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Yu X, Qie M, Huang L, Hou M. Successful pregnancy in a female with embryonal rhabdomyosarcoma of the cervix who received biopsy and chemotherapy alone without recurrence after 16 years: a case report and literature review. BMC Womens Health 2023; 23:466. [PMID: 37658404 PMCID: PMC10474710 DOI: 10.1186/s12905-023-02623-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Embryonal rhabdomyosarcoma (ERMS) of the uterine cervix is rare, but the population affected is mostly underage females. The scope of surgery has now evolved from extensive to limited, and organ-preserving surgery combined with chemotherapy is recommended to preserve the patient's fertility. However, reports of birth outcomes are rare. CASE A minor woman with cervical ERMS who underwent only an outpatient biopsy of the lesion had no residual lesion on subsequent multipoint cervical biopsy and refused radical surgery or cervical conization, after which the patient received a nonclassical regimen of chemotherapy. The patient stopped the chemotherapy on her own, but the patient conceived spontaneously 16 years later with a good pregnancy outcome and no recurrence. CONCLUSIONS This case suggests that preservation of reproductive function is often feasible in immature women with cervical ERMS, and the prognosis is usually good as long as the primary tumour can be surgically removed and the lesion is free of residual disease. We also look forward to reports of subsequent growth and pregnancy outcomes in other children with reproductive tract RMS. In cervical ERMS, accurate evaluation of the disease and development of an individualized treatment plan are crucial, and the protection of reproductive function and psychological well-being deserves special attention.
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Affiliation(s)
- Xiuzhang Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Number 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Number 17, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Mingrong Qie
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Number 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Number 17, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Liyan Huang
- Department of Pathology, West China Second University Hospital, Sichuan University, Number 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Minmin Hou
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Number 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Number 17, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China.
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2
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Nout R, Calaminus G, Planchamp F, Chargari C, Lax SF, Martelli H, McCluggage WG, Morice P, Pakiz M, Schmid MP, Stunt J, Timmermann B, Vokuhl C, Orbach D, Fotopoulou C. ESTRO/ESGO/SIOPe guidelines for the management of patients with vaginal cancer. Radiother Oncol 2023; 186:109662. [PMID: 37244358 DOI: 10.1016/j.radonc.2023.109662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/29/2023] [Indexed: 05/29/2023]
Abstract
Primary vaginal malignancies are rare, comprising only 2% of all female genital tract malignancies in adults and 4.5% in children. As part of its mission to improve the quality of care for women with gynecological cancers across Europe, the European Society of Gynaecological Oncology (ESGO) jointly with the European Society for Radiotherapy & Oncology (ESTRO) and the European Society of Pediatric Oncology (SIOPe) developed evidence-based guidelines in order to improve the management of patients with vaginal cancer within a multidisciplinary setting. ESTRO/ESGO/SIOPe nominated practicing clinicians who are involved in the management of vaginal cancer patients and have demonstrated leadership through their expertise in clinical care and research, their national and international engagement and profile as well as dedication to the topics addressed to serve on the expert panel (13 experts across Europe comprising the international development group). To ensure that the statements were evidence based, the current literature was reviewed and critically appraised. In the case of absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Prior to publication, the guidelines were reviewed by 112 independent international practitionners in cancer care delivery and patient representatives and their comments and input were incorporated and addressed accordingly. These guidelines cover comprehensively the diagnostic pathways as well as the surgical, radiotherapeutical and systemic management and follow-up of adult patients (including those with rare histological subtypes) and pediatric patients (vaginal rhabdomyosarcoma and germ cell tumours) with vaginal tumours.
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Affiliation(s)
- Remi Nout
- Department of radiotherapy, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - Gabriele Calaminus
- Department of paediatric hematology and oncology, University Children's Hospital, Bonn, Germany
| | | | - Cyrus Chargari
- Departement of radiation oncology, Institut Gustave Roussy, Villejuif, France
| | - Sigurd F Lax
- Department of Pathology, Hospital Graz II, Graz and School of Medicine, Johannes Kepler University, Linz, Austria
| | - Hélène Martelli
- Department of Paediatric surgery, Hôpital Universitaire Bicêtre, Paris, France
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Philippe Morice
- Department of gynecologic surgery, Institut Gustave Roussy, Villejuif, France
| | - Maja Pakiz
- Department of gynecologic oncology and breast oncology, University Medical Centre Maribor, Maribor, Slovenia
| | - Maximilian Paul Schmid
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center Vienna, Vienna, Austria
| | - Jonáh Stunt
- Department of radiotherapy, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Beate Timmermann
- Department of particle therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Essen, Germany
| | - Christian Vokuhl
- Department of pathology, Universitätsklinikum Bonn, Bonn, Germany
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), PSL University, Institut Curie, Paris, France
| | - Christina Fotopoulou
- Department of surgery & cancer, Queen Charlotte's & Chelsea Hospital, London, United Kingdom
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3
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Nout RA, Calaminus G, Planchamp F, Chargari C, Lax S, Martelli H, McCluggage WG, Morice P, Pakiz M, Schmid MP, Stunt J, Timmermann B, Vokuhl C, Orbach D, Fotopoulou C. ESTRO/ESGO/SIOPe Guidelines for the management of patients with vaginal cancer. Int J Gynecol Cancer 2023; 33:1185-1202. [PMID: 37336757 DOI: 10.1136/ijgc-2023-004695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Primary vaginal malignancies are rare, comprising only 2% of all female genital tract malignancies in adults and 4.5% in children. As part of its mission to improve the quality of care for women with gynecological cancers across Europe, the European Society of Gynaecological Oncology (ESGO) jointly with the European Society for Radiotherapy & Oncology (ESTRO) and the European Society of Pediatric Oncology (SIOPe) developed evidence-based guidelines in order to improve the management of patients with vaginal cancer within a multidisciplinary setting.ESTRO/ESGO/SIOPe nominated practicing clinicians who are involved in the management of vaginal cancer patients and have demonstrated leadership through their expertise in clinical care and research, their national and international engagement and profile as well as dedication to the topics addressed to serve on the expert panel (13 experts across Europe comprising the international development group). To ensure that the statements were evidence based, the current literature was reviewed and critically appraised.In the case of absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Prior to publication, the guidelines were reviewed by 112 independent international practitionners in cancer care delivery and patient representatives and their comments and input were incorporated and addressed accordingly.These guidelines cover comprehensively the diagnostic pathways as well as the surgical, radiotherapeutical and systemic management and follow-up of adult patients (including those with rare histological subtypes) and pediatric patients (vaginal rhabdomyosarcoma and germ cell tumours) with vaginal tumours.
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Affiliation(s)
- Remi A Nout
- Radiotherapy, Erasmus MC Cancer Centre, Rotterdam, Please Select, Netherlands
| | - Gabriele Calaminus
- Department of Paediatric Hematology and Oncology, University Children's Hospital, Bonn, Germany
| | | | - Cyrus Chargari
- Department of Radiation Oncology, Institut Gustave-Roussy, Villejuif, Île-de-France, France
| | - Sigurd Lax
- Pathology, Hospital Graz Sud-West, Graz, Austria
- Johannes Kepler Universitat Linz, Linz, Austria
| | - Hélène Martelli
- Department of Paediatric surgery, Hôpital Universitaire Bicêtre, Paris, France
| | | | - Philippe Morice
- Surgery, Institut Gustave-Roussy, Villejuif, Île-de-France, France
| | - Maja Pakiz
- Department of Gynecologic Oncology and Breast Oncology, University Medical Centre Maribor, Maribor, Slovenia
| | - Maximilian P Schmid
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center Vienna, Wien, Austria
| | - Jonáh Stunt
- Department of Radiotherapy, Erasmus MC Cancer Centre, Rotterdam, Zuid-Holland, Netherlands
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
- West German Proton Therapy Centre, Essen, Germany
| | - Christian Vokuhl
- Department of Pathology, Universitätsklinikum Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris, France
| | - Christina Fotopoulou
- Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, London, UK
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4
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Castle JT, Levy BE, Allison DB, Rodeberg DA, Rellinger EJ. Pediatric Rhabdomyosarcomas of the Genitourinary Tract. Cancers (Basel) 2023; 15:2864. [PMID: 37345202 PMCID: PMC10216134 DOI: 10.3390/cancers15102864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 06/23/2023] Open
Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in the pediatric and adolescent population, with 350 new cases diagnosed each year. While they can develop anywhere in the body, the genitourinary tract is the second most common primary location for an RMS to develop. Overall survival has improved through the increased use of protocols and multidisciplinary approaches. However, the guidelines for management continue to change as systemic and radiation therapeutics advance. Given the relative rarity of this disease compared to other non-solid childhood malignancies, healthcare providers not directly managing RMS may not be familiar with their presentation and updated management. This review aims to provide foundational knowledge of the management of RMSs with an emphasis on specific management paradigms for those arising from the genitourinary tract. The genitourinary tract is the second most common location for an RMS to develop but varies greatly in symptomology and survival depending on the organ of origin. As the clinical understanding of these tumors advances, treatment paradigms have evolved. Herein, we describe the breadth of presentations for genitourinary RMSs with diagnostic and treatment management considerations, incorporating the most recently available guidelines and societal consensus recommendations.
