 | volume= 38 | issue= 4 | pages= 797-804 | pmid=9240649 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240649  }} </ref>
** Clinical group I [[alveolar rhabdomyosarcoma]] (36 GY)
** Clinical group II (41.4 GY)
** Clinical group III (50.4 GY)
* [[Radiotherapy]] is usually initiated after 4 [[chemotherapy]] cycles.<ref name="pmid17368885">{{cite journal| author=Douglas JG, Arndt CA, Hawkins DS| title=Delayed radiotherapy following dose intensive chemotherapy for parameningeal rhabdomyosarcoma (PM-RMS) of childhood. | journal=Eur J Cancer | year= 2007 | volume= 43 | issue= 6 | pages= 1045-50 | pmid=17368885 | doi=10.1016/j.ejca.2007.01.033 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17368885  }} </ref><ref name="pmid15234036">{{cite journal| author=Michalski JM, Meza J, Breneman JC, Wolden SL, Laurie F, Jodoin M et al.| title=Influence of radiation therapy parameters on outcome in children treated with radiation therapy for localized parameningeal rhabdomyosarcoma in Intergroup Rhabdomyosarcoma Study Group trials II through IV. | journal=Int J Radiat Oncol Biol Phys | year= 2004 | volume= 59 | issue= 4 | pages= 1027-38 | pmid=15234036 | doi=10.1016/j.ijrobp.2004.02.064 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15234036  }} </ref>
* The only exception for starting [[radiotherapy]] from the first day is [[vision loss]] and [[spinal cord compression]].
* [[Radiotherapy]] dosage is based on following criteria:<ref name="pmid11846299">{{cite journal| author=Raney RB, Anderson JR, Barr FG, Donaldson SS, Pappo AS, Qualman SJ et al.| title=Rhabdomyosarcoma and undifferentiated sarcoma in the first two decades of life: a selective review of intergroup rhabdomyosarcoma study group experience and rationale for Intergroup Rhabdomyosarcoma Study V. | journal=J Pediatr Hematol Oncol | year= 2001 | volume= 23 | issue= 4 | pages= 215-20 | pmid=11846299 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11846299  }} </ref>
** Completeness of [[tumor]] [[resection]] before [[chemotherapy]]
** Completeness of a delayed primary [[tumor]] [[excision]] after [[adjuvant chemotherapy]]
* The decision of pursuing [[radiotherapy]] on children under 3 years old is difficult regarding to these factors:<ref name="pmid23280478">{{cite journal| author=Eaton BR, McDonald MW, Kim S, Marcus RB, Sutter AL, Chen Z et al.| title=Radiation therapy target volume reduction in pediatric rhabdomyosarcoma: implications for patterns of disease recurrence and overall survival. | journal=Cancer | year= 2013 | volume= 119 | issue= 8 | pages= 1578-85 | pmid=23280478 | doi=10.1002/cncr.27934 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23280478  }} </ref><ref name="pmid18455321">{{cite journal| author=McDonald MW, Esiashvili N, George BA, Katzenstein HM, Olson TA, Rapkin LB et al.| title=Intensity-modulated radiotherapy with use of cone-down boost for pediatric head-and-neck rhabdomyosarcoma. | journal=Int J Radiat Oncol Biol Phys | year= 2008 | volume= 72 | issue= 3 | pages= 884-91 | pmid=18455321 | doi=10.1016/j.ijrobp.2008.01.058 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18455321  }} </ref>
** The long-term [[Complications|complication]] of [[radiotherapy]]
** Limited data on [[cancer]] outcomes
* [[Medication]] summery that are used for [[medical]] [[therapy]] are listed below:<ref name="pmid22560526">{{cite journal| author=Arndt CA, Rose PS, Folpe AL, Laack NN| title=Common musculoskeletal tumors of childhood and adolescence. | journal=Mayo Clin Proc | year= 2012 | volume= 87 | issue= 5 | pages= 475-87 | pmid=22560526 | doi=10.1016/j.mayocp.2012.01.015 | pmc=3538469 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22560526  }} </ref><ref name="pmid10423470">{{cite journal| author=Arndt CA, Crist WM| title=Common musculoskeletal tumors of childhood and adolescence. | journal=N Engl J Med | year= 1999 | volume= 341 | issue= 5 | pages= 342-52 | pmid=10423470 | doi=10.1056/NEJM199907293410507 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10423470  }} </ref>
** [[Vincristine|Vincristin]]
** [[Cyclophosphamide]]
** [[Dactinomycin]]
** [[Ifosfamide]]
** [[Etoposide]]
** [[Irinotecan]]
** Mensa
*** Use to inhibit [[hemorrhagic cystitis]]
** [[Filgrastim]]
** [[Sulfamethoxazole-Trimethoprim|Trimethoprim-sulfamethoxazole]]
*** Use for pneumocystic [[pneumonia]] [[prophylaxis]] after [[chemotherapy]]
**  [[Clotrimazole]]
*** Use for [[thrush]] [[prophylaxis]] after [[chemotherapy]]
** [[Chlorhexidine]] [[mouth]] rinse
** Use for [[gingivitis]] [[prophylaxis]] after [[chemotherapy]]


==References==
==References==

Latest revision as of 14:32, 11 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]

Overview

Treatment for rhabdomyosarcoma may consists of chemotherapy, radiation therapy and surgery and treatments depends on staging classification and risk stratification. Rhabdomyosarcoma chemotherapy depends on patient's risk groups. Vincristine, actinomycin D,and cyclophosphamide are the fundamental chemotherapy standard based on Children's Oncology Group. Ifosfamide, vincristine, and actinomycin D are the fundamental chemotherapy standard base on European Soft tissue Sarcoma Group. Patients's response to chemotherapy is classified to five groups as complete response, good response, poor response, objective response, and progressive disease. Radiation therapy may be used as local therapy and is usually initiated after 4 chemotherapy cycles. The only exception for starting radiotherapy from the first day is vision loss and spinal cord compression. Radiotherapy dosage is based on completeness of tumor resection before chemotherapy and completeness of a delayed primary tumor excision after adjuvant chemotherapy.

