Sarcoma and Cutaneous Tumors

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MO_22_2797 - Worse Survival in Older Adults with Rhabdomyosarcoma: Results of a Large Single Institutional Cohort

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Worse Survival in Older Adults with Rhabdomyosarcoma: Results of a Large Single Institutional Cohort
A. Raldow1, A. Jacobson2, R. Miao3, S. I. Goldberg3, H. Wang3, E. Choy4, G. Cote2, K. A. Raskin5, F. J. Hornicek6, T. F. DeLaney3, and Y. L. E. Chen3; 1Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, 2Massachusetts General Hospital, Boston, MA, 3Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, 4Division of Hematology-Oncology, Massachusetts General Hospital, Boston, MA, 5Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, 6Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA

Purpose/Objective(s): While rhabdomyosarcoma (RMS) is one of the typical tumors of childhood, it is rare in adults, accounting for 2-5% of adult soft tissue sarcomas. Experience with treatment of young adults and adults with RMS is limited, but data suggest that older patients have inferior outcomes compared with children. The purpose of this retrospective study is to review the clinical outcomes of non-childhood primary RMS.

Materials/Methods: The clinicopathologic features, treatment methods, and disease outcomes were reviewed retrospectively 138 patients (ages 15 years or older) with RMS who were consecutively treated between 1969 and 2015 at a single institution. Overall survival (OS) and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method. A log-rank test was used to compare overall survival in patients age 40 years or older versus younger than 40 years.

Results: The mean age was 37 years (range: 15-86 years), median follow-up time was 20.8 months, (range 0 – 410 months), median tumor size was 6.15 cm (range: 0.9-26 months) and 69 (50.0%) of patients were female. Patients presented with localized (70, 52.6%), regional (28, 21.1%), and distant (31, 23.3%) extents of disease. Tumor sites included genitourinary/gynecological/pelvic (44, 31.9%), head & neck (54, 39.1%) and trunk/extremity (40, 29.0%). RMS histology groups were embryonal (41, 29.7%), alveolar (40, 29.0%), pleomorphic (19, 13.8%), and not otherwise specified (38, 27.5%). Patients were treated as follows: surgery alone (29, 23.2%), RT alone (44, 31.9%), preoperative RT followed by surgery plus or minus additional postoperative radiation (17, 12.3%), surgery followed by postoperative RT (30, 21.7%), or no surgery and no RT (14, 10.1%). Of the patients that underwent RT, the median dose was 55.8 Gy (range: 27-80 Gy). The majority of patients received chemotherapy on presentation (97, 70.3%); vincristine, doxorubicin, cyclophasphamide alternating with ifosfamide and etoposide (VAC/IE) was the most common regimen. Five-year OS and RFS for the entire cohort were 31.8% (95% CI: 20.0-42.1%) and 32.3% (95% CI: 24.1-40.9%), respectively. The median OS was 1.9 years (95% CI: 1.4-3.1 years) and the median RFS was 1.3 years (95% CI: 0.7-1.8 years). On univariate analysis, age, type of treatment delivered (surgery alone, RT alone, surgery and RT), site, M stage, and whether or not patients underwent systemic therapy were significant with respect to overall survival (p < .05). Patients who were 40 years or older had a significantly higher risk of death than those patients younger than 40 years (p = .0009).

Conclusion: Non-childhood RMS is an aggressive sarcoma with a significant incidence of metastatic recurrence; older adults have poorer outcomes as compared to younger adults. Further study is necessary to determine the reasons for this age effect, which may be due to differences in distribution of histopathologic subtypes and sites, increasing chemoresistance of RMS in older patients, or worse patient tolerance for therapy.

Author Disclosure: A. Raldow: None. A. Jacobson: None. R. Miao: None. S.I. Goldberg: None. T.F. DeLaney: None. Y.E. Chen: Employee; Beth Israel Deaconess Medical Center.

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