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Affiliation(s)
- Jennifer T. Castle
- Department of Surgery, Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA;
| | - Brittany E. Levy
- Department of Surgery, University of Kentucky, Lexington, KY 40536, USA;
| | - Derek B. Allison
- Department of Pathology and Laboratory Medicine, Department of Urology, Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA;
| | - David A. Rodeberg
- Department of Surgery, Department of Pediatric Surgery, University of Kentucky, Lexington, KY 40536, USA;
| | - Eric J. Rellinger
- Department of Surgery, Department of Pediatric Surgery, Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
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5
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Lautz TB, Martelli H, Fuchs J, Chargari C, Smeulders N, Granberg CF, Wolden SL, Sparber-Sauer M, Hawkins DS, Bisogno G, Koscielniak E, Rodeberg DA, Seitz G. Local treatment of rhabdomyosarcoma of the female genital tract: Expert consensus from the Children's Oncology Group, the European Soft-Tissue Sarcoma Group, and the Cooperative Weichteilsarkom Studiengruppe. Pediatr Blood Cancer 2023; 70:e28601. [PMID: 32762004 DOI: 10.1002/pbc.28601] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 12/22/2022]
Abstract
The International Soft-Tissue Sarcoma Consortium (INSTRuCT) was founded as an international collaboration between different pediatric soft-tissue sarcoma cooperative groups (Children's Oncology Group, European Pediatric Soft-Tissue Sarcoma Group, and Cooperative Weichteilsarkom Studiengruppe). Besides other tasks, a major goal of INSTRuCT is to develop consensus expert opinions for best clinical treatment. This consensus paper for patients with rhabdomyosarcoma of the female genital tract (FGU-RMS) provides treatment recommendations for local treatment, long-term follow-up, and fertility preservation. Therefore, a review of the current literature was combined with recommendations of the treatment protocols of the appropriate clinical trials. Additionally, opinions of international FGU-RMS experts were incorporated into recommendations. Results were that the prognosis of FGU-RMS is favorable with an excellent response to chemotherapy. Initial complete surgical resection is not indicated, but diagnosis should be established properly. In patients with tumors localized at the vagina or cervix demonstrating incomplete response after induction chemotherapy, local radiotherapy (brachytherapy) should be carried out. In patients with persistent tumors at the corpus uteri, hysterectomy should be performed. Fertility preservation should be considered in all patients. In conclusion, for the first time, an international consensus for the treatment of FGU-RMS patients could be achieved, which will help to harmonize the treatment of these patients in different study groups.
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Affiliation(s)
- Timothy B Lautz
- Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Helene Martelli
- Department of Pediatric Surgery, Bicetre Hospital, Assistance Publique-Hopitaux de Paris, Hopitaux Universitaires Paris-Sud, Le Kremlin Bicetre, France
| | - Joerg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tubingen, Germany
| | - Cyrus Chargari
- Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Naima Smeulders
- Department of Pediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | | | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Monika Sparber-Sauer
- Klinikum Stuttgart, Zentrum für Kinder-, Jugend-, und Frauenmedizin, Olgahospital, Pediatrics 5, Stuttgart, Germany
| | - Douglas S Hawkins
- Hematology/Oncology Division, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Gianni Bisogno
- Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Ewa Koscielniak
- Klinikum Stuttgart, Zentrum für Kinder-, Jugend-, und Frauenmedizin, Olgahospital, Pediatrics 5, Stuttgart, Germany
| | - David A Rodeberg
- Division Pediatric Surgery, East Carolina University, Greenville, North Carolina
| | - Guido Seitz
- Department of Pediatric Surgery, University Hospital Giessen-Marburg, Marburg, Germany
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6
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Sarcoma Botryoides: Optimal Therapeutic Management and Prognosis of an Unfavorable Malignant Neoplasm of Female Children. Diagnostics (Basel) 2023; 13:diagnostics13050924. [PMID: 36900067 PMCID: PMC10000398 DOI: 10.3390/diagnostics13050924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/05/2023] [Accepted: 02/14/2023] [Indexed: 03/05/2023] Open
Abstract
Embryonal rhabdomyosarcoma (ERMS) is a rare malignancy and occurs primarily in the first two decades of life. Botryoid rhabdomyosarcoma is an aggressive subtype of ERMS that often manifests in the genital tract of female infants and children. Due to its rarity, the optimal treatment approach has been a matter of debate. We conducted a search in the PubMed database and supplemented it with a manual search to retrieve additional papers eligible for inclusion. We retrieved 13 case reports and case series, from which we summarized that the current trend is to approach each patient with a personalized treatment plan. This consists of a combination of local debulking surgery and adjuvant or neoadjuvant chemotherapy (NACT). Effort is made in every approach to avoid radiation for the sake of preserving fertility. Radical surgeries and radiation still have a role to play in extensive disease and in cases of relapse. Despite the rarity and aggressiveness of this tumor, disease-free survival and overall prognosis is excellent, especially when it is diagnosed early, compared with other subtypes of rhabdomyosarcoma (RMS). We conclude that the practice of a multidisciplinary approach is appropriate, with favorable outcomes; however, larger-scale studies need to be organized to have a definite consensus on optimal management.
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7
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Terlizzi M, Minard V, Haie-Meder C, Espenel S, Martelli H, Guérin F, Chargari C. Implementation of Image-Guided Brachytherapy for Pediatric Vaginal Cancers: Feasibility and Early Clinical Results. Cancers (Basel) 2022; 14:cancers14133247. [PMID: 35805018 PMCID: PMC9265517 DOI: 10.3390/cancers14133247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Brachytherapy is one of the cornerstones of the treatment of pediatric vaginal tumors in combination with surgery and chemotherapy from a conservative perspective. In this retrospective series, we present our experience with 3D pulsed dose rate brachytherapy for the treatment of children with vaginal tumors. Our results show that this treatment has good compliance and provides an excellent local control rate. The toxicity rate is also favorable, with gynecological toxicities being the most frequent. Given the rarity of these diseases, their management should be entrusted to expert centers. Abstract Background: Brachytherapy (BT) has a major role in pediatric cancers of the lower genital tract, as part of a multimodal organ conservative strategy. Scarce data are available on the location of image-guided BT. Methods: Medical records of all consecutive girls treated in our center between 2005 and 2020 for a vaginal tumor with exclusive image-guided PDR-BT were retrospectively examined, with a focus on treatment parameters, patient compliance, and clinical outcome, including analysis of local control, survival and late toxicity rates. Results: Twenty-six patients were identified, with a median age of 25 months. Histological types were rhabdomyosarcoma, malignant germ cell tumor (MGCT) and clear cell adenocarcinoma in 18 (69%), 7 (27%) and 1 (4%) patients, respectively. Ten (33%) patients had prior surgery and 25 (96%) received chemotherapy prior to BT. The median prescribed dose was 60 Gy through pulses of 0.42 Gy. Global compliance was satisfactory, but three (12%) patients required replanning because of applicator displacement. After a median follow-up of 47.5 months, one patient with MGCT referred for salvage treatment of a local recurrence had a local and metastatic relapse. The local control rate probability was 96% at the last follow-up. Late toxicity rates ≥ grade 2 and ≥ grade 3 were reported in 23% and 11%, respectively, with gynecological toxicities being the most frequent side effect. Two patients required dilatation for vaginal stenosis. Conclusions: PDR-BT allowed similar local control compared to the historical low-dose rate technique. An indirect comparison suggests fewer treatment-related toxicities by integrating image guidance and optimization capabilities, but longer follow-up is necessary. Due to the rarity of the disease and the technical aspects of BT in these very young patients, referral to specialized high-volume centers is recommended.
