Journal article
Lymph Node Metastases in Pediatric and Young Adult Patients with Non-Rhabdomyosarcoma Soft Tissue Sarcoma (NRSTS): Findings from Children’s Oncology Group (COG) Study ARST0332
European journal of cancer (1990), Vol.180, pp.P89-P98
11/2022
DOI: 10.1016/j.ejca.2022.11.014
PMCID: PMC9940640
PMID: 36566574
Abstract
To better define the clinical features and outcomes of young patients with non-rhabdomyosarcoma soft tissue sarcoma (NRSTS) with regional and distant lymph node (LN) metastases treated in a standardized fashion, we analyzed lymph node involvement in COG study ARST0332, which evaluated a risk-based treatment strategy for young patients with all stages of NRSTS.
Patients <30 years old with newly diagnosed NRSTS and LN metastases enrolled on ARST0332 were studied. Regional LN sampling was required for those with epithelioid sarcoma, clear cell sarcoma, or clinically/radiographically enlarged LNs. Tumor features and extent of pre-enrollment resection determined treatment, including chemotherapy, radiotherapy, and delayed surgery. Recommendations for LN metastases included LN dissection at the time of primary tumor resection and dose-adapted radiotherapy based on extent of LN resection.
Twenty of 529 eligible and evaluable ARST0332 patients with NRSTS had LN metastases; epithelioid sarcoma had the highest incidence (18%, 5 of 28). Pre-treatment imaging identified LN enlargement in 19 of 20 patients; 1 had no pre-treatment LN imaging. At 6.9 years median follow-up for surviving patients, 5-year overall survival (OS) was 85.7% (95% CI: 33.4%, 97.9%) for 7 patients with isolated LN metastases and 15.4% (95% CI: 2.5%, 38.8%) for 13 patients with additional extranodal metastases. LN recurrence occurred in only 1 patient without LNs sampled at initial diagnosis.
LN metastases occur in about 4% of pediatric/young adult NRSTS, are limited to a few histologic subtypes, and are rare in patients who did not have clinical or imaging evidence of lymphadenopathy, suggesting that biopsies of non-enlarged LNs are not necessary to identify occult involvement. Patients with isolated LN metastases have high 5-year OS (∼85%) and should be treated with curative intent.
•Large prospective study of NRSTS with lymph node (LN) involvement in young patients.•Occult lymph node involvement is exceedingly rare.•Isolated LN metastases have a favorable prognosis so should be treated aggressively.•Complete enlarged LN excision and nodal bed radiation correlate with better outcome.
Details
- Title: Subtitle
- Lymph Node Metastases in Pediatric and Young Adult Patients with Non-Rhabdomyosarcoma Soft Tissue Sarcoma (NRSTS): Findings from Children’s Oncology Group (COG) Study ARST0332
- Creators
- Elysia Alvarez - University of California, DavisJiayi He - Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CASheri L. Spunt - Stanford University School of MedicineAndrea Hayes-Jordan - Department of Surgery, University of North CarolinaSimon C. Kao - Department of Radiology, The University of Iowa Carver College of Medicine, Iowa City, IADavid M. ParhamLynn Million - Stanford University School of MedicineAaron R. Weiss - Maine Medical CenterDonald A. Barkauskas - Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA
- Resource Type
- Journal article
- Publication Details
- European journal of cancer (1990), Vol.180, pp.P89-P98
- DOI
- 10.1016/j.ejca.2022.11.014
- PMID
- 36566574
- PMCID
- PMC9940640
- NLM abbreviation
- Eur J Cancer
- ISSN
- 0959-8049
- eISSN
- 1879-0852
- Publisher
- Elsevier Ltd
- Language
- English
- Date published
- 11/2022
- Academic Unit
- Radiology; Stead Family Department of Pediatrics
- Record Identifier
- 9984339355802771
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