Rhabdomyosarcoma in childhood

In spite of an excellent improvement of treatment strategies many questions about the best therapeutic approach in rhabdomyosarcoma remain open. The rare incidence (4,5 per million children and year), the biological heterogeneity, the different localisations and stages of disease still remain a challenge for the interdisciplinary cooperation in paediatric oncology. The optimum treatment consists of a qualified combination of chemo- and radiotherapy as well as surgical intervention. The importance of each modality is to be defined in every individual case. Only with such an approach severe mutilations can be avoided and a better chance of survival offered. A national study for rhabdomyosarcoma of the Austrian Paediatric Oncology Group is presented, which has been established in close collaboration with the paediatric onologists of West-Germany. The study protocol since January 1982 is still in use. Therapeutic strategies of the Intergroup Rhabdomyosarcoma Study Group were taken into consideration. The chemotherapy essentially consists of a modified T9- and T11-protocol (Memorial Sloan Kettering Cancer Center, New York) including newer drugs like cisplatin and VP16-213. The surgical intervention is recommended as primary resection only when multilations can be avoided (otherwise a biopsy is proposed). The secondary and definitive resection or biopsy is provided for the time period after completion of 16 weeks of chemotherapy. The addition of radiotherapy after the second look operation promises the maximum of curative effect. The following chemotherapy is planned for further 16 or 36 weeks according to the stage of disease. Because of the rather small number of patients and because of the necessity of a close collaboration between surgeons, urologists, radiotherapists and paediatricians it is recommended to transfer the patient to a center of paediatric oncology. (Author)