1. Local Control for Intermediate Risk Rhabdomyosarcoma: Results from D9803 according to Histology, Group, Site and Size A Report from the Children’s Oncology Group
Suzanne Wolden, Elizabeth Lyden, Carola Arndt, Douglas Hawkins,
James Anderson, David Rodeberg, Ken Brown, Sarah Donaldson

2. D9803 background Intermediate risk RMS 1999-2005
Phase III: VAC vs VAC/VTC
617 eligible patients enrolled
Local control analysis limited to nonmetastatic, centrally confirmed alveolar or embryonal RMS
Soft Tissue Sarcoma

3. Patients 423 eligible for local failure analysis
Alveolar histology, Group I/II 41
Embryonal histology, Group III 280
Alveolar histology, Group III 102
Local failure defined as local progression as 1st event (+/- regional or distant failure)
Median follow-up 6.6 years
Soft Tissue Sarcoma

4. Local failure: Alveolar Group I-II
10% local failure, n=41
All events at 5 years: 31%
Soft Tissue Sarcoma

5. EFS and local failure: Group III
5-yr EFS: 70%
Overall failure rate 30%
5-yr local failure: 19%
63% of all failures are local
Soft Tissue Sarcoma

6. Local failure: Group III by histology
ERMS 20%
ARMS 17%
p=0.97
Soft Tissue Sarcoma

7. Local failure: Group III by primary site
Retroperitoneal 33%
Parameningeal 19%
Everything else 14%
Soft Tissue Sarcoma

8. Local failure: Only tumors >5cm
Retroperitoneal 33%
Retroperitoneal 30%
Parameningeal 24%
Parameningeal 19%
Extremity, B/P 19%
Everything else 14%
Soft Tissue Sarcoma

9. Local failure: Group III by size
>= 5 cm 25%
< 5 cm 10%
p=0.0004
Soft Tissue Sarcoma

10. Local failure: Group III by nodal status
Soft Tissue Sarcoma

11. Comparison to IRS III & IV
Patient subsets
IRS-III
IRS-IV
D9803
All patients
19%
13%
Embryonal histology
20%
Alveolar histology (+ UDS for IRS-III)
17%
Parameningeal
16%
Extremity 7%
15%
Bladder/prostate
14% N0 N1
32%
< 5 cm
10%
5+ cm
21%
25%
Soft Tissue Sarcoma

12. Summary
Local control was excellent (90%) for Group I/II ARMS representing only 32% of all failures with strategy of postoperative RT
Local failure accounted for 63% of all failures in Group III patients & did not vary by histology or nodal status
Local failure was highest for RP primary tumors (33%) compared to all other sites (14-19%)
Local failure higher for tumors > 5cm (25% vs 10%)
Results are similar to IRS III
Soft Tissue Sarcoma

13. Future directions
Suggestions for next COG Intermediate Risk RMS study:
RT boost to 55.8 Gy (from 50.4) for tumors arising in retroperitoneal & parameningeal sites and all tumors >5cm.
Limit pre-chemotherapy volume to 30.6 Gy (from 36 Gy).
Reduce total dose for complete response or resection at week 12 to 30.6 Gy.
Study PET response related to local failure
Soft Tissue Sarcoma