Skip to main content

Advertisement

SpringerLink
Log in

Surgical lessons from the Intergroup Rhabdomyosarcoma Study (IRS) pertaining to extremity tumors

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

The large number of patients entered into the Intergroup Rhabdomyosarcoma Study (IRS) has allowed a study of prognostic factors and clinical management decisions for a specific primary site-the extremities. A retrospective review of IRS I (1972–1978) and IRS II (1978–1984) included 217 patients with sarcomas of the extremities of 1,415 patients without distant metastases. Disease-free survival and survival data from this subgroup of patients demonstrated that: (a) the UICC clinical staging system has clear-cut validity, (b) total gross resection of sarcomas of the extremities is an optimal therapeutic approach in spite of proven benefits from nonoperative therapies, (c) results of treatment are improved by reexcision of the initial resection site if the histologic margin is involvedor the initial resection was an unplanned procedure for diagnosis, (d) regional lymph node biopsy or dissection is an important procedure for planning and conduct of the treatment program, and (e) vigorous and thorough surgical procedures are required for optimal end results of treatment of extremity sarcomas despite the proven value of nonoperative therapies.

Résumé

Grâce à l'essai de l'IRS (Intergroup Rhabdomyosarcome Study), les facteurs de pronostic intervenant dans la décision thérapeutique ont été étudiés chez un grand nombre de patients ayant un rhabdomyosarcome des extrémités. Deux études rétrospectives IRS I (1972–1978) et IRS II (1978–1984) comportaient 217 patients ayant un sarcome des extrémités sur 1,415 patients sans métastase à distance. Il a été démontré que: (a) la classification clinique UICC a une grande valeur, (b) la résection complète des sarcomes des extrémités représente une approche thérapeutique optimale malgré les effets positifs prouvés des thérapeutiques non opératoires, (c) les résultats sont améliorés par une nouvelle excision lorsque l'histologie montre que la section n'était pas complète, ou lorsque l'intervention initiale ne visait que le diagnostic, (d) la biopsie ou le curage ganglionnaire est un geste important dans la planification et la conduite du traitement, et (e) une chirurgie active et complète est nécessaire pour obtenir les meilleurs résultats pour les sarcomes des extrémités malgré la valeur prouvée des thérapeutiques non opératoires.

Resumen

El vasto número de pacientes ingresado al Estudio Intergrupo sobre Rabdomiosarcoma (Intergroup Rhabdomyosarcoma Study, IRS) hace posible el análisis de los factores de pronóstico y de toma de decisiones en cuanto a manejo clínico para un lugar específico de ubicación del tumor primario: las extremidades. La revisión retrospectiva del IRS I (1972–1978) y del IRS II (1978–1984) incluyó 217 pacientes con sarcomas de las extremidades, entre 1,415 pacientes sin metástasis distantes. Los datos sobre supervivencia libre de enfermedad y supervivencia global en este subgrupo de pacientes demostró que: (a) la clasificación del estadio clínico de la Unión Internacional contra el Cáncer tiene clara validez, (b) la resección total de los sarcomas de las extremidades constituye una modalidad terapéutica óptima, a pesar de los beneficios probados de modalidades terapéuticas no operatorias, (c) los resultados del tratamiento pueden ser mejorados con la reoperación sobre el lugar de la resección inicial si los márgenes aparecen histológicamente comprometidos o si la resección inicial fue un procedimiento simple no planeado que sólo se realizó para diagnóstico, así el estudio microscópico inicial indique que los márgenes están libres o nó, (d) la biopsia o la disección ganglionar regional es un procedimiento de importancia tanto para la planeación como para la ejecución del programa terapéutico, y (e) se requieren vigorosos y completos procedimientos quirúrgicos para el logro de óptimos resultados finales en el tratamiento de los sarcomas de las extremidades a pesar del valor probado de las terapias no operatorias.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Moore, O., Grossi, D.: Embryonal rhabdomyosarcoma of the head and neck. Cancer12:69, 1959

    Google Scholar 

  2. Lawrence, W., Jr., Jegge, G., Foote, F.W.: Embryonal rhabdomyosarcoma, a clinicopathologic study. Cancer17:361, 1964

    Google Scholar 

  3. Heyn, R.M., Holland, R., Newton, W.A., Tefft, M., Breslow, N., Hartmann, J.R.: The role of combined chemotherapy in the treatment of rhabdomyosarcoma in children. Cancer34:2128, 1974

    Google Scholar 

  4. Maurer, H.M., Moon, T., Donaldson, M., Fernandez, C., Gehan, E.A., Hammond, D., Hays, D.M., Lawrence, W., Newton, W., Regab, A., Raney, B., Soule, E.H., Sutow, W.W., Tefft, M.: The Intergroup Rhabdomyosarcoma Study. A preliminary report. Cancer40:2015, 1977

