Rhabdomyosarcoma

General Information | Treatment Options | Resources

 

Treatment
  • Overview
  • Standard Treatment
  • Clinical Trials
  • Treatment By Stage

There are different types of treatment for patients with childhood rhabdomyosarcoma.

Different types of treatments are available for children with rhabdomyosarcoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

Children with rhabdomyosarcoma should have their treatment planned by a team of doctors with expertise in treating cancer in children.

Because rhabdomyosarcoma can form in many different parts of the body, many different kinds of treatments are used. Your child's care will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other health care professionals who are experts in treating children. These may include the following specialists:

  • Pediatric surgeon.
  • Radiation oncologist.
  • Pediatric hematologist.
  • Pediatric nurse specialist.
  • Geneticist or cancer genetics risk counselor.
  • Social worker.
  • Rehabilitation specialist.
  • Psychologist.

Some cancer treatments cause side effects months or years after treatment has ended.

Some cancer treatments cause side effects that continue or appear months or years after cancer treatment has ended. These are called late effects. Late effects of cancer treatment for rhabdomyosarcoma may include:

  • Physical problems.
  • Changes in mood, feelings, thinking, learning, or memory.
  • Second cancers (new types of cancer).

Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.)

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Three types of standard treatment are used:

Surgery

Surgery (removing the cancer in an operation) is used to treat childhood rhabdomyosarcoma. Surgery is usually wide local excision, which is removal of the tumor and some of the normal tissue around it, including lymph nodes. When an extra amount of normal tissue is removed from around the tumor, it is called an en bloc removal of a cuff of normal tissue. A second surgery may be needed to remove all the cancer. Whether surgery is done and the type of surgery done depends on the following:

  • Where in the body the tumor started.
  • The effect the surgery will have on the child's appearance.
  • The effect the surgery will have on the child's important body functions.
  • How the tumor responded to chemotherapy or radiation therapy that may have been given first.

Rhabdomyosarcoma can form in many different places in the body and the surgery will be different for each site. Surgery to treat rhabdomyosarcoma of the eye or genital areas is usually a biopsy. Chemotherapy or radiation therapy may be given before surgery to shrink large tumors.

For most children with rhabdomyosarcoma, complete removal of the tumor by surgery is not possible. Even if the doctor removes all the cancer that can be seen at the time of the surgery, patients will be given chemotherapy, with or without radiation therapy, after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or stop them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. The type and amount of radiation therapy and when it is given depend on where in the body the tumor started, how much tumor remained after surgery, and the age of the child.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

High-dose chemotherapy with stem cell transplant

High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.

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.

Previously Untreated Childhood Rhabdomyosarcoma

Surgery options

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.

Chemotherapy options

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 options

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 uses a computer to create a 3-dimensional picture of the tumor. The radiation beams are shaped to fit the tumor.
  • Intensity-modulated radiation therapy (IMRT) uses images created by a computer that show the size and shape of the tumor. Thin beams of radiation of different intensities are aimed at the tumor from many angles.
  • Proton-beam therapy is a type of high-energy, external radiation therapy that uses streams of protons (small, positively-charged particles of matter) to produce radiation.
  • 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.

Recurrent 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.

 

 

Cancer information from the NCI PDQ service