Does surgery have a role in the treatment of local relapses of non‐metastatic rhabdomyosarcoma?

Purpose Patients with non‐metastatic rhabdomyosarcoma (RMS) have a cure rate of 50–90%, but up to one‐third of them experience mostly a local recurrence. Second‐line treatment is not standardized as for newly diagnosed tumors. We evaluated the role of surgery on local relapses in a series of patients with RMS. Methods This retrospective analysis involves 70 patients enrolled in two consecutives Italian Studies, RMS88 and RMS96, who presented local recurrence. After relapse, 40/70 underwent a surgical excision (Surgery Group, SG), that was demolitive in 10/40; 24/40 had radiotherapy, 16/40 did not receive radiotherapy or data are not known. Thirty patients out of 70 did not receive any surgical treatment (No‐Surgery Group, NSG), and 20/30 received radiotherapy. Results Overall survival (OS) after local relapse was 41.6% (mean follow‐up 59 months, range 1–226). OS of SG patients was 54% versus 24.7% of the NSG patients ( P  = 0.0117). Furthermore, OS among the SG was 61.4% with and 41.8% without radiotherapy, and 37.1% with and 0% without radiotherapy among the NSG ( P  < 0.0001). One patient developed a second local relapse after excision without radiotherapy for the first one, and was cured with further treatment. Demolitive surgery did not improve survival compared to conservative surgery (40% vs. 58.4%, P  = 0.1462). Conclusion The treatment of recurrent RMS represents a challenge. In our experience, patients with local relapse had a poor prognosis. SG patients had a better outcome than NSG patients and those treated with resection plus radiotherapy had the best outcome; patients who did not receive any local treatment had an unfavorable outcome. Pediatr Blood Cancer 2011; 57: 1261–1265. © 2011 Wiley Periodicals, Inc.