Clinical group and modified TNM stage for rhabdomyosarcoma: A review from the Children's Oncology Group

Jacquelyn N. Crane, Department of Pediatrics, Stanford University, Stanford, California, USA.
Wei Xue, Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA.
Amira Qumseya, Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA.
Zhengya Gao, Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA.
Carola A. Arndt, Department of Pediatric and Adolescent Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, USA.
Sarah S. Donaldson, Department of Radiation Oncology, Stanford University, Stanford, California, USA.
Douglas J. Harrison, Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas, USA.
Douglas S. Hawkins, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA.
Corinne M. Linardic, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA.
Leo Mascarenhas, Children's Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles, California, USA.
William H. Meyer, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
David A. Rodeberg, Division of Pediatric Surgery, Department of Surgery, East Carolina University, Greenville, North Carolina, USA.
Erin R. Rudzinski, Department of Laboratories, Seattle Children's Hospital, Seattle, Washington, USA.
Barry L. Shulkin, Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
David O. Walterhouse, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Rajkumar Venkatramani, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Aaron R. Weiss, Department of Pediatrics, Maine Medical Center, Portland, Maine, USA.

Document Type

Article

Publication Date

3-6-2022

Institution/Department

Pediatrics; Barbara Bush Children’s Hospital Scholars Academy

Journal Title

Pediatric blood & cancer

Abstract

The Children's Oncology Group (COG) uses Clinical Group (CG) and modified Tumor Node Metastasis (TNM) stage to classify rhabdomyosarcoma (RMS). CG is based on surgicopathologic findings and is determined after the completion of initial surgical procedure(s) but prior to chemotherapy and/or radiation therapy. The modified TNM stage is based on clinical and radiographic findings and is assigned prior to any treatment. These systems have evolved over several decades. We review the history, evolution, and rationale behind the current CG and modified TNM classification systems used by COG for RMS. Data from the seven most recently completed and reported frontline COG trials (D9602, D9802, D9803, ARST0331, ARST0431, ARST0531, ARST08P1) were analyzed, and confirm that CG and modified TNM stage remain relevant and useful for predicting prognosis in RMS. We propose updates based on recent data and discuss factors warranting future study to further optimize these classification systems.

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