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Acute and late effects on normal tissues following combined chemo- and radiotherapy for childhood rhabdomyosarcoma and Ewing's sarcoma.

Twenty-three patients with rhabdomyosarcoma and 15 patients with Ewing's sarcoma, treated with radiation therapy to the local site and systemic multiagent chemotherapy are described. Acute reactions from combination chemotherapy and radiation therapy were noted in both groups of patients. These reactions often appeared after low doses of irradiation, required unplanned interruptions of treatments, and in some patients, led to discontinuation of radiation therapy. The chronic effects on normal tissues in both groups of patients have been severe in several cases.

Antineoplastic Agents↗

Perianal rhabdomyosarcoma in childhood.

The case of a child with a stage I perianal embryonal botryoid rhabdomyosarcoma is presented, with description of coordinated management utilizing local excision, irradiation, and cyclic chemotherapy resulting in a 3-year tumor-free survival. Previously reported pediatric cases are summarized.

Anal Canal↗

Rhabdomyosarcoma of lung arising in congenital cystic adenomatoid malformation.

An asymptomatic congenital cystic adenomatoid malformation of lung discovered at age 18 months, and unchanging for 14 months prior to its removal, was found to harbor a small embryonal rhabdomyosarcoma following excision. With lobectomy and chemotherapy, the tumor-free interval has now exceeded three years. The case represents a well-documented occurrence of malignant tumor arising within a congenital malformation, an association that is unlikely to be the result of chance.

Female↗

Embryonal rhabdomyosarcoma of the ampulla of vater.

The first case to appear in the world literature is described of an embryonal rhabdomyosarcoma in a child arising from the region of the ampulla of Vater and projecting into the lumen of the duodenum.

Ampulla of Vater↗

Extraskeletal Ewing's sarcoma: a preliminary review of 26 cases encountered in the Intergroup Rhabdomyosarcoma Study.

Twenty-six of three hundred and fourteen (26/314) patients whose tumors were reviewed by the Pathology Evaluation Committee of the Intergroup Rhabdomyosarcoma Study have histologic subtypes I and II which have morphologic characteristics similar to Ewing's sarcoma of bone. They are somewhat more common in an extremity lesion but have no relation to patient age. Disease-free survival is good; seventeen of twenty-six (17/26) or sixty-five (65%) percent thus far.

Child↗

Ultrastructural investigation of NI3S2-induced rhabdomyosarcoma in Wistar rat: comparative study with emphasis on myofibrillar differentiation and ciliar formation.

Nickel-sulfid-induced rhabdomyosarcomas were studied by both light and electron microscopy. The successive stages differentiating tumor cells were described, and two differentiation types of rhabdomyoblasts could be observed 1) with the characteristic pattern of fetal differentiation--i.e., myofilament apparation before Z-line formation--and 2) with synthesis of these elements in the reverse order. An organized T-system is not evident. The sarcoplasmic reticulum is irregular and its cisternae often contain a granular substance or microcrystals. The only well-developed element of tumoral myofibrils is the Z-line; the other zones of sarcomeres are seldom clearly defined. Several unusual granular structures were observed. No virus particles were found. The formation of cilia appears only in interphase rhabdomyoblasts and has to be considered as aberrant and temporary formations from centrioles. They generally possess a "9 + 0" microtubular pattern, but often could be observed as rudimentary forms with a "7 + 2" microtubular arrangement. This case is another example demonstrating the relationship of cilia formation with cell division, especially after suppression of mitotic control. The histology and the electron microscopy results are discussed in relation to the differentiation pattern and the ultrastructural features of embryonic, regenerating and pathological muscle differentiating in vitro.

Animals↗

Rhabdomyosarcoma of the kidney in children.

Among 227 consecutive renal tumors examined from the Hospital de Niños de Buenos Aires, seven examples of a distinctive clinicopathological entity occurred. These renal neoplasms were all unilateral, grossly infiltrative without a definitive capsule. Microscopically, the lesion was characterized by a sarcomatous pattern with a rhabdomyoblastic differentiation. Four of them had regional lymph node involvement at surgery. Four developed bone metastases and none had lung metastases. In three instances, the bone metastases were histologically similar to the original neoplasm. The age of the patients ranged from 11 months to 5 1/2 years. A male predominance was observed. Two patients died; one is alive 5 years after surgery; three are alive with metastases; one has been followed for less than a year. In this study, it is proposed that another group of tumors be removed from the Wilms' tumor classification. The neoplasm has been described previously in the literature under several names. It is not clearly related clinicopathologically to nephroblastoma. The term rhabdomyosarcoma is proposed in view of its entirely different biological behavior.

Bone Neoplasms↗

Computerized tomography in rhabdomyosarcoma of the head and neck.

