Late effects following treatment for female pelvic rhabdomyosarcoma (RMS)

Abstract

8547 Background Most girls treated for RMS of the pelvic region are cured, but the effects of this treatment on long term health status are poorly documented. Methods We retrospectively reviewed the medical records of all 5-year survivors of female pelvic RMS treated at our institution between 3/62 and 12/96. Late effects occurring beyond 5 years from diagnosis were recorded and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Results Among the 26 patients studied, the median age at diagnosis of RMS was 3.4 years (range, 0.2–17.2 years). The most common tumor sites were vagina (n=7), pelvis/retroperitoneum (n=6), and bladder (n=4). All patients received chemotherapy, which in some cases included an alkylating agent (n=23), doxorubicin (n=16), or etoposide (n=2). Radiotherapy was administered to 22 patients (dose range 16–60.5 Gy, median 46 Gy). Doxorubicin cardiomyopathy and secondary osteosarcoma were responsible for 2 deaths. Median follow-up for the 24 survivors is 19.6 years (range, 7.0–39.6 years) and 22 of the 24 patients had been seen or contacted within 3 years of the analysis. A total of 238 toxicities were identified in the 26 patients (143 grade 1/2, 95 grade 3/4). Twenty-three patients (88%) had at least one grade 3/4 toxicity. The 4 patients who did not receive radiotherapy had a significantly lower median number of late effects (1) compared to the 22 who received radiotherapy (9) (p=0.003). The most common grade 3/4 toxicities were endocrine (17 patients), gynecologic (14 patients), urologic (10 patients), and gastrointestinal (8 patients). Eighteen patients (69%) were sterile due to hysterectomy, bilateral oophorectomy or ovarian failure. Surgical intervention for treatment of late complications was required in fourteen patients (54%). Conclusions This retrospective study suggests that most long term survivors of female pelvic RMS experience severe late effects that adversely affect multiple organ systems. Prospective studies are needed to better define late effects in this patient population, and to assess the impact of these complications on quality of life, functional outcome, and ongoing medical needs. No significant financial relationships to disclose.