Improved care of rhabdomyosarcoma in Jordan using less intensive therapy

Background: The care of rhabdomyosarcoma (RMS) is complex due to its multimodal nature. By following standard protocols with acceptable toxicity and building local expertise, better outcome should be achievable. Procedure: A retrospective study was conducted of records of patients (n=45; 31 males; median age 26 months) with RMS treated at King Hussein Cancer Center in Jordan from January 2004 to December 2008. Patient demographics, tumor characteristics, risk stratification, treatment plan, and outcomes were studied. In June 2006, the cyclophosphamide dose was lowered from 2.2g/m² to 1.2g/m² per cycle because of the significant toxicity with higher dose. Survival rates, hematological toxicities, period of hospitalization due to febrile neutropenia (FN), and response rate at week 12 of treatment were compared between low- and high-dose cyclophosphamide groups. Results: Four-year progression-free survival (PFS) and overall survival (OS) rates were 61%±7.5% and 72%±6.9%, respectively. There was a significant difference in outcome by risk group in 4-year PFS (low-risk, 88%±12%; intermediate-risk 63%±9.3%; high-risk, 14%±13%; P=0.0001) and OS (low-risk, 88%±12%; intermediate-risk 79%±7.5%; high-risk, 17%±15%; P=0.0011). There was significant reduction in hematological toxicities, incidence of FN, and period of hospitalization for FN in patients given low-dose cyclophosphamide but no significant difference in PFS between low- and high-dose cyclophosphamide groups. Conclusions: Survival rates of patients with RMS in some developing countries can be improved by following or modifying evidence-based approaches successful in developed countries and establishing multidisciplinary strategies. Therapy intensity should be increased in developing countries only when evidence supports its utility.