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Affiliation(s)
- Mario Terlizzi
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (M.T.); (C.H.-M.); (S.E.)
| | - Véronique Minard
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France;
| | - Christine Haie-Meder
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (M.T.); (C.H.-M.); (S.E.)
| | - Sophie Espenel
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (M.T.); (C.H.-M.); (S.E.)
| | - Hélène Martelli
- Department of Pediatric Surgery, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 94270 Le Kremlin Bicêtre, France; (H.M.); (F.G.)
| | - Florent Guérin
- Department of Pediatric Surgery, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 94270 Le Kremlin Bicêtre, France; (H.M.); (F.G.)
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (M.T.); (C.H.-M.); (S.E.)
- Correspondence:
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8
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Zakem SJ, Cost CR, Cost NG, Robin TP, Milgrom SA. Brachytherapy in children, adolescents, and young adults: An underutilized modality in the United States? Pediatr Blood Cancer 2022; 69:e29412. [PMID: 34699136 DOI: 10.1002/pbc.29412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/21/2021] [Accepted: 10/02/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Brachytherapy (BT) delivers highly conformal radiation and spares surrounding tissues, which may limit late effects in pediatric, adolescent, and young adult (AYA) patients. We aimed to characterize trends in BT use for this population in the United States, focusing on patients with rhabdomyosarcoma (RMS). METHODS The National Cancer Database was queried to identify patients ≤ 21 who were treated for solid tumor malignancies in the United States from 2004 to 2016. We obtained disease, treatment, and outcome data for patients treated with BT, in particular for RMS. RESULTS 99 506 pediatric and AYA patients met study inclusion. Of these, 22 586 (23%) received radiation therapy (external beam radiation therapy [EBRT] and/or BT) and 240 (0.2%) received BT. Among patients treated with BT, 139 (58%) underwent surgery and 58 (24%) received EBRT. A total of 3836 patients were treated for RMS during this period. Of these, 2531 (66%) received any radiation and 37 (1%) received BT (EBRT + BT in 3, BT in 34). Of patients treated with BT for RMS, 28 (76%) underwent surgery + BT. Survival data were available for 31 patients treated with BT for RMS. With a median follow-up of 63 months, overall survival was 100% for patients with RMS of a favorable site treated with BT. CONCLUSIONS BT is rarely used to treat pediatric and AYA patients in the United States. Patients treated with BT for RMS experienced favorable survival, suggesting that this approach may not compromise oncologic outcomes and warrants further study as a therapeutic option in pediatric and AYA patients, specifically in RMS.
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Affiliation(s)
- Sara J Zakem
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Carrye R Cost
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, Children's Hospital Colorado, Aurora, Colorado
| | - Nicholas G Cost
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, Colorado.,Surgical Oncology Program, Children's Hospital Colorado, Aurora, Colorado
| | - Tyler P Robin
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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9
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Meng L, Zhang Q, Han Q, Sun X, Liu Y, Huang X. Embryonic cervical rhabdomyosarcoma complicated with uterine inversion with cerebral venous sinus thrombosis as the first symptom: a case report and literature review. J Int Med Res 2021; 49:3000605211031776. [PMID: 34369193 PMCID: PMC8358511 DOI: 10.1177/03000605211031776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The probability of rhabdomyosarcoma occurring in the cervix is less than 0.5% and may be associated with a pathogenic dicer 1, ribonuclease III (DICER1) gene variation. Tumour-induced hypercoagulability and high levels of cancer antigen (CA) 125 are risk factors for cerebral venous sinus thrombosis (CVST). In addition, although nonpuerperal uterine inversion is very rare and is usually caused by leiomyomas from the uterus, large cervical masses can also be the cause. This case report describes a 24-year-old woman with uterine inversion caused by an embryonic cervical rhabdomyosarcoma that presented with CVST as her first symptom. The patient underwent laparoscopic total uterus and bilateral salpingectomy, during which the uterus was found to be completely inverted. Postoperative pathology confirmed embryonic cervical rhabdomyosarcoma. The patient quickly developed lung and para-aortic lymph node metastases. Two months later, the patient died of complications. When coagulation indices in patients with tumours are abnormal, especially when the levels of D-dimer and CA125 increase, it is recommended that anticoagulant therapy is administered in a timely manner to prevent the occurrence of CVST. Furthermore, for large cervical tumours, physicians should also be alert to the occurrence of uterine inversion.
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Affiliation(s)
- Li Meng
- Department of Gynaecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Qianqian Zhang
- Department of Gynaecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Qingqing Han
- Department of Gynaecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Xianghang Sun
- Department of Gynaecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yin Liu
- Department of Obstetrics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Xianghua Huang
- Department of Gynaecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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10
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Pawlik J, Pawlik W, Branecka-Woźniak D, Kotrych K, Cymbaluk-Płoska A. Rhabdomyosarcoma of the Cervix in a Post-Menopausal Woman-An Unparalleled Phenomenon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157851. [PMID: 34360144 PMCID: PMC8345433 DOI: 10.3390/ijerph18157851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/15/2021] [Accepted: 07/23/2021] [Indexed: 11/20/2022]
Abstract
Rhabdomyosarcoma of the cervix is a soft tissue sarcoma that usually occurs in young women. It is very rare in adulthood. We discuss symptoms, the process of diagnosis of rhabdomyosarcoma embryonale of the cervix in a 61-year-old women and differences in treatment dependent on patient’s age. A 61-year-old woman with symptoms such as palpable mass in the external cervical opening and post-menopausal hemorrhaging was admitted to the oncology ward where excision of the polyp was performed. Embryonal rhabdomyosarcoma (ERMS) was diagnosed by histopathological examination of obtained tissues. The diagnosis was complemented by chest computed tomography and pelvis magnetic resonance imaging to exclude metastases. A Wertheim–Meigs operation and excision of the ovaries, the fallopian tubes and the surrounding tissue was performed in the course of treatment. In the patient’s follow-up of 25 months to date, there have been no signs of recurrence or symptoms connected to ERMS. Based on the therapeutic outcome, the decision to limit the treatment to a surgical resection was adequate for a post-menopausal patient. Because of the rarity of ERMS in the post-menopausal age, we think that the patient should be carefully followed up to further examine this issue and develop diagnostic and treatment guidelines.
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Affiliation(s)
- Jakub Pawlik
- Department of Gynecological Surgery and Oncology of Adults and Adolescents, Pomeranian Medical University, 70-111 Szczecin, Poland; (W.P.); (A.C.-P.)
- Correspondence:
| | - Weronika Pawlik
- Department of Gynecological Surgery and Oncology of Adults and Adolescents, Pomeranian Medical University, 70-111 Szczecin, Poland; (W.P.); (A.C.-P.)
| | - Dorota Branecka-Woźniak
- Department of Gynecology and Reproductive Health, Pomeranian Medical University, 71-210 Szczecin, Poland;
| | - Katarzyna Kotrych
- Department of General and Dental Radiology, Pomeranian Medical University, 70-111 Szczecin, Poland;
| | - Aneta Cymbaluk-Płoska
- Department of Gynecological Surgery and Oncology of Adults and Adolescents, Pomeranian Medical University, 70-111 Szczecin, Poland; (W.P.); (A.C.-P.)
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11
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Bell SG, Konney TO, Appiah-Kubi A, Tawiah A, Amo-Antwi K, Annan JJK, Lawrence ER, Lieberman R, Johnston C. Two rare presentations of embryonal rhabdomyosarcoma of the cervix in teenagers at a low-resource teaching hospital in Ghana: A case series. Gynecol Oncol Rep 2021; 36:100750. [PMID: 33850996 PMCID: PMC8022137 DOI: 10.1016/j.gore.2021.100750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/01/2021] [Accepted: 03/14/2021] [Indexed: 11/05/2022] Open
Abstract
We report on two cases of embryonal rhabdomyosarcoma of the cervix in Ghana. Only 20% of rhabdomyosarcoma diagnoses in children occur in the genitourinary tract. Embryonal rhabdomyosarcoma of the cervix is rare, with no standardized treatment. The teenaged patients underwent fertility-sparing surgery followed by chemotherapy. This treatment regimen is accessible in low-income countries.
