loading page

Local Control and Survival Outcomes in Pediatric Non-rhabdomyosarcoma Soft Tissue Sarcoma: The Mayo Clinic Experience
  • +6
  • Elizabeth L. McKone,
  • Kristofer W. Roberts,
  • William Harmsen,
  • William Breen,
  • Anita Mahajan,
  • Wendy Allen-Rhoades,
  • Peter Rose,
  • Nadia Laack,
  • Safia Ahmed
Elizabeth L. McKone
Mayo Clinic Minnesota Department of Radiation Oncology
Author Profile
Kristofer W. Roberts
Concord Hospital Payson Center for Cancer Care
Author Profile
William Harmsen
Mayo Clinic Division of Biomedical Statistics and Informatics
Author Profile
William Breen
Mayo Clinic Minnesota Department of Radiation Oncology
Author Profile
Anita Mahajan
Mayo Clinic Minnesota Department of Radiation Oncology
Author Profile
Wendy Allen-Rhoades
Mayo Clinic Minnesota
Author Profile
Peter Rose
Mayo Clinic Minnesota Department of Orthopedic Surgery
Author Profile
Nadia Laack
Mayo Clinic Minnesota Department of Radiation Oncology
Author Profile
Safia Ahmed
Mayo Clinic Arizona

Corresponding Author:ahmed.safia@mayo.edu

Author Profile

Abstract

Objective: Pediatric patients with non-rhabdomyosarcoma soft tissue sarcoma (NRSTS) undergo aggressive multimodality treatment. This single institutional analysis of outcomes in this group explored factors associated with local control and survival. Methods: Patients ≤18 years old diagnosed with NRSTS between 10/1990-11/2021 who received radiotherapy (RT) were retrospectively identified. Overall Survival (OS) and disease-free survival (DFS) analyses were performed using Kaplan Meier methods. Cumulative incidence of local and distant failure were estimated. Univariate analysis was performed. Results: Fifty-one pediatric patients with NRSTS were included. Extremity tumors were most common (33/51, 65%), with 80% T1 or T2 (AJCC 8 th) and 90% non-metastatic. Surgery in 49/51 (96%) resulted in 32 (65%) R0 resections. All received RT (median EQD2 50 Gy, range 42.4-76.9), with brachytherapy or intraoperative (IORT) boosts in 21 cases (41%) (mean EQD2 24.5 Gy). Thirty-four (66.7%) received chemotherapy. With 5.7 years median follow up, 5-year OS and DFS were 70.7% and 67.9%, respectively. Positive margins were significantly associated with worse OS on univariate analysis. Two-year local failure incidence for EBRT was 18.1% and 5.3% for EBRT+boost (HR 3.67, p=0.24). Among 6 observed local failures, 5 occurred after EBRT alone, 3 of which had positive margins. Among the EBRT+boost group, 2 had positive margins, neither with local recurrence. Conclusion: Multimodality treatment of pediatric NRSTS results in 5-year OS and DFS around 70%. R0 resection is essential to optimize outcomes in this population. Although incidence of R1 resections has declined in the modern era, IORT/brachytherapy boost may have a role in selected patients at high-risk for local recurrence.