Rhabdomyosarcoma case

[xrt123]

Had a weird case of Head and neck rhabdomyosarcoma in a pediatric patient where the patient failed in the abdomen 6 months after completion of radiation and chemotherapy. Staging shows only solitary disease in the abdomen which will be difficult to resect. Any good ideas on what the best course of treatment would be recurrent rhabdomyosarcoma well out of field? If they can't resect would you do chemo first and then art to gross disease?

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[Palex80]

I'd like to hear a bit more about histology. What type of RMS is this?

Besides that, primary radiochemotherapy (do not delay RT too long!) is a reasonable option for this patient.

 

[napoleondynamite]

In field recurrence? What dose was used? Strange as these tend to be very radio sensitive. If outside your prior field and inoperable, I'd zap.

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[xrt123]

Out of field recurrence. Originally an embryonal sarcoma of the let neck (nonparameningeal), microscopic disease left behind at resection and positive nodes. She was low risk (stage1 group IIc). Got 41.4 Gy to head and neck. Now almost a year after completing treatment we have a biopsy proven recurrence at the pancreatic uncinate process/proximal duodenum. No other sites of disease.

 

[napoleondynamite]

XRT much less morbid than surgery. I'm always skeptical about bioavailability of chemo in that location, just doesn't seem to work great. I'd treat. Sucks, but I'd treat.

Poor kid.

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