We report two cases of embryonal rhabdomyosarcoma (ERMS) of the cervix in teenagers presenting to Komfo Anokye Teaching Hospital in Kumasi, Ghana within one month of each other. Between October and November 2019, two patients presented with ERMS of the cervix. They both underwent fertility-sparing surgery followed by chemotherapy with vincristine, actinomycin-D, and cyclophosphamide. Preoperative workup for the two patients was minimal due to limited availability and high cost of imaging in a low-resource setting. Both patients were discussed at a multidisciplinary tumor board meeting to guide best management practices. Both patients had local surgical resection with histological confirmation of ERMS and negative margins, followed by six cycles of vincristine, actinomycin-D, and cyclophosphamide. Neither of the patients had perioperative complications or received radiation therapy. At the time of publication, both patients are currently alive and without evidence of recurrence. Fertility-sparing surgery followed by chemotherapy for patients with ERMS of the cervix is accessible in low-income countries.
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Affiliation(s)
- Sarah G Bell
- University of Michigan, Department of Obstetrics and Gynecology, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | | | - Adu Appiah-Kubi
- Komfo Anokye Teaching Hospital, Okomfo Anokye Road, Kumasi, Ghana
| | - Augustine Tawiah
- Komfo Anokye Teaching Hospital, Okomfo Anokye Road, Kumasi, Ghana
| | | | | | - Emma R Lawrence
- University of Michigan, Department of Obstetrics and Gynecology, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Richard Lieberman
- University of Michigan, Department of Obstetrics and Gynecology, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Carolyn Johnston
- University of Michigan, Department of Obstetrics and Gynecology, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
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12
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Gynecologic Malignancies in Children and Adolescents: How Common is the Uncommon? J Clin Med 2021; 10:jcm10040722. [PMID: 33673108 PMCID: PMC7918615 DOI: 10.3390/jcm10040722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 01/07/2023] Open
Abstract
The aim of this study is to assess the projected incidence and prognostic indicators of gynecologic malignancies in the pediatric population. In this population-based retrospective cohort study, girls ≤18 years with ovarian, uterine, cervical, vaginal and vulvar malignancies diagnosed between 2000 and 2016 were identified from the Surveillance, Epidemiology and End Results (SEER)-18 registry. The Kaplan-Meier method was used to analyze overall survival (OS). The age-adjusted annual incidence of gynecologic malignancies was 6.7 per 1,000,000 females, with neoplasms of the ovary accounting for 87.5%, vagina 4.5%, cervix 3.9%, uterus 2.5% and vulva 1.6% of all gynecologic malignancies. Malignant germ-cell tumors represented the most common ovarian neoplasm, with an increased incidence in children from 5-18 years. Although certain subtypes were associated with advanced disease stages, the 10-year OS rate was 96.0%. Sarcomas accounted for the majority of vaginal, cervical, uterine and vulvar malignancies. The majority of vaginal neoplasms were observed in girls between 0-4 years, and the 10-year OS rate was 86.1%. Overall, gynecologic malignancies accounted for 4.2% of all malignancies in girls aged 0-18 years and the histologic subtypes and prognosis differed significantly from patients in older age groups.
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13
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Moufarrij SM, Edwards C, McKenzie L, Adeyemi-Fowode O. Successful Pregnancy after Intervention for Spindle-Cell Embryonal Rhabdomyosarcoma: A Case Report. J Pediatr Adolesc Gynecol 2020; 33:613-615. [PMID: 32224250 DOI: 10.1016/j.jpag.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/05/2020] [Accepted: 03/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Embryonal rhabdomyosarcoma, the most common soft tissue malignancy in childhood, is treated with surgery and chemotherapy. Because of the young age at the time of presentation, a discussion of future reproduction is appropriate and conservative management should be considered. We present a case of embryonal rhabdomyosarcoma that was successfully and conservatively managed with chemotherapy, allowing for future pregnancies. CASE A 17-year-old nulliparous woman with embryonal rhabdomyosarcoma underwent 6 cycles of chemotherapy with adriamycin, dacarbazine, cyclophosphamide, and vincristine, resulting in radiographic resolution of the disease. She was able to conceive without medical intervention and to have successful vaginal deliveries. SUMMARY AND CONCLUSION The standard of care for embryonal rhabdomyosarcoma is surgery and chemotherapy; however, conservative management should be considered when preservation of fertility is a goal.
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Affiliation(s)
| | - Creighton Edwards
- Department of Gynecologic Oncology, Baylor College of Medicine, Houston, Texas
| | - Laurie McKenzie
- Department of Reproductive Endocrinology and Infertility, Baylor College of Medicine, Houston, Texas
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14
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Aljehani AM, Abu-Zaid A, Alomar O, Jabrah EA, Alkushi A. Primary Uterine Rhabdomyosarcoma in a 54-Year-Old Postmenopausal Woman. Cureus 2020; 12:e9841. [PMID: 32953348 PMCID: PMC7497219 DOI: 10.7759/cureus.9841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Rhabdomyosarcoma (RMS) is a malignant neoplasm that originates from undifferentiated myogenic progenitor cells. It is predominantly a pediatric disease, and its occurrence in adults is exceedingly rare. Adult primary RMS of gynecologic origin is an uncommon phenomenon, and the cervix is the most frequently involved site. The incidence of adult primary uterine RMS is extremely scarce. Herein, we present the case of primary uterine RMS in a 54-year-old Saudi postmenopausal woman who presented to clinic attention with a six-month history of abdominal pain and vaginal bleeding.
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Affiliation(s)
- Ala M Aljehani
- Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | | | - Osama Alomar
- Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Emad A Jabrah
- Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Abdulmohsen Alkushi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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15
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Ambreen A, Ahmed F, Zafar S, Khan S. A case report of an aggressive rhabdomyosarcoma associated with non-puerperal uterine inversion. J OBSTET GYNAECOL 2019; 40:434-437. [PMID: 31342794 DOI: 10.1080/01443615.2019.1601166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Afshan Ambreen
- Obstetrics and Gynecology Department, Fatima Memorial College of Medicine and Dentistry, Lahore, Pakistan
| | - FarhatulAin Ahmed
- Obstetrics and Gynecology Department, Fatima Memorial College of Medicine and Dentistry, Lahore, Pakistan
| | - Sobia Zafar
- Obstetrics and Gynecology Department, Fatima Memorial College of Medicine and Dentistry, Lahore, Pakistan
| | - Sara Khan
- Hudson Institute of Medical Research, Melbourne, Australia
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16
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Imaging of diseases of the vagina and external genitalia in children. Pediatr Radiol 2019; 49:827-834. [PMID: 30612158 DOI: 10.1007/s00247-018-4324-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/29/2018] [Accepted: 12/09/2018] [Indexed: 10/27/2022]
Abstract
A wide range of congenital or acquired conditions, some pretty rare, may affect the vulva and vagina in children. Swelling, visible or palpable masses and abnormal discharges are common symptoms of conditions affecting the vulva and/or the lower genital tract. The majority of these diseases are benign. Ultrasonography is pivotal to elucidate the anatomical origin of these conditions and make the diagnosis. Magnetic resonance imaging can be relevant to improve diagnostic confidence and, if needed, to plan more accurate surgical treatment. The aim of this pictorial essay is to review the related imaging findings to help make radiologists familiar with these conditions.
