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    Influence of noncompliance with radiation therapy protocol guidelines and operative bed recurrences for children with rhabdomyosarcoma and microscopic residual disease: a report from the Children's Oncology Group

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    Authors
    Million, Lynn
    Anderson, James
    Breneman, John
    Hawkins, Douglas S
    Laurie, Fran
    Michalski, Jeff
    Wharam, Moody
    Rodeberg, David A.
    Wolden, Suzanne
    Donaldson, Sarah S.
    UMass Chan Affiliations
    Department of Radiation Oncology
    Document Type
    Journal Article
    Publication Date
    2011-06-01
    Keywords
    Adolescent
    Age Factors
    Child
    Child, Preschool
    Clinical Protocols
    *Guideline Adherence
    Humans
    Infant
    Neoplasm Recurrence, Local
    Neoplasm, Residual
    Radiotherapy Dosage
    Rhabdomyosarcoma, Alveolar
    Rhabdomyosarcoma, Embryonal
    Tumor Burden
    Neoplasms
    Oncology
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    http://dx.doi.org/10.1016/j.ijrobp.2010.01.058
    Abstract
    PURPOSE: Postoperative radiation therapy (RT) is recommended for patients with rhabdomyosarcoma having microscopic disease. Sometimes RT dose/volume is reduced or omitted in an attempt to avoid late effects, particularly in young children. We reviewed operative bed recurrences to determine if noncompliance with RT protocol guidelines influenced local-regional control. METHODS AND MATERIALS: All operative bed recurrences among 695 Group II rhabdomyosarcoma patients in Intergroup Rhabdomyosarcoma Study Group (IRS) I through IV were reviewed for deviation from RT protocol. Major/minor dose deviation was defined as >10% or 6-10% of the prescribed dose (40-60 Gy), respectively. Major/minor volume deviation was defined as tumor excluded from the RT field or treatment volume not covered by the specified margin (preoperative tumor volume and 2- to 5-cm margin), respectively. No RT was a major deviation. RESULTS: Forty-six of 83 (55%) patients with operative bed recurrences did not receive the intended RT (39 major and 7 minor deviations). RT omission was the most frequent RT protocol deviation (19/46, 41%), followed by dose (17/46, 37%), volume (9/46, 20%), and dose and volume deviation (1/46, 2%). Only 7 operative bed recurrences occurred in IRS IV (5% local-regional failure) with only 3 RT protocol deviations. Sixty-three (76%) patients with recurrence died of disease despite retrieval therapy, including 13 of 19 nonirradiated children. CONCLUSION: Over half of the operative bed recurrences were associated with noncompliance; omission of RT was the most common protocol deviation. Three fourths of children die when local-regional disease is not controlled, emphasizing the importance of RT in Group II rhabdomyosarcoma.
    Source
    Int J Radiat Oncol Biol Phys. 2011 Jun 1;80(2):333-8. doi: 10.1016/j.ijrobp.2010.01.058. Epub 2010 Jun 18. Link to article on publisher's site
    DOI
    10.1016/j.ijrobp.2010.01.058
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/47943
    PubMed ID
    20646841
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ijrobp.2010.01.058
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