Rhabdomyosarcoma of the head and neck may be treated with surgery, radiotherapy and chemotherapy or a combination thereof. Precise delineation of the full extent of the tumor in the head and neck is essential. Routine radiographs with hypocycloidal tomography and CT are complementary in defining the full extent of the lesion. Tomography is superior to CT scanning in demonstrating fine bone detail. Demonstration of the soft tissue tumor and its extensions is better seen on CT. The ability to discriminate differences more accurately in densities allows computerized tomography to appreciate better the integrity of the bone margins such as the thin walls of the sinuses.

Adolescent↗

Breast metastases in children with rhabdomyosarcoma.

Of 108 consecutively diagnosed patients with rhabdomyosarcoma, seven subsequently developed clinically evident metastatic tumors of the breast. These patients were unusual in that all had primary tumors located on an extremity or the buttock, and six of the seven tumors had alveolar histology. Sex distribution and age of the patients indicated that the physiologic state of the breast was an important determining factor in the development of such metastases.

Adolescent↗

Parameningeal rhabdomyosarcoma in the young.

Forty cases of young patients with embryonal rhabdomyosarcoma or undifferentiated sarcoma in parameningeal sites of the head and neck were reviewed. All 40 were treated with radiation therapy in conjunction with surgery and 16 were also treated with adjuvant chemotherapy. The overall five year survival rate was 35%. A primary tumor dose of at least 5000 rad resulted in a significantly greater survival rate compared with lesser doses. Meningeal involvement at diagnosis was present in 20 patients (50%) and the 30% five year survival rate for this group was no different than that for patients without initial meningeal involvement (41%). At first or second relapse, meningeal involvement was present in six of 37 patients and in two patients this occurred as an isolated event with distant meningeal seeding; in four other patients, meningeal involvement was a manifestation of local recurrence. As of the time of the last follow-up examination, control of the primary tumor had been achieved in 22 of the 40 (55%). It is considered that primary tumor radiation treatment parameters may be critical in determining the incidence of subsequent meningeal relapse.

Adolescent↗

Soft-tissue sarcoma of the trunk in childhood. Results of the intergroup rhabdomyosarcoma study.

Disease-free survival data were obtained on 30 children with soft-tissue sarcoma of the trunk. The children were clinically grouped and treated in accord with the IRS protocol (Cancer 1977; 40:2015) from November 1972 through December 1976. Histologically, 40% of the tumors were alveolar rhabdomyosarcoma (RMS), 20% were embryonal RMS, 20% were extraosseous Ewing's sarcoma, 17% were undifferentiated sarcoma, and 3% were pleomorphic RMS. In 13 patients with primary tumors of the chest wall, the male-to-female (M:F) ratio was 3:11, and the median age was 12.5 yr. Five of the ten patients (50%) with localized tumor (Groups I-III) were disease-free at a median of 4.7 yrs. after diagnosis; two died of locally recurrent tumor, two died of metastases to lungs or bones, and 1 died of intracranial hemorrhage. None of the four with chest wall tumors and distant metastases (Group IV) survived. In ten patients with localized paraspinal primary tumors, the M:F ratio was 8:2, and the median age was 3.5 yrs. None had metastases. Seven of ten (70%) were disease-free at a median of 4.7 yrs. after diagnosis. Two died after regional recurrence developed (one retroperitoneal, one meningeal), and one died of lung metastases. In six patients with primary tumors of the abdominal wall, the M:F ratio was 3:3 and the median age was 9.5 yrs. Three of five with localized tumor (Groups I-III) were disease-free at a median of 5 yr. after diagnosis; one died after regional recurrence, and one died from accidental trauma. The one Group IV patient died of tumor. Overall, 15 of 30 patients (50%) are alive and free of recurrent disease at a median of 5+ yr. after initiation of treatment. The authors conclude that prognosis is most favorable for patients with paraspinal tumors, least favorable for those with chest wall tumors, and intermediate in patients with abdominal wall tumors. Prognostic differences appeared to be influenced by extent of disease at diagnosis and histologic subtype of the sarcoma.

Abdominal Neoplasms↗

Bladder and prostatic tumors in the intergroup Rhabdomyosarcoma study (IRS-I): results of therapy.

Sixty-four children with primary rhabdomyosarcoma of the bladder or prostate were enrolled in the IRS during the initial five years (October 1972-November 1977). Observation of these patients for from 2 1/2-8 years forms the basis of this report. The chemotherapy-radiotherapy regimens employed (IRS) for each Clinical Group were: (1) Group I (completely excised tumor), sequential actinomycin-D (ACD), vincristine (VCN), and cyclophosphamide (CYP), i.e., standard (VAC), with or without radiotherapy (RT); (2) Group II (resected local disease with node involvement, "microscopic" residual, or local extension), RT plus sequential ACD and VCN, or RT plus standard VAC; (3) Group III, (gross residual disease); and (4) Group IV (dissemination), RT and either pulse VAC or pulse VAC plus Adriamycin (ADR). Pulse VAC consisted of VCN (day 1), plus daily intravenous ACD and CYP (days 1-5). Relapse rates were: Group I, 0/8; Group II, 6/23; and the mortality in Group III, 6/23; and in Group IV, 7/10. Among patients with bladder tumors, the rate of relapse was 2/11 following pelvic exenteration (anterior, 10; total 1); 5/12 following partial cystectomy or gross tumor excision; and 3/5 following a primary chemotherapy-radiotherapy (PCR) regimen. In patients with prostatic tumors (Groups I-III), relapse occurred in 0/14 patients treated initially by pelvic exenteration (anterior, 12; total, 2); and in 2/11 patients treated by a PCR regimen.

