Efficacy and influencing factors of surgery combined with neoadjuvant chemoradiotherapy in the treatment of children with non-orbital head and neck rhabdomyosarcoma
10.3760/cma.j.cn115330-20220429-00236
- VernacularTitle:手术联合新辅助放化疗治疗儿童非眼眶型头颈部横纹肌肉瘤的疗效及预后分析
- Author:
Nian SUN
1
;
Shengcai WANG
;
Xiaoli MA
;
Jie ZHANG
;
Yan SU
;
Zhikai LIU
;
Yuanhu LIU
;
Guoxia YU
;
Yanzhen LI
;
Xuexi ZHANG
;
Qiaoyin LIU
;
Zhiyong LIU
;
Xin NI
Author Information
1. 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科，北京 100045
- Keywords:
Head and neck neoplasms;
Rhabdomyosarcoma;
Pediatric;
Surgery;
Neoadjuvant chemoradiotherapy;
Prognosis
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2022;57(12):1403-1408
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy and influencing factors of surgery combined with neoadjuvant chemoradiotherapy in the treatment of children with non-orbital head and neck rhabdomyosarcoma (HNRMS).Methods:Information from 45 children diagnosed as non-orbital HNRMS and subjected to surgery combined with neoadjuvant chemoradiotherapy in Beijing Children′s Hospital affiliated to Capital Medical University from August 2017 to July 2021 was analyzed. The patients included 25 males and 20 females, aged from 1 to 17 years old. The primary tumor site, pathological subtype, clinical stage, risk group, therapeutic regimen, resection range and outcome of all cases were also collected. The survival curves were made using the Kaplan-Meier method and the potential prognostic factors were investigated by Cox regression analysis.Results:Fifteen (33.3%) of 45 children achieved negative surgical margin under complete tumor resection. The postoperative pathological results showed that there were 20 cases of embryonic subtype, 19 cases of alveolar subtype and 6 cases of spindle sclerosis subtype. The postoperative follow-up time ranged from 4 to 71 months, with a median of 26 months. During the follow-up period, 13 children died, among whom brain metastasis was the most common cause of death, accounting for 7/13. The 3-year overall survival rate was 67.6%. Multivariate analysis showed that non-embryonic subtype ( HR=6.26, 95% CI: 1.52-25.87, P=0.011) and failure to reach R0 resection ( HR=9.37, 95% CI: 1.18-74.34, P=0.034) were independent risk factors affecting overall survival rate. Conclusion:Surgery combined with neoadjuvant chemoradiotherapy can offer a good efficacy for children with non-orbital HNRMS. Non-embryonic subtype and resection without negative operative microscopic margins are independent risk factors for poor prognosis, and brain metastasis is the main cause of death in these children.