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17
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Ovarian conservation in management of pediatric gynecology malignancies. Curr Opin Obstet Gynecol 2018; 30:316-325. [DOI: 10.1097/gco.0000000000000484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Minard-Colin V, Walterhouse D, Bisogno G, Martelli H, Anderson J, Rodeberg DA, Ferrari A, Jenney M, Wolden S, De Salvo G, Arndt C, Merks JHM, Gallego S, Schwob D, Haie-Meder C, Bergeron C, Stevens MCG, Oberlin O, Hawkins D. Localized vaginal/uterine rhabdomyosarcoma-results of a pooled analysis from four international cooperative groups. Pediatr Blood Cancer 2018; 65:e27096. [PMID: 29781567 PMCID: PMC8117251 DOI: 10.1002/pbc.27096] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Vaginal/uterine rhabdomyosarcoma (VU RMS) is one of the most favorable RMS sites. To determine the optimal therapy, the experience of four cooperative groups (Children's Oncology Group [COG], International Society of Pediatric Oncology (SIOP) Malignant Mesenchymal Tumor Group [MMT], Italian Cooperative Soft Tissue Sarcoma Group [ICG], and European pediatric Soft tissue sarcoma Study Group [EpSSG]) was analyzed. PROCEDURE From 1981 to 2009, 237 patients were identified. Median age (years) at diagnosis differed by tumor location; it was 1.9 for vagina (n = 160), 2.7 for uterus corpus (n = 26), and 13.5 for uterus cervix (n = 51). Twenty-eight percent of patients received radiation therapy (RT) as part of primary therapy (23% COG, 27% MMT, 46% ICG, and 42% EpSSG), with significant differences in the use of brachytherapy between the cooperative groups (23% COG, 76% MMT, 64% ICG, and 88% EpSSG). RESULTS Ten-year event-free (EFS) and overall survival (OS) were 74% (95% CI, 67-79%) and 92% (95% CI, 88-96%), respectively. In univariate analysis, OS was inferior for patients with uterine RMS and for those with regional lymph node involvement. Although EFS was slightly lower in patients without initial RT (71% without RT vs. 81% with RT; P = 0.08), there was no difference in OS (94% without RT vs. 89% with RT; P = 0.18). Local control using brachytherapy was excellent (93%). Fifty-one (51.5%) of the 99 survivors with known primary therapy and treatment for relapse were cured with chemotherapy with or without conservative surgery. CONCLUSIONS About half of all patients with VU RMS can be cured without systematic RT or radical surgery. When RT is indicated, modalities that limit sequelae should be considered, such as brachytherapy.
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Affiliation(s)
| | - David Walterhouse
- Division of Hematology, Oncology, and Stem Cell
Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago,
Illinois
| | - Gianni Bisogno
- Pediatric Hematology and Oncology Division, Padova
University, Padova, Italy
| | - Helene Martelli
- Department of Pediatric Surgery, CHU Bicetre, Le
Kremlin-Bicêtre, France
| | - James Anderson
- Department of Oncology Clinical Research, Merck Research
Laboratories, North Wales, Pennsylvania
| | - David A. Rodeberg
- Department of Surgery, East Carolina University,
Greenville, North Carolina
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto
Nazionale Tumori, Milano, Italy
| | - Meriel Jenney
- Department of Pediatric Oncology, University of Wales,
Cardiff, United Kingdom
| | - Suzanne Wolden
- Department of Radiotherapy, Memorial Sloan Kettering Cancer
Center, New York City, New York
| | - Gianluca De Salvo
- Clinical Trials and Biostatistics Unit, IRCCS Istituto
Oncologico Veneto, Padova, Italy
| | - Carola Arndt
- Department of Pediatric and Adolescent Medicine, Mayo
Clinic and Foundation, Rochester, Minnesota
| | - Johannes H. M. Merks
- Department of Pediatric Oncology, Emma Children's
Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Soledad Gallego
- Department of Pediatric Oncology, Hospital Universitari
Vall d'Hebron, Barcelona, Spain
| | | | | | - Christophe Bergeron
- Department of Pediatric and Adolescent Oncology, Centre
Leon Berard, Lyon, France
| | - Michael C. G. Stevens
- Department of Paediatric Oncology, Bristol Royal Hospital
for Children, University of Bristol, Bristol, United Kingdom
| | - Odile Oberlin
- Department of Pediatric and Adolescent Oncology, Gustave
Roussy, Villejuif, France
| | - Douglas Hawkins
- Division of Hematology/Oncology, Seattle Children's
Hospital, University of Washington, Seattle, Washington,Fred Hutchinson Cancer Research Center, University of
Washington, Seattle, Washington
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19
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Michlitsch JG, Romao RLP, Gleason JM, Braga LH, Allen L, Gupta A, Lorenzo AJ. Local control for vaginal botryoid rhabdomyosarcoma with pre-rectal transperineal surgical resection and autologous buccal graft vaginal replacement: A novel, minimally invasive, radiation-sparing approach. J Pediatr Surg 2018; 53:1374-1380. [PMID: 29258699 DOI: 10.1016/j.jpedsurg.2017.11.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 11/05/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Localized vaginal rhabdomyosarcoma (RMS) is associated with a favorable prognosis, but strategies for local control remain controversial. The use of radiotherapy (RT) can have important long-term sequelae, while traditional resection involves major reconstructive surgery. We describe a new surgical approach employing a minimally-invasive resection and immediate reconstruction. MATERIALS AND METHODS Records from 4 consecutive patients with localized vaginal RMS managed in 4 major pediatric referral centers were reviewed. All cases were performed with a standardized technique. RESULTS Patients were diagnosed at a median age of 24months. Each underwent a total/subtotal vaginectomy with autologous buccal graft vaginal replacement. Final margins were focally positive in one patient and negative in three. None received radiotherapy. To date, all patients have patent buccal neovaginas, enjoy a favorable aesthetic result, and remain disease-free at a median follow-up of 35months. CONCLUSIONS We report 4 cases of localized vaginal RMS successfully treated with a minimally invasive surgical approach. All patients have avoided radiation and remain disease-free. Our initial data suggest that surgical local control and immediate reconstruction are feasible and can spare these patients the long-term complications of RT. Longer follow-up is critical to ensure disease-free survival with a functional, successfully reconstructed neovagina. TYPE OF STUDY Case series. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Rodrigo L P Romao
- Department of Surgery and Urology, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joseph M Gleason
- Division of Urology, Department of Surgery, St. Jude Children's Research Hospital and University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Luis H Braga
- Division of Urology, McMaster Children's Hospital; Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Allen
- Section of Pediatric Gynecology, Department of Surgery, The Hospital for Sick Children; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Abha Gupta
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Armando J Lorenzo
- Division of Urology, Department of Surgery, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
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20
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Abstract
PURPOSE OF REVIEW Three primary categories of gynecologic cancer are found in pediatric and adolescent patients: stromal carcinomas including juvenile granulosa cell tumors and Sertoli-Leydig cell tumors, rhabdomyosarcomas arising from the vagina and cervix (sarcoma botryoides), and ovarian germ cell tumors which comprise a wide range of histologies. These entities are rare and treatment approaches have focused on decreasing late effects of chemotherapy treatment. Here, we review presentation, histologic classifications, diagnosis, and treatment recommendations for pediatric gynecologic cancers. RECENT FINDINGS Event-free and overall survival for these cancers is high, and the goals of treatment are minimization of morbidity and preservation of fertility with unilateral salpingo-oophorectomies and limited staging. Surveillance of tumor markers after surgery is helpful in monitoring for disease progression and adjuvant chemotherapy is often reserved for patients at recurrence. Recent literature supports avoiding chemotherapy even in high-grade germ cell tumors in the pediatric population.
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22
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Rhabdomyosarcoma of the Vagina in an Adolescent Girl. J Pediatr Adolesc Gynecol 2017; 30:649-651. [PMID: 28578184 DOI: 10.1016/j.jpag.2017.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 05/18/2017] [Accepted: 05/25/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Gynecologic neoplasms are rare in children and represent only less than 5% of all childhood tumors. Rhabdomyosarcoma (RMS) of the female genital tract of children accounts for only 3.5% of the cases. CASE A 16-year-old adolescent presented with a proliferating growth and foul smelling discharge from her vagina, which, on biopsy was diagnosed as RMS. She received chemotherapy and radiation to the primary site. She is alive in remission at 8 years, and with normal menstrual function. SUMMARY AND CONCLUSION RMS of the vagina is a rare, but highly curable tumor in adolescent girls. Any abnormal vaginal bleeding in girls should be promptly investigated using pelvic examination and appropriate imaging. An organ-preserving approach should be considered in these patients.
