Treatment Options for Childhood Rhabdomyosarcoma

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 not near the brain and spinal cord 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 done, 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 are removed. For tumors in the legs, lymph nodes near the tumor and in the groin area are 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, including the retroperitoneum and pelvis: Chemotherapy, and sometimes radiation therapy, is given to shrink the tumor first, followed by surgery (wide local excision). The surgery is done to remove as much of the remaining tumor as is safely possible.
• For tumors of the gallbladder or bile ducts: Surgery is done to remove as much of the tumor as is safely possible, followed by chemotherapy.
• 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 is safely possible and some nearby lymph nodes, 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 a biopsy of the lymph nodes in the back of the abdomen is done, especially if the lymph nodes are enlarged or 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 bladder and prostate

• 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 and vulva is usually treated with chemotherapy and radiation therapy.
• Rhabdomyosarcoma of the uterus is usually treated with chemotherapy and radiation therapy. Sometimes surgery may be needed to remove any remaining cancer cells.

Rhabdomyosarcoma in unusual areas

• For tumors of the brain: Surgery to remove the tumor followed by radiation therapy and chemotherapy.
• 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 is not harmed.
• 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 kidney: Surgery is done to remove as much of the tumor as is safely possible.
• For tumors of the ovary: Combination chemotherapy may be followed by surgery to remove the remaining tumor.

Metastatic rhabdomyosarcoma

• Metastatic rhabdomyosarcoma is not usually treated with surgery other than a biopsy for diagnosis.

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.

Intermediate-risk patients

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

High-risk patients

• Combination chemotherapy.
• A clinical trial of new combinations of anticancer drugs, with and without targeted therapy (monoclonal antibody).
• A clinical trial of immunotherapy.

Radiation therapy may be used if childhood rhabdomyosarcoma tumor cells remain after surgery, after chemotherapy, or if the tumor is of 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 (internal radiation therapy) for cancer in areas such as the vagina, vulva, bladder, prostate, head, or neck.
• A clinical trial of second-look surgery after chemotherapy is given to decrease the amount of radiation therapy that will be needed.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with previously untreated childhood rhabdomyosarcoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

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 targeted therapy.
• 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 list of cancer clinical trials that are now accepting patients with recurrent childhood rhabdomyosarcoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.