Adolescent↗

Embryonal rhabdomyosarcoma in adults.

A series of 54 cases of embryonal rhabdomyosarcomas in adults were studied. The neoplasms were classified according to anatomic site, size, histologic pattern, age, and sex of the patients and modality of treatment. The major anatomic sites were the extremities (21 cases), genitourinary organs (13 cases) and the trunk (nine cases). The overall five-year survival rate was 21% but 79% of the patients were dead at an average time of 17 months after the primary diagnosis was made. On the other hand, 80% of the patients with Stage II disease (tumor size less than 5 cm) survived five years. In general, patients who were treated with surgery only or surgery and radiation or chemotherapy did much better than patients treated with chemotherapy and/or radiation therapy only. When the rate of recurrences, metastasis and time of death due to spread of neoplasm was compared in cases diagnosed between 1950-1969 and 1970-1978, patients in the last nine years had fewer recurrences, less metastases and better survival than those who had their neoplasm diagnosed and treated between 1950 and 1969.

Adult↗

Immunohistochemical and electron microscopic assessment of childhood rhabdomyosarcoma. Increased frequency of diagnosis over routine histologic methods.

Histologic examination was carried out in 65 cases of childhood rhabdomyosarcoma (RMS), 53 embryonal, and 12 alveolar. Cross-striations were seen on light microscopy in 12 (23%) embryonal and 4 (33%) alveolar tumors. The capacity of immunohistochemical staining (PAP technique) to increase diagnostic accuracy was assessed, using antibodies against myoglobin, the MM isoenzyme of creatine kinase, desmin, calcium magnesium-dependent ATPase of sarcoplasmic reticulum and calsequestrin. Myoglobin was detected in 16 (30%) embryonal and eight (67%) alveolar RMS, higher numbers than obtained by viewing cross-striations on light microscopy. The creatine kinase antibody was slightly better than the antibody to myoglobin and 15 of 25 (60%) embryonal RMS were positive when both specificities were used. The remaining three antibodies were less useful. Of 13 (two alveolar and 11 embryonal) RMS studied by electron microscopy, four showed cross-striations, contained late myoblasts, and were positive for myoglobin. Three additional cases showed only late myoblasts and one of these was positive for myoglobin. Thus, 16 of 25 (64%) of the embryonal and seven of nine (78%) of the alveolar RMS showed either positive immunostaining or ultrastructural features of RMS. This study indicates that a combination of immunohistochemical staining, using antimyoglobin and anticreatine kinase (MM isoenzyme) antibodies, and electron microscopy are useful markers in the diagnosis of childhood RMS.

Ca(2+) Mg(2+)-ATPase↗

Ovarian rhabdomyosarcoma presenting as leukemia. Case report.

A condition of pure ovarian rhabdomyosarcoma in a 16-year-old female is described. The tumor presented with a leukemia-like picture, with extensive peripheral blood and bone marrow involvement which led to an initial diagnosis of acute lymphoblastic leukemia. The diagnosis was achieved at autopsy and was supported by ultrastructural findings of Z-band-like material and alternating thin and thick filaments.

Adolescent↗

Pulmonary rhabdomyosarcoma with isolated small bowel metastasis. A report of a case with immunohistochemical and ultrastructural studies.

A unique case of pulmonary rhabdomyosarcoma with an isolated, symptomatic small bowel metastasis is presented. The tumor affected the middle lobe, and was treated with a right pneumonectomy. Eleven months after the operation, an isolated small bowel metastasis, which produced intestinal obstruction, was resected. The patient is currently alive, 11 months after operation. The myogenous nature of the tumor was confirmed by the immunohistochemical demonstration of myoglobin in the pulmonary and enteric lesion by the ultrastructural findings of poorly developed sarcomeres.

Adult↗

The improvement in survival associated with combined chemotherapy in childhood rhabdomyosarcoma. A historical comparison of 345 patients in the same center.

Since no randomized trial with a control group without chemotherapy is ethically possible in rhabdomyosarcoma patients in view of the first results of chemotherapy in this disease, the authors report the results of an historical comparison of 345 patients treated with or without combined chemotherapy. The results confirm the overall improvement of survival rates with combined chemotherapy. The greatest benefit from combined chemotherapy was observed in clinical Stage III and IV tumors of the head and neck (with the exception of orbital tumors) and of the genitourinary tract. The efficacy of combined chemotherapy is uncertain for other clinical stages and for limb tumors.

Antineoplastic Combined Chemotherapy Protocols↗