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Is fertility-preservation safe for adult non-metastatic gynecologic rhabdomyosarcoma patients? Systematic review and pooled survival analysis of 137 patients. Arch Gynecol Obstet 2017; 297:559-572. [DOI: 10.1007/s00404-017-4591-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/10/2017] [Indexed: 11/26/2022]
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Affiliation(s)
- Brian T Caldwell
- Department of Pediatric Urology, Children's Hospital Colorado, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA; Division of Urology, Department of Surgery, University of Colorado School of Medicine, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA.
| | - Duncan T Wilcox
- Department of Pediatric Urology, Children's Hospital Colorado, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA; Division of Urology, Department of Surgery, University of Colorado School of Medicine, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA
| | - Nicholas G Cost
- Department of Pediatric Urology, Children's Hospital Colorado, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA; Division of Urology, Department of Surgery, University of Colorado School of Medicine, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA
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25
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Xie W, Shen K, Yang J, Cao D, Yu M, Wang Y. Conservative management of primary vaginal endodermal sinus tumor and rhabdomyosarcoma. Oncotarget 2017; 8:63453-63460. [PMID: 28969004 PMCID: PMC5609936 DOI: 10.18632/oncotarget.18829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/04/2017] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to evaluate the conservative management and prognosis of primary vaginal endodermal sinus tumor and rhabdomyosarcoma in children. Medical records of children with vaginal endodermal sinus tumor and rhabdomyosarcoma between 1996 and 2015 were reviewed. A total of 24 patients (median age, 12 months; range, 7–44 months) were included in this study, comprising 17 patients with endodermal sinus tumor and 7 patients with rhabdomyosarcoma. Among the 17 patients with endodermal sinus tumor, 15 were initially treated at our hospital with chemotherapy alone, and 2 were initially treated in other hospitals with conservative surgery and chemotherapy. All 7 patients with botryoid rhabdomyosarcoma received chemotherapy without well-defined protocols. At a median follow-up of 51 months (range, 4–237 months), 3 patients (12.5%; 1 with endodermal sinus tumor and 2 with rhabdomyosarcoma) developed recurrence. At the last follow-up, 22 patients (91.7%) were alive without evidence of disease, 1 patient with botryoid rhabdomyosarcoma died of disease progression, and 1 patient with endodermal sinus tumor died of respiratory and circulatory failure. To allow preservation of sexual and reproductive function, conservative therapeutic strategies should be considered for children with vaginal endodermal sinus tumor and botryoid rhabdomyosarcoma.
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Affiliation(s)
- Weimin Xie
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Mei Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yao Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Nasioudis D, Alevizakos M, Chapman-Davis E, Witkin SS, Holcomb K. Rhabdomyosarcoma of the lower female genital tract: an analysis of 144 cases. Arch Gynecol Obstet 2017. [DOI: 10.1007/s00404-017-4438-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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27
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Impact of adjuvant therapy on recurrence patterns in stage I uterine carcinosarcoma. Gynecol Oncol 2017; 145:78-87. [PMID: 28215838 DOI: 10.1016/j.ygyno.2017.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/25/2017] [Accepted: 02/01/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND To examine recurrence patterns in women with stage I uterine carcinosarcoma (UCS) stratified by adjuvant therapy pattern. METHODS We examined 443 cases of stage I UCS derived from a retrospective cohort of 1192 UCS cases from 26 institutions. Adjuvant therapy patterns after primary hysterectomy-based surgery were correlated to recurrence patterns. RESULTS The most common adjuvant therapy was chemotherapy alone (41.5%) followed by chemotherapy/radiotherapy (15.8%) and radiotherapy alone (8.4%). Distant-recurrence was the most common recurrence pattern (5-year cumulative rate, 28.1%) followed by local-recurrence (13.3%). On multivariate analysis, chemotherapy but not radiotherapy remained an independent prognostic factor for decreased risk of local-recurrence (5-year cumulative rates 8.7% versus 19.8%, adjusted-hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.25-0.83, P=0.01) and distant-recurrence (21.2% versus 38.0%, adjusted-HR 0.41, 95%CI 0.27-0.62, P<0.001). The chemotherapy/radiotherapy group had a lower 5-year cumulative local-recurrence rate compared to the chemotherapy alone group but it did not reach statistical significance (5.1% versus 10.1%, adjusted-HR 0.46, 95%CI 0.13-1.58, P=0.22). Radiotherapy significantly decreased local-recurrence when tumors had high-grade carcinoma, sarcoma component dominance, and deep myometrial tumor invasion (all, P<0.05); and combining radiotherapy with chemotherapy was significantly associated with decreased local-recurrence compared to chemotherapy alone in the presence of multiple risk factors (5-year cumulative rates, 2.5% versus 21.8%, HR 0.12, 95%CI 0.02-0.90; P=0.013) but not in none/single factor (P=0.36). CONCLUSION Adjuvant chemotherapy appears to be effective to control both local- and distant-recurrences in stage I UCS; adding radiotherapy to chemotherapy may be effective to control local-recurrence when the tumor exhibits multiple risk factors.
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[Rhabdomyosarcoma of adult genital tract: A short review]. ACTA ACUST UNITED AC 2016; 45:821-826. [PMID: 27212613 DOI: 10.1016/j.jgyn.2016.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 11/24/2022]
Abstract
Rhabdomyosarcoma, most common soft tissue tumor in children, represent 8% of solid tumors in children. Conversely, in adults, this histology is very rare and no consensual recommendation is supported. If gynecological localization is one of the most frequent in children, it is a minority in adults. The management of this type of tumor is based on treatment multimodality combining surgery, chemotherapy, radiotherapy and brachytherapy. This pathological separate entity differs from other sarcomas by its greater sensitivity to chemotherapy and radiotherapy. The aim of this study is to conduct a general review of diagnostic and treatment of genital tract rhabdomyosarcoma in adults, and to report pathological characteristics of this type of tumor.
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Kieran K, Shnorhavorian M. Current standards of care in bladder and prostate rhabdomyosarcoma. Urol Oncol 2016; 34:93-102. [PMID: 26776454 DOI: 10.1016/j.urolonc.2015.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/21/2015] [Accepted: 12/21/2015] [Indexed: 11/25/2022]
Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue tumor in children, and 15% to 20% arise from the genitourinary tract. Multicenter collaborative studies have improved survival substantially, and in addition to excellent oncologic control, current treatment focuses on organ preservation and minimization of late treatment effects. The multiple modalities needed to treat RMS dictate that treating physicians must be familiar with the disease as well as the goals and possible sequelae of treatment with chemotherapy, radiotherapy, and surgery. This article discusses the current standards of care for bladder and prostate RMS.
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Fertility-sparing surgery for the management of young women with embryonal rhabdomyosarcoma of the cervix: A case series. Gynecol Oncol Rep 2016; 18:4-7. [PMID: 27642626 PMCID: PMC5018073 DOI: 10.1016/j.gore.2016.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To report three cases of embryonal rhabdomyosarcoma (ERMS) of the cervix in young women successfully treated with fertility-sparing surgery and chemotherapy. METHODS Between January 2014 and December 2015, three cases of ERMS of the cervix were confirmed in young women at a single tertiary cancer center. All cases were managed by a pediatric oncologist and a gynecologic oncologist with a combination of surgery and chemotherapy. Fertility-sparing surgeries (cervical conization or robotic-assisted radical trachelectomy) were offered to patients depending on the tumor size. RESULTS All patients were nulliparous and aged 14, 20 and 21 years and all presented with abnormal uterine bleeding. The first patient was managed with radical trachelectomy followed by adjuvant chemotherapy. The second patient underwent primary hysteroscopic resection of the tumor followed by completion cervical conization and adjuvant chemotherapy. The third patient received neoadjuvant chemotherapy followed by loop electrosurgical excision procedure (LEEP) with positive residual margins. She then underwent completion radical trachelectomy. None of the patients experienced perioperative complications. None of the women received radiation. All patients are alive with no evidence of disease. CONCLUSION Fertility-sparing surgery and chemotherapy in well-selected patients with ERMS of the cervix result in low complication rates and excellent oncologic outcomes. This treatment option may be considered in young patients who wish to preserve fertility by avoiding hysterectomy. A collaborative effort between pediatric oncologists and gynecologic oncologists is imperative to facilitate innovative approaches to these rare tumors in young adults.
