2461 - Outcomes and Treatment Patterns in Pediatric Head and Neck Rhabdomyosarcoma: A Retrospective Study of 105 Patients
Presenter(s)
M. S. Qamber1,2, M. Berawi1, N. Sarhan1, M. Y. Alsmairat1, W. A. Asha1, A. Almousa1, I. Sultan3, H. Halalsheh3, K. Ghandour4, and A. K. Ibrahimi1; 1Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan, 2Department of Radiation Oncology, Bahrain Oncology Center, Muharraq, Bahrain, 3Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan, 4Department of Pediatric Surgery, King Hussein Cancer Center, Amman, Jordan
Purpose/Objective(s): Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children, with 40% of cases occurring in the head and neck region. This study aims to evaluate the outcomes of pediatric patients with head and neck RMS treated at a single institution and to identify factors that may impact survival.
Materials/Methods: A retrospective review was conducted on pediatric patients with head and neck RMS cases treated at a single institution between 2003 and 2024 in patients under 18 years of age. Treatment included surgical resection when feasible, while non-resectable cases were managed with initial chemotherapy followed by surgery and/or Radiotherapy (RT) per Intergroup Rhabdomyosarcoma Study IV and Children's Oncology Group protocols. Kaplan-Meier survival analysis was performed, and univariate analysis explored factors influencing Overall Survival (OS), including age, histologic subtype, parameningeal involvement, metastasis at diagnosis, tumor size, extent of surgical resection, and RT use. Log-rank tests and multivariate Cox regression were used to identify significant survival predictors.
Results: A total of 105 patients were eligible for analysis, median age was 5.96 years (2.4 months – 17.96 years), 61 patients (58.1%) had parameningeal primaries , 23 (21.9%) had metastasis at presentation, and 11 (10.7%) were infants (less than 24 months). Twenty-two patients (21%) had alveolar RMS. A total of twenty patients (19%) underwent gross total resection. Ninety-one patients (86.7%) received RT. The 5 year (OS) was 60.7% and the 5 year disease free survival was 49.8%. In univariate analysis, infant age group (p=0.023), metastasis at presentation (p<0.001), no radiotherapy (p<0.001), and primary tumor more than 5 cm (p=0.001) were associated with inferior OS. In multivariate analysis, metastasis at presentation (HR=3.66; 95%CI: 1.45-9.22; p=0.006) and no radiotherapy (HR: 13.60; 95%CI: 3.67-50.41, p<0.001) were the only independent factors for inferior OS.
Conclusion: The Absence of radiotherapy and the presence of metastasis at diagnosis were independent predictors of poorer overall survival in childhood head and neck RMS. Notably, in our cohort of pure head and neck RMS, the alveolar subtype was not associated with worse overall survival. The management of pediatric head and neck RMS remains challenging, highlighting the need for prospective, multi-institutional studies to explore novel treatment approaches.