Medical Therapy

Patients response Tumor volume reduction
Complete response No measurable tumor volume as compared to initial one
Good response Volume reduction of > 2/3 tumor as compared to initial one
Poor response Volume reduction of > 1/3 and < 2/3 as compared to initial one
Objective response Volume reduction of > 1/3 as compared to initial one
Progressive disease Volume increase of > 1/3 or new lesion development

References

  1. ↑ Hawkins DS, Gupta AA, Rudzinski ER (2014). "What is new in the biology and treatment of pediatric rhabdomyosarcoma?". Curr Opin Pediatr. 26 (1): 50–6. doi:10.1097/MOP.0000000000000041. PMC 4096484. PMID 24326270.
  2. ↑ 2.0 2.1 Dantonello TM, Int-Veen C, Harms D, Leuschner I, Schmidt BF, Herbst M; et al. (2009). "Cooperative trial CWS-91 for localized soft tissue sarcoma in children, adolescents, and young adults". J Clin Oncol. 27 (9): 1446–55. doi:10.1200/JCO.2007.15.0466. PMID 19224858.
  3. ↑ Oberlin O, Rey A, Sanchez de Toledo J, Martelli H, Jenney ME, Scopinaro M; et al. (2012). "Randomized comparison of intensified six-drug versus standard three-drug chemotherapy for high-risk nonmetastatic rhabdomyosarcoma and other chemotherapy-sensitive childhood soft tissue sarcomas: long-term results from the International Society of Pediatric Oncology MMT95 study". J Clin Oncol. 30 (20): 2457–65. doi:10.1200/JCO.2011.40.3287. PMID 22665534.
  4. ↑ Dantonello TM, Stark M, Timmermann B, Fuchs J, Selle B, Linderkamp C; et al. (2015). "Tumour volume reduction after neoadjuvant chemotherapy impacts outcome in localised embryonal rhabdomyosarcoma". Pediatr Blood Cancer. 62 (1): 16–23. doi:10.1002/pbc.25207. PMID 25263634.
  5. ↑ Wharam MD, Hanfelt JJ, Tefft MC, Johnston J, Ensign LG, Breneman J; et al. (1997). "Radiation therapy for rhabdomyosarcoma: local failure risk for Clinical Group III patients on Intergroup Rhabdomyosarcoma Study II". Int J Radiat Oncol Biol Phys. 38 (4): 797–804. PMID 9240649.
  6. ↑ Douglas JG, Arndt CA, Hawkins DS (2007). "Delayed radiotherapy following dose intensive chemotherapy for parameningeal rhabdomyosarcoma (PM-RMS) of childhood". Eur J Cancer. 43 (6): 1045–50. doi:10.1016/j.ejca.2007.01.033. PMID 17368885.
  7. ↑ Michalski JM, Meza J, Breneman JC, Wolden SL, Laurie F, Jodoin M; et al. (2004). "Influence of radiation therapy parameters on outcome in children treated with radiation therapy for localized parameningeal rhabdomyosarcoma in Intergroup Rhabdomyosarcoma Study Group trials II through IV". Int J Radiat Oncol Biol Phys. 59 (4): 1027–38. doi:10.1016/j.ijrobp.2004.02.064. PMID 15234036.
  8. ↑ Raney RB, Anderson JR, Barr FG, Donaldson SS, Pappo AS, Qualman SJ; et al. (2001). "Rhabdomyosarcoma and undifferentiated sarcoma in the first two decades of life: a selective review of intergroup rhabdomyosarcoma study group experience and rationale for Intergroup Rhabdomyosarcoma Study V." J Pediatr Hematol Oncol. 23 (4): 215–20. PMID 11846299.
  9. ↑ Eaton BR, McDonald MW, Kim S, Marcus RB, Sutter AL, Chen Z; et al. (2013). "Radiation therapy target volume reduction in pediatric rhabdomyosarcoma: implications for patterns of disease recurrence and overall survival". Cancer. 119 (8): 1578–85. doi:10.1002/cncr.27934. PMID 23280478.
  10. ↑ McDonald MW, Esiashvili N, George BA, Katzenstein HM, Olson TA, Rapkin LB; et al. (2008). "Intensity-modulated radiotherapy with use of cone-down boost for pediatric head-and-neck rhabdomyosarcoma". Int J Radiat Oncol Biol Phys. 72 (3): 884–91. doi:10.1016/j.ijrobp.2008.01.058. PMID 18455321.
  11. ↑ Arndt CA, Rose PS, Folpe AL, Laack NN (2012). "Common musculoskeletal tumors of childhood and adolescence". Mayo Clin Proc. 87 (5): 475–87. doi:10.1016/j.mayocp.2012.01.015. PMC 3538469. PMID 22560526.
  12. ↑ Arndt CA, Crist WM (1999). "Common musculoskeletal tumors of childhood and adolescence". N Engl J Med. 341 (5): 342–52. doi:10.1056/NEJM199907293410507. PMID 10423470.

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