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Literature Review of Benign Müllerian Papilloma Contrasted With Vaginal Rhabdomyosarcoma. J Pediatr Adolesc Gynecol 2016; 29:333-7. [PMID: 26948653 DOI: 10.1016/j.jpag.2015.02.114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 02/04/2015] [Accepted: 02/26/2015] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVES Benign müllerian papillomas of the genital tract are rare and, hence, can be mistaken for vaginal rhabdomyosarcoma on initial clinical review. This review of the literature will consolidate the previous cases of müllerian papilloma reported and looks for clues to differentiate the 2 entities. DESIGN AND SETTING We provide a case report and literature review, with patients from a pediatric adolescent gynecology clinic in a tertiary center. METHODS We conducted a search of English-language publications from 1951 (the first case report) until January 2014 by using the search words "Müllerian papilloma" and "prepubertal bleeding." References from previous published reports were also obtained for completeness. MAIN OUTCOME Literature review of benign müllerian papilloma. RESULTS Since 1951, 56 cases of müllerian papilloma were reported, including 4 cases at our institution. Comorbid conditions were found in 31.5% of cases (with 3 cases associated with mesenchymal tumors). The average length of time from onset of symptoms (primarily vaginal bleeding) to diagnosis was 6.7 months (range, 1 day to 3 years), with only 1 case diagnosed incidentally. Median age of presentation was 5 years (range, 1 day to 52 years). Most cases were localized and resected with ease. Histology reveals complex papillary lesions without cytologic atypia. CONCLUSION Benign müllerian papilloma is distinguished from the more significant diagnosis of vaginal rhabdomyosarcoma by initial length of vaginal bleeding at presentation, lack of vaginal wall extension, ease of resection, and histopathology. This is compared with vaginal rhabdomyosarcoma which commonly exhibits both localized and distant spread.
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Affiliation(s)
- Neville F Hacker
- Gynecologic Oncology Cancer Centre, Royal Hospital for Women, Randwick, Australia
| | - Patricia J Eifel
- Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, TX, USA
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Neoadjuvant Intraarterial Chemotherapy for Treatment of Malignant Vaginal Tumors in Children: A Single-Center Experience. J Vasc Interv Radiol 2016; 27:996-1000. [DOI: 10.1016/j.jvir.2016.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 03/12/2016] [Accepted: 03/14/2016] [Indexed: 11/17/2022] Open
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Harel M, Ferrer FA, Shapiro LH, Makari JH. Future directions in risk stratification and therapy for advanced pediatric genitourinary rhabdomyosarcoma. Urol Oncol 2016; 34:103-15. [DOI: 10.1016/j.urolonc.2015.09.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/19/2015] [Accepted: 09/22/2015] [Indexed: 11/17/2022]
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Shamberger RC. Cooperative group trials in pediatric oncology: the surgeon's role. J Pediatr Surg 2013; 48:1-13. [PMID: 23331786 DOI: 10.1016/j.jpedsurg.2012.10.068] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/13/2012] [Indexed: 11/27/2022]
Abstract
The early history of the pediatric cooperative group trials is reviewed, and the surgeons who played a critical role in their formation are discussed. The vital information provided from the tumor specimens submitted as part of the protocols is presented, as well as how this information advanced our management of infants and children treated on current protocols of the Children's Oncology Group. Finally, a survey of the surgeons currently active in the clinical trials defined the "critical lessons" learned from the sequence of protocols by the cooperative groups which have advanced our surgical treatment of patients today.
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Affiliation(s)
- Robert C Shamberger
- The Department of Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
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Garrett LA, Harmon DC, Schorge JO. Embryonal rhabdomyosarcoma of the uterine corpus. J Clin Oncol 2012; 31:e48-50. [PMID: 23248250 DOI: 10.1200/jco.2012.43.1841] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Leslie A Garrett
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
The most common childhood genitourinary cancers are Wilms tumour, rhabdomyosarcoma and germ cell tumour (GCT). Long-term survival rates for patients with these tumours are generally excellent, ranging from 80% to 100%. However, the high cure rates have highlighted the need to minimize the long-term complications of treatments (referred to as 'late effects'), which can be caused by the three treatment modalities used to treat genitourinary tumours: surgery, chemotherapy and radiation therapy. Serious late effects, such as death, second cancers and tumour recurrence, are uncommon but do occur occasionally. Chronic health conditions--such as cardiac, pulmonary and fertility disorders--are more prevalent. Given the high prevalence of late effects, survivors of childhood genitourinary malignancies require regular surveillance and health promotion delivered by health-care providers with specialist knowledge of the long-term complications of treatment.
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Affiliation(s)
- Karim T Sadak
- Division of Oncology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010, USA
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Terezakis SA, Wharam MD. Radiotherapy for rhabdomyosarcoma: indications and outcome. Clin Oncol (R Coll Radiol) 2012; 25:27-35. [PMID: 22990007 DOI: 10.1016/j.clon.2012.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 04/19/2012] [Accepted: 05/17/2012] [Indexed: 11/25/2022]
Abstract
Rhabdomyosarcoma is the most common soft tissue sarcoma of childhood. Improvements in the clinical outcomes of rhabdomyosarcoma have been secondary to the intensification and refinement of treatment investigated by the Intergroup Rhabdomyosarcoma Study Group. Advances in diagnostic imaging techniques have led to improvements in staging and contribute to precision in radiation field design. Radiation treatment has been integrated into the primary treatment of most patients with rhabdomyosarcoma. Each treatment site has special considerations with regards to prognosis, outcomes and potential morbidities that affect the choice of local therapy. Advanced radiotherapy techniques using conformal treatment with intensity-modulated radiotherapy and proton therapy are particularly advantageous for the treatment of sites close to critical structures, such as the head and neck and genitourinary system. Active investigation is underway to develop strategies to reduce the radiation dose and volume in an effort to minimise late toxicity and improve the therapeutic ratio.
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Affiliation(s)
- S A Terezakis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Abstract
This article reviews common pediatric urologic cancers involving the genitourinary system. Rhabdomyosarcoma may occur in the bladder, prostate, paratesticular regions, vagina, or uterus. Some of these locations, such as the paratesticular region, have a more favorable outcome. Benign neoplasms account for the majority of pediatric testicular tumors and most are managed with testis-sparing surgery. Most genitourinary malignancies are expected to have a good outcome. One focus of treatment is organ preservation but not at the expense of a good oncologic outcome. Late sequelae of anticancer therapy are a concern and every attempt is made to decrease the intensity of tumor treatment.
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Malempati S, Hawkins DS. Rhabdomyosarcoma: review of the Children's Oncology Group (COG) Soft-Tissue Sarcoma Committee experience and rationale for current COG studies. Pediatr Blood Cancer 2012; 59:5-10. [PMID: 22378628 PMCID: PMC4008325 DOI: 10.1002/pbc.24118] [Citation(s) in RCA: 274] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 02/03/2012] [Indexed: 11/07/2022]
Abstract
The prognosis for children and adolescents with rhabdomyosarcoma (RMS) has improved with refinements in multi-modal therapy. Since 1972, the Intergroup Rhabdomyosarcoma Study Group (now the Children's Oncology Group Soft-Tissue Sarcoma Committee) has conducted serial studies for RMS. This review describes the IRSG and COG experience with RMS, presents the current risk stratification definitions, and provides rationale for the current generation of COG RMS studies.
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Affiliation(s)
- Suman Malempati
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon 97239-3098, USA.
| | - Douglas S. Hawkins
- Division of Hematology/Oncology, Seattle Children’s Hospital, Seattle, Washington
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Abstract
Neoplasms of striated and smooth muscle in children are a diverse group of neoplasms that have some unique aspects in contrast to these tumors in adults. Rhabdomyosarcoma is the most common soft tissue sarcoma of infancy and childhood and is relatively common in adolescents. In contrast, smooth muscle tumors are relatively rare, and the various types of rhabdomyoma and smooth and skeletal muscle hamartomas are very uncommon. In recent years, the understanding of the pathologic and genetic aspects of rhabdomyosarcoma has been enhanced by adjunct techniques, such as immunohistochemistry and cytogenetic or molecular genetic analysis. The current classification of rhabdomyosarcoma emphasizes the histologic-prognostic correlations. This article reviews the clinicopathologic features of striated and smooth muscle tumors with an emphasis on the unique aspects of these neoplasms in children and adolescents and the differential diagnosis.
