Previously Untreated Childhood Rhabdomyosarcoma
        Surgery options
        Chemotherapy options
        Radiation therapy options
Recurrent Childhood Rhabdomyosarcoma

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Childhood rhabdomyosarcoma may be treated with chemotherapy and/or radiation therapy before or after surgery. Treatment with surgery may include the following:

Rhabdomyosarcoma of the head and neck

• For tumors of the head and neck that are close to the skin and not in or near the eye: Treatment may include surgery (wide local excision). Some lymph nodes may be removed from the same side of the neck as the tumor. Surgery will be followed by chemotherapy with or without radiation therapy.
• For tumors of the head and neck that are in or near the eye: A biopsy of the tumor is followed by chemotherapy and radiation therapy. If the tumor remains or comes back after treatment with chemotherapy and radiation therapy, surgery to remove the eye and some tissues around the eye may be needed.
• For tumors of the head and neck that cannot be removed by surgery: Chemotherapy and radiation therapy are given.

Rhabdomyosarcoma of the arms or legs

• For tumors of the arms or legs: Surgery (wide local excision and en bloc removal of a cuff of normal tissue) may be done. For tumors in the arms, lymph nodes near the tumor and in the armpit area may be removed. For tumors in the legs, lymph nodes near the tumor and in the groin area may be removed. A second surgery may be done to remove any remaining tumor cells.

Rhabdomyosarcoma of the chest or abdomen

• For tumors in the chest wall or abdominal wall: Surgery (wide local excision) may be done. A second surgery may be done to remove any remaining tumor cells.
• For tumors of the chest or abdomen: Surgery alone or chemotherapy and radiation therapy, followed by surgery to remove the tumor.
• For large tumors of the chest or abdomen: Chemotherapy and/or radiation therapy is given to shrink the tumor first, followed by surgery (wide local excision) to remove the remaining tumor.
• For tumors of the muscles or tissues around the anus or between the vulva and the anus or the scrotum and the anus: Surgery is done to remove as much of the tumor as possible and some nearby lymph nodes, followed by chemotherapy.
• For tumors of the gallbladder or bile ducts: Surgery is done to remove as much of the tumor as possible, followed by chemotherapy.

Rhabdomyosarcoma of the area near the testicles

• Rhabdomyosarcoma of the testicular area is usually treated with surgery to remove the testicle and spermatic cord. Sometimes the lymph nodes in the back of the abdomen are removed, especially if the child is older than 9 years. CT scans may be done every 3 months after surgery to see if the cancer is growing in nearby lymph nodes.

Rhabdomyosarcoma of the prostate or bladder

• For tumors that are only at the top of the bladder: Surgery (wide local excision) is done.
• For tumors of the prostate or other parts of the bladder: Chemotherapy and radiation therapy are given first to shrink the tumor. A biopsy is done and if cancer cells remain, surgery to remove the tumor is done. Surgery may include removal of the prostate, part of the bladder, or pelvic exenteration without removal of the rectum. (This may include removal of the lower colon and bladder. In girls, the cervix, vagina, ovaries, and nearby lymph nodes may be removed).

Rhabdomyosarcoma of the vagina, vulva, or uterus

• Rhabdomyosarcoma of the vagina, vulva, or uterus is usually treated with a biopsy followed by chemotherapy.
• For tumors of the vagina, vulva, or uterus: Chemotherapy is given first to shrink the tumor, followed by surgery. Radiation therapy may be given after surgery.

Rhabdomyosarcoma in unusual areas

• For tumors of the diaphragm: A biopsy of the tumor is followed by chemotherapy to shrink the tumor. Surgery may be done later to remove any remaining cancer cells.
• For tumors of the larynx (voice box): A biopsy of the tumor is followed by chemotherapy and radiation therapy. Surgery is usually not done, so that the voice can be saved.

Metastatic rhabdomyosarcoma

• Metastatic rhabdomyosarcoma is not usually treated with surgery. However, if the cancer has spread to the lungs, chemotherapy and radiation therapy are given to shrink the tumor, followed by surgery to remove any remaining cancer cells in the lung.

Every child treated for rhabdomyosarcoma should receive chemotherapy. The dose of the chemotherapy and the number of treatments given depend on the child's risk group, as follows:

Low-risk patients

• Combination chemotherapy, with or without radiation therapy.
• A clinical trial of different doses and schedules of combination chemotherapy, with or without radiation therapy.

Intermediate-risk patients

• Combination chemotherapy.
• A clinical trial of combination chemotherapy with radiation therapy.

High-risk patients

• Combination chemotherapy.
• A clinical trial of different doses and schedules of combination chemotherapy, with or without radiation therapy.
• A clinical trial of high-dose chemotherapy with stem cell transplant for high-risk childhood rhabdomyosarcoma.
• A clinical trial of anticancer drugs taken by mouth.

Radiation therapy may be used if childhood rhabdomyosarcoma tumor cells remain after surgery, after chemotherapy, or if the tumor is the alveolar type.

Treatment may include certain kinds of radiation therapy that cause less damage to normal tissue and lessen late effects of treatment. These include:

• Conformal radiation therapy.
• Intensity-modulated radiation therapy.
• Fractionated stereotactic radiation therapy.
• Proton-beam therapy.
• A clinical trial of brachytherapy (also called internal radiation therapy) for cancer in areas such as the vagina, vulva, head, or neck.
• A clinical trial of second-look surgery after chemotherapy to reduce the need for radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with previously untreated childhood rhabdomyosarcoma.

Treatment options for recurrent childhood rhabdomyosarcoma are based on many factors, including where in the body the cancer has come back, what type of treatment the patient had before, and the needs of the individual child. Treatment may include one or more of the following:

• Chemotherapy with one or more anticancer agents.
• Surgery.
• Radiation therapy.
• A clinical trial of different schedules and combinations of chemotherapy.
• A clinical trial of new chemotherapy regimens.
• A clinical trial of new anticancer drugs.
• A clinical trial of high-dose chemotherapy followed by stem cell transplant using the patient's own stem cells.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent childhood rhabdomyosarcoma.

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