Rhabdomyosarcoma medical therapy
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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
- Rhabdomyosarcoma treatment include combination of surgery, radiotherapy, and chemotherapy.[1]
- Rhabdomyosarcoma treatments depends on staging classification and risk stratification. For more information click here.
- Rhabdomyosarcoma chemotherapy depends on patient's risk groups.
- Vincristine, actinomycin D,and cyclophosphamide are the fundamental chemotherapy standard based on Children's Oncology Group.
- In low-risk patients, cyclophosphamide dosage and chemotherapy duration can be decreased in order to decline chemotherapy toxicity.
- Ifosfamide, vincristine, and actinomycin D are the fundamental chemotherapy standard base on European Soft tissue Sarcoma Group.[2][3]
- Ifosfamide is used instead of cyclophosphamide to decrease gonadal toxicity amount.
- Patients's response to chemotherapy is classified to following groups:[2][4]
| 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 |
- Radiotherapy indication in patient's with rhabdomyosarcoma:[5]
- 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.[6][7]
- The only exception for starting radiotherapy from the first day is vision loss and spinal cord compression.
- Radiotherapy dosage is based on following criteria:[8]
- 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:[9][10]
- The long-term complication of radiotherapy
- Limited data on cancer outcomes
- Medication summery that are used for medical therapy are listed below:[11][12]
- Vincristin
- Cyclophosphamide
- Dactinomycin
- Ifosfamide
- Etoposide
- Irinotecan
- Mensa
- Use to inhibit hemorrhagic cystitis
- Filgrastim
- 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
- ↑ 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.
- ↑ 2.0 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.