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Affiliation(s)
- David M Parham
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Kriseman ML, Wang WL, Sullinger J, Schmeler KM, Ramirez PT, Herzog CE, Frumovitz M. Rhabdomyosarcoma of the cervix in adult women and younger patients. Gynecol Oncol 2012; 126:351-6. [PMID: 22609112 DOI: 10.1016/j.ygyno.2012.05.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 05/08/2012] [Accepted: 05/09/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Cervical rhabdomyosarcoma is extremely rare, and there is a paucity of literature on the subject. The purpose of this study was to describe the clinical and pathologic features of cervical rhabdomyosarcoma. METHODS We retrospectively reviewed all patients with cervical rhabdomyosarcoma who presented to our institution from 1980 to 2010. We reviewed pathologic, demographic, and clinical information. RESULTS During the study period, 11 females presented with cervical rhabdomyosarcoma. The median age at presentation was 18.4 years, and 6 patients were <19 years old at diagnosis. Vaginal bleeding was the most common presenting symptom, and a vaginal mass was often a co-presenting symptom. Eight patients (73%) presented with stage IB disease, and 8 (73%) presented with the embryonal (botryoid) histologic subtype. Nine patients (82%) received multimodal therapy consisting of surgery with chemotherapy, radiation therapy, or both. All patients were without evidence of disease after completion of primary therapy, but 3 patients experienced local recurrence. At a median follow-up of 23 months, 6 patients (55%) were without evidence of disease, 1 (9%) was alive with disease, 1 (9%) had died of disease, and 3 (27%) had died of other causes. Three patients (27%) had other primary malignancies in addition to rhabdomyosarcoma-1 had a Sertoli-Leydig tumor, 1 had a Sertoli-Leydig tumor and a pinealoblastoma, and 1 had thyroid cancer and a parotid adenocarcinoma. CONCLUSIONS With multimodal therapy, cervical rhabdomyosarcoma appears to be associated with a good prognosis. Favorable prognostic factors such as early stage at diagnosis and a favorable histologic subtype may contribute to the excellent observed survival.
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Affiliation(s)
- Maya L Kriseman
- Department of Obstetrics and Gynecology, Baylor College of Medicine, USA
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Abstract
Children that undergo treatment for cancer are at risk of suffering from subfertility or hormonal dysfunction due to the detrimental effects of radiotherapy and chemotherapeutic agents on the gonads. Cryopreservation of ovarian tissue prior to treatment offers the possibility of restoring gonadal function after resumption of therapy. Effective counseling and management of pediatric patients is crucial for preserving their future reproductive potential. The purpose of this article is to review recent literature and to revise recommendations we made in a 2007 article. Pediatric hemato-oncology, reproductive endocrinology, surgery, anesthesia and bioethics perspectives are discussed and integrated to propose guidelines for offering ovarian cryopreservation to premenarcheal girls with cancer.
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Badalyan V, Burgula S, Schwartz RH. Congenital paraurethral cysts in two newborn girls: differential diagnosis, management strategies, and spontaneous resolution. J Pediatr Adolesc Gynecol 2012; 25:e1-e4. [PMID: 22088318 DOI: 10.1016/j.jpag.2011.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 02/08/2011] [Accepted: 02/15/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND At least five types of interlabial masses of different etiologies may present in a female neonate. The more serious type of interlabial mass must be differentiated from the benign and self-resolving paraurethral or hymenal cyst. Clues include appearance and color of the mass and the location of the mass in relation to the urethral meatus and the vaginal opening. Clinicians should be able to distinguish lesions that require aggressive intervention, i.e. surgery, from those that self-resolve and merely require observation. CASE Two unrelated newborn girls each had a protruding faint-yellow-colored spherical interlabial cyst. The cyst was located anterior to the vaginal orifice and partially obscured the urethral meatus. Neither girl had any voiding problems. No other congenital anomalies were detected. Both cysts resolved rapidly and completely without surgical intervention. SUMMARY AND CONCLUSION Paraurethral cysts of the newborn and hymenal cysts rarely cause urinary obstruction or spotting, and are self-resolving. When positively identified, no evaluation of upper urinary tract is required and neither aspiration of cyst contents or marsupialization procedure is necessary.
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Affiliation(s)
- Vahe Badalyan
- Department of Pediatrics, Inova Fairfax Hospital for Children, Falls Church, Virginia, USA.
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Abstract
Rhabdomyosarcoma (RMS) is a malignant childhood tumor of mesenchymal origin that currently has a greater than 70% overall 5-year survival. Multimodality treatment is determined by risk stratification according to pretreatment stage, postoperative group, histology, and site of the primary tumor. Pretreatment staging is dependent on primary tumor site, size, regional lymph node status, and presence of metastases. Unique to RMS is the concept of postoperative clinical grouping that assesses the completeness of disease resection and takes into account lymph node evaluation. At all tumor sites, the clinical grouping, and therefore completeness of resection, is an independent predictor of outcome. Overall, the prognosis for RMS is dependent on primary tumor site, patient age, completeness of resection, extent of disease, including the presence and number of metastatic sites and histology and biology of the tumor cells. Therefore, the surgeon plays a vital role in RMS by contributing to risk stratification for treatment, local control of the primary tumor, and outcome. The current state-of-the-art treatment is determined by treatment protocols developed by the Soft Tissue Sarcoma Committee of the children's Oncology Group.
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Affiliation(s)
- Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
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48
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Selek U, Selek U, Beyzadeoglu M, Ozyigit G. Pediatric Tumors. Radiat Oncol 2012. [DOI: 10.1007/978-3-642-27988-1_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Sarcoma of vulva, vagina and ovary. Best Pract Res Clin Obstet Gynaecol 2011; 25:797-801. [DOI: 10.1016/j.bpobgyn.2011.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 07/08/2011] [Indexed: 11/19/2022]
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Fernandez-Pineda I, Spunt SL, Parida L, Krasin MJ, Davidoff AM, Rao BN. Vaginal tumors in childhood: the experience of St. Jude Children's Research Hospital. J Pediatr Surg 2011; 46:2071-5. [PMID: 22075335 PMCID: PMC3476720 DOI: 10.1016/j.jpedsurg.2011.05.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 05/06/2011] [Accepted: 05/06/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE The aim of this study was to retrospectively analyze the clinical presentation, histology, treatment, and outcomes of children with vaginal tumors who were treated at a single institution. METHODS A retrospective review of medical records and pathologic materials of all children with vaginal tumors treated at St Jude Children's Research Hospital between 1970 and 2009 was conducted. RESULTS Eighteen patients (median age, 3.7 years; range, 0.1-15 years) were identified. Three different histologies were found: rhabdomyosarcoma (RMS; n = 13), germ cell tumor (n = 3), and clear cell adenocarcinoma (n = 2). Bleeding or blood-tinged discharge was the most common clinical presentation (66%), followed by a protruding mass (39%). Vaginal and uterine salvage was 44.4% (8 of 18 patients). Thirteen patients (72.2%) remain disease-free, with a median follow-up of 23.2 years (range, 2-39 years). Four patients (22.2%) died of disease progression (1 RMS, 2 germ cell tumor, and 1 clear cell adenocarcinoma), and 1 patient with RMS died of colon cancer 12 years after the primary diagnosis had been made. CONCLUSIONS Vaginal tumors are extremely rare in the pediatric population. Early recognition of symptoms like bleeding and a protruding vaginal mass may prevent morbidity and mortality. Our findings confirm the good prognosis of vaginal RMS.
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Affiliation(s)
| | - Sheri L Spunt
- Department of Oncology. St. Jude Children’s Research Hospital, Memphis, TN
| | - Lalit Parida
- Department of Surgery. St. Jude Children’s Research Hospital, Memphis, TN
| | - Matthew J Krasin
- Division of Radiation Oncology, Department of Radiological Sciences, St Jude Children’s Research Hospital, Memphis, TN
| | - Andrew M Davidoff
- Department of Surgery. St. Jude Children’s Research Hospital, Memphis, TN
| | - Bhaskar N Rao
- Department of Surgery. St. Jude Children’s Research Hospital, Memphis, TN
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