We read with great interest the Article by Gianni Bisogno and colleagues, which showed that maintenance therapy improved survival in this group. As cited by the authors, the Soft Tissue Sarcoma Cooperative Group (Cooperative Weichteilsarkom Studiengruppe; CWS) has previously evaluated maintenance therapy in a non-randomised way in patients with metastatic disease. Additionally, the CWS-2002P study evaluated a similar maintenance therapy (vinblastine instead of vinorelbine) in an almost identically defined high-risk rhabdomyosarcoma patient group. We are also convinced that maintenance therapy could be an effective treatment for high-risk rhabdomyosarcoma and requires further evaluation. The results of the RMS 2005 study are, however, not entirely convincing. The primary endpoint of the study and primary goal for clinicians treating patients with high-risk rhabdomyosarcoma is to avoid relapse. In the study, this goal was not achieved; 5-year disease-free survival in the intention-to-treat population was 77·6% with maintenance therapy versus 69·8% without (p=0·061), and in the per-protocol analysis 77·8% vs 69·6% (p=0·053). This outcome is surprising as only one patient of 186 in the untreated therapy group, and three of 185 participants in the maintenance therapy group, were excluded in the per-protocol analysis. The 5-year overall survival was significantly higher in the therapy group (86·5%) compared with patients who stopped treatment (73·7%). As the authors stated, patient, tumour and relapse-related factors all influence survival after relapse and these factors were similarly distributed in both groups of the study. However, post-relapse therapy has a pivotal role for outcome and this factor could not be evaluated. The authors' hypothesis that “the combined regimen might have killed any residual tumour cells resistant to the drugs administered during the standard treatment” is not correct given the fact that relapse could not be significantly reduced by the maintenance therapy.

中文翻译：

---

高危横纹肌肉瘤患者的新护理标准？

我们非常感兴趣地阅读了Gianni Bisogno及其同事的文章，该文章表明维持治疗改善了该组患者的生存率。正如作者所引用的那样，软组织肉瘤合作小组（Cooperative Weichteilsarkom Studiengruppe； CWS）以前曾以非随机的方式评估了转移性疾病患者的维持治疗。此外，CWS-2002P研究在几乎相同定义的高风险横纹肌肉瘤患者组中评估了类似的维持疗法（长春碱代替长春瑞滨）。我们还坚信维持疗法可能是治疗高危横纹肌肉瘤的有效方法，需要进一步评估。但是，RMS 2005研究的结果并不完全令人信服。该研究的主要终点和临床医生治疗高危横纹肌肉瘤患者的主要目标是避免复发。在研究中，这个目标没有实现。维持治疗组意向治疗人群的5年无病生存率为77·6％69·8％无（P = 0·061），并在按方案分析77·8％VS69·6％（p = 0·053）。按方案分析，未治疗组的186名患者中只有1名患者和维持治疗组的185名参与者中有3名被排除在外，这一结果令人惊讶。与停止治疗的患者（73·7％）相比，治疗组的5年总生存率明显更高（86·5％）。如作者所述，患者，肿瘤和复发相关因素均影响复发后的生存，并且这些因素在两组研究中的分布相似。但是，复发后治疗对于结局具有关键作用，因此无法评估该因素。作者的