    Google Scholar 

  5. Harmer, M.H., editor: TNM Classification of Pediatric Tumors, Geneva, UICC International Union Against Cancer, 1982

    Google Scholar 

  6. Lawrence, Jr., W., Gehan, E.A., Hays, D.M., Beltangady, M., Maurer, H.M. (For the IRS Committee): Prognostic significance of staging factors of the UICC staging system in childhood rhabdomyosarcoma: A report from the Intergroup Rhabdomyosarcoma Study (IRS-II). J. Clin. Oncol.5:46, 1987

    Google Scholar 

  7. Lawrence, Jr., W., Hays, D.M., Heyn, R., Tefft, M., Crist, W., Beltangady, M., Newton, W., Wharam, M.: Lymphatic metastasis with childhood rhabdomyosarcoma sarcoma: A report from the Intergroup Rhabdomyosarcoma Study (IRS). Cancer60:910, 1987

    Google Scholar 

  8. Gehan, E.A., Glover, F.N., Maurer, H.M., Sutow, W.W., Hays, D.M., Lawrence, W., Newton, W., Soule, E.H. (For the IRS Committee): Prognostic factors in children with rhabdomyosarcoma. Natl. Cancer Inst. Monogr.56:83, 1981

    Google Scholar 

  9. Newton, W.A., Soule, E.H., Hamoudi, A.B., Reiman, H., Shimada, H., Beltangady, M., Maurer, H.M. (For the IRS Committee): Histopathology of childhood sarcomas, Intergroup Rhabdomyosarcoma Studies I & II: Clinicopathologic correlation. J. Clin. Oncol.6:67, 1988

    Google Scholar 

  10. Kaplan, E.L., Meier, P.: Nonparametric estimation from incomplete observations. J. Am. Stat. Assoc.53:457, 1958

    Google Scholar 

  11. Peto, R., Pike, M.C., Armitage, P., Breslow, N.E., Cox, D.R., Howard, S.V., Mantel, N., McPherson, K., Peto, J., Smith, P.G.: Design and analysis of randomized clinical trials requiring prolonged observation of each patient II analysis and examples. Br. J. Cancer35:1, 1977

    Google Scholar 

  12. Hays, D.M., Beltangady, M., Lawrence, Jr., W., Wharam, M., Newton, W., Maurer, H.: Early secondary surgery (ESS) in patients with extremity-trunk primaries and microscopic residual (MR) following initial surgery: The Intergroup Rhabdomyosarcoma Study (IRS). (Abstract 852). Proc. Am. Soc. Clin. Oncol.6:216, 1987

    Google Scholar 

  13. Giuliano, A.E., Eilber, F.R.: The rationale for planned reoperation after unplanned total soft tissue excision of soft tissue sarcoma. J. Clin. Oncol.5:1344, 1985

    Google Scholar 

  14. Maurer, H.M., Beltangady, M., Gehan, E.A., Crist, W., Hammond, D., Hays, D.M., Heyn, R., Lawrence, W., Newton, W., Ortega, J., Ragab, A.H., Raney, R.B., Ruymann, F.B., Soule, E., Tefft, M., Webber, B., Wharam, M.D., Vietti, T.J.: The Intergroup Rhabdomyosarcoma Study—I: A final report. Cancer61:209, 1988

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Medical College of Virginia, MCV Station, P.O. Box 11, 23298-0001, Richmond, Virginia, USA

    Walter Lawrence Jr. M.D.

Authors
  1. Walter Lawrence Jr. M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel M. Hays M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ruth Heyn M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohan Beltangady Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Harold M. Maurer M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Intergroup Rhabdomyosarcoma Study Committee

Additional information

William Crist, M.D., Edmund A. Gehan, Ph.D., Denman Hammond, M.D., Pat Morris Jones, M.D., William Newton, Jr., M.D., A.H. Ragab, M.D., R. Beverly Raney, Jr., M.D., Frederick B. Ruymann, M.D., Melvin Tefft, M.D., Bruce Webber, M.D., and Moody Wharam, M.D.

Supported by grants CA-24507, CA-30138, CA-30969, CA-29139, and CA-13539 from the National Cancer Institute.

Representing Children's Cancer Study Group, Pediatric Oncology Group, United Kingdom Children's Cancer Study Group, and Pediatric Intergroup Statistical Center.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lawrence, W., Hays, D.M., Heyn, R. et al. Surgical lessons from the Intergroup Rhabdomyosarcoma Study (IRS) pertaining to extremity tumors. World J. Surg. 12, 676–684 (1988). https://doi.org/10.1007/BF01655884

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01655884

Keywords

Search

Navigation