What is the role of radiation therapy in the treatment of pediatric rhabdomyosarcoma (RMS)?

Updated: Mar 28, 2019
  • Author: Roshni Dasgupta, MD, MPH; Chief Editor: Eugene S Kim, MD, FACS, FAAP  more...
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RT is administered to patients who are at increased risk for local tumor recurrence. It is used in almost all RMS patients (except clinical group I embryonal RMS [ERMS]) to improve local control and outcome. Candidates for RT primarily include patients with group I alveolar RMS (ARMS; 36 Gy), group II RMS (41.4 Gy), or group III RMS (50.4 Gy).

The impact of therapy is determined by the location of the primary and the degree of residual disease remaining after surgical resection when RT is initiated [31] . RT dosing can be adjusted on the basis of either the completeness of resection before chemotherapy (clinical grouping) or the completeness of a delayed primary excision after adjuvant chemotherapy. RT in very young children with RMS poses a unique therapeutic challenge because of concerns about long-term toxicity. [9]

Outcomes and local control are worse for for infants than for older children because the former are frequently undertreated. Intensity-modulated RT (IMRT) and proton-beam RT can help reduce the total dose and decrease late effects. [32, 33]

Patients with group II disease (microscopic residual disease) have a high risk of local recurrence if prescribed RT is omitted or reduced. Million et al noted that more than half of the patients who experienced relapse at the original tumor site received nonstandard RT and that three quarters of these patients died of their disease. [34]

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