Professional Documents
Culture Documents
Management of Rhabdomyosarco MA: Presenter: DR Manas Dubey Moderator: DR Rakesh Dhankhar
Management of Rhabdomyosarco MA: Presenter: DR Manas Dubey Moderator: DR Rakesh Dhankhar
RHABDOMYOSARCO
MA
PRESENTER: Dr MANAS DUBEY
MODERATOR: Dr RAKESH DHANKHAR
in adolescence.
Age <1 year and >10 years have inferior
survival.
Adults with RMS have been reported to have
SITES DISTRIBUTION*
Genitourinary( bladder and prostate- m/c, 31%
gynecologic tumors, paratesticular tumors)
Orbit 9%
Retroperitoneal 7%
Trunk 5%
Other sites 3%
Natural History and Pattern of
spread
Sites.
CT SCAN
Obtain a chest CT scan to evaluate for
metastases to the lungs. Chest CT scanning is
best performed before surgery to avoid
atelectasis, which can be confused with
metastasis.
adjacent bony destruction seen in over 20% of
cases.
Ct scan ….
testicular rhabdomyosarcoma.
STAGING SYSTEMS
II Unfavorable sites T1 or T2 a, ≤ 5 cm N0 or NX M0
III Unfavorable sites T1 or T2 a, ≤ 5 cm N1 M0
b, > 5 cm N0 or N1 or NX
Group Definition
I A localized tumor that is completely
(Approximately 13% of all patients are in removed with pathologically clear margins
this group.) and no regional lymph node involvement.
II A localized tumor that is grossly removed
(Approximately 20% of all patients are in with (a) microscopic disease at the
this group.) margin, (b) involved, grossly removed
regional lymph nodes, or (c) both (a) and
(b).
III A localized tumor with gross residual
(Approximately 48% of all patients are in disease after incomplete removal or
this group.) biopsy only.
IV Distant metastases are present at
(Approximately 18% of all patients are in diagnosis.
this group.)
PATHOLOGICAL
CLASSIFICATION
PATHOLOGICAL SUBTYPE COMMENT
Superior prognosis 5-year survival rate of 88% to 95%
a) Botryoid rhabdomyosarcoma Botryoid tumors are usually noninvasive and
b) Spindle cell rhabdomyosarcoma localized and occur in mucosal-lined organs such as
the vagina, urinary bladder, middle ear, biliary tree,
and nasopharynx
Spindle cell subtype found in paratesticular sites.
Intermediate prognosis 83% failure-free survival at 3 years
a) Embryonal rhabdomyosarcoma found most commonly in the orbit, head and neck,
and genitourinary sites.
Poor prognosis •projected 3-year failure-free survival for
a) Alveolar rhabdomyosarcoma children with the alveolar subtype is 66%
b) Undifferentiated sarcoma And patients with undifferentiated sarcoma is 55%.
c) Anaplastic rhabdomyosarcoma
Subtypes whose prognosis is not
presently evaluable
a. Rhabdomyosarcoma with rhabdoid
features
Note: Pleomorphic type is extremely rare; and treated like SOFT
TISSUE SARCOMA
Contd….
PROGNOSTIC FACTORS
AGE ( 1 to 9 yr – good
prognosis )
SITE
EXTENT OF DISAESE
PATHOLOGIC
CHARACTERISTIC
CONTD……
Favourable sites.
unfavourable
sites.
MANAGEMENT
Longitudina
l incision
Handbook of Cancer Chemotherapy 8th Ed. Year 2011 Roland T.Skeel Samir
N.Khleif
Contd….
Low-risk patients :
Standard treatment options- Certain subgroups of
low-risk patients have achieved survival rates higher than 90%
by undergoing two-drug chemotherapy with vincristine and
dactinomycin (VA) plus RT for residual tumor.
Characteristics of Low-Risk Patients with High Survival
Rates Using Two-Drug Therapy with VA ± RT
(5-year overall FFS rate = 88% 5-year OS rate = 97% COG-D9602 Study )
• Timing of RT =
• generally 1 to 3 months after chemotherapy initiation
.
THANK YOU
Contd….
IRSG YEARS
IRSG - I 1972 - 1978
IRSG - II 1978-1984
IRSG-III 1984-1991
IRSG-IV 1991-1997
IRSG-V 1997-2002