Treatment results of Para-Testicular Rhabdomyosarcoma (PT-RMS) using radiation as an alternative to retro-peritoneal nodal dissection: A single Institution experience


Submitted: August 5, 2023
Accepted: August 31, 2023
Published: November 15, 2023
Abstract Views: 797
PDF: 256
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Background: Para-testicular Rhabdomyosarcoma (PT-RMS) has a favorable treatment outcome adopting multidisciplinary management; resection, namely high inguinal orchiectomy ± retro-peritoneal lymph node dissection (RPLND) followed by standard or intensive chemotherapy ± adjuvant radiation therapy. Patients and methods: This is a retrospective study including all patients with pathologically proven PT-RMS, presented to the National Cancer Institute, Cairo University, during the period from 2005 to 2020. Endpoints included overall survival, disease free survival and patterns of failure of different treatment modalities. Results: Forty one patients were identified. Median age in our cohort was 15 years (range: 2-54 years). After a median follow up of 26 months (range, 3-75 months) ,two and five years OS were 100% and 91.7% respectively and median survival was not reached. Patients who underwent retro-peritoneal nodal dissection had a 5-year DFS rate of 100% versus 73% for those who received radiation to para-aortic nodes (p = 0.185). Limitations include retrospective nature and deviation from COG protocol. Conclusions: This study shows promising results suggesting that less aggressive local treatment modalities including radiation to para-aortic chain could be an option in PT-RMS, given the excellent results of this subtype. However further validation in a prospective study is warranted.


Stewart LH, Lioe TF, Johnston SR. Thirty-year review of intrascrotal rhabdomyosarcoma. Br J Urol. 1991; 68:418-20. DOI: https://doi.org/10.1111/j.1464-410X.1991.tb15364.x

Raney RB Jr, Tefft M, Lawrence W Jr, et al. Paratesticular sarcoma in childhood and adolescence. A report from the Intergroup Rhabdomyosarcoma Studies I and II, 1973-1983. Cancer. 1987; 60:2337-43. DOI: https://doi.org/10.1002/1097-0142(19871101)60:9<2337::AID-CNCR2820600937>3.0.CO;2-3

Raney RB, Walterhouse DO, Meza JL, et al. Results of the Intergroup Rhabdomyosarcoma Study Group D9602 protocol, using vincristine and dactinomycin with or without cyclophosphamide and radiation therapy, for newly diagnosed patients with low-risk embryonal rhabdomyosarcoma: a report from the Soft Tissue Sarcoma Committee of the Children’s Oncology Group. J Clin Oncol. 2011; 29:1312-1318. DOI: https://doi.org/10.1200/JCO.2010.30.4469

Rogers TN, Seitz G, Fuchs J, et al. Surgical management of paratesticular rhabdomyosarcoma: A consensus opinion from the Children's Oncology Group, European pediatric Soft tissue sarcoma Study Group, and the Cooperative Weichteilsarkom Studiengruppe. Pediatr Blood Cancer. 2021; 68:e28938. DOI: https://doi.org/10.1002/pbc.28938

Crane JN, Xue W, Qumseya A, et al. Clinical group and modified TNM stage for rhabdomyosarcoma: A review from the Children's Oncology Group. Pediatr Blood Cancer. 2022; 69:e29644. DOI: https://doi.org/10.1002/pbc.29644

Crist WM, Anderson JR, Meza JL, et al. Intergroup rhabdomyosarcoma study-IV: Results for patients with nonmetastatic disease. J Clin Oncol. 2001; 19:3091-3102. DOI: https://doi.org/10.1200/JCO.2001.19.12.3091

Kumar R, Kapoor R, Khosla D, et al. Paratesticular rhabdomyosarcoma in young adults: A tertiary care institute experience. Indian J Urol. 2013; 29:110-3. DOI: https://doi.org/10.4103/0970-1591.114030

Rogers TN, De Corti F, Burrieza GG, et al. Paratesticular rhabdomyosarcoma— impact of locoregional approach on patient outcome: a report from the European paediatric Soft tissue sarcoma Study Group (EpSSG). Pediatr Blood Cancer. 2020; 67:e28479. DOI: https://doi.org/10.1002/pbc.28479

Heidenreich A, Albers P, Hartmann M, et al. Complications of primary nerve sparing retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumors of the testis: experience of the German Testicular Cancer Study Group. J Urol. 2003; 169:1710-1714. DOI: https://doi.org/10.1097/01.ju.0000060960.18092.54

Beck SD, Bey AL, Bihrle R, Foster RS. Ejaculatory status and fertility rates after primary retroperitoneal lymph node dissection. J Urol. 2010; 184:2078-2080. DOI: https://doi.org/10.1016/j.juro.2010.06.146

Steiner H, Zangerl F, Stöhr B, et al. Results of bilateral nerve sparing laparoscopic retroperitoneal lymph node dissection for testicular cancer. J Urol. 2008; 180:1348-1353. DOI: https://doi.org/10.1016/j.juro.2008.06.040

Gupta AA, Anderson JR, Pappo AS, et al. Patterns of chemotherapy- induced toxicities in younger children and adolescents with rhabdomyosarcoma: a report from the children's oncology group soft tissue sarcoma committee. Cancer. 2012;118:1130-1137. DOI: https://doi.org/10.1002/cncr.26358

LaQuaglia MP, Ghavimi F, Heller G, et al. Mortality in pediatric paratesticular rhabdomyosarcoma: a multivariate analysis. J Urol. 1989; 142:473-478. DOI: https://doi.org/10.1016/S0022-5347(17)38788-8

Lawrence W Jr, Gehan EA, Hays DM, et al. Prognostic significance of staging factors of the UICC staging system in childhood rhabdomyosarcoma: a report from the Intergroup Rhabdomyosarcoma Study (IRS II). J Clin Oncol. 1987; 5:46. DOI: https://doi.org/10.1200/JCO.1987.5.1.46

Stevens MC, Rey A, Bouvet N, et al. Treatment of nonmetastatic rhabdomyosarcoma in childhood and adolescence: third study of the International Society of Paediatric Oncology–SIOP Malignant Mesenchymal Tumor 89. J Clin Oncol. 2005; 23:2618-2628. DOI: https://doi.org/10.1200/JCO.2005.08.130

Abdelazim, Y. A., Zaki, M. F., Abdel Mohsen, M. M., Emad, R. M., Mohamad, H. G., Abdelfatah, D., & Kalil, E. M. (2023). Treatment results of Para-Testicular Rhabdomyosarcoma (PT-RMS) using radiation as an alternative to retro-peritoneal nodal dissection: A single Institution experience. Archivio Italiano Di Urologia E Andrologia, 95(4). https://doi.org/10.4081/aiua.2023.11642

Downloads

Download data is not yet available.

Citations