Clinical outcomes of adult and childhood rhabdomyosarcoma treated with vincristine, d-actinomycin, and cyclophosphamide chemotherapy

Clinicopathological and treatment response characteristics of updated rhabdomyosarcoma histomolecular subtypes: An Asian population-based study

AIM

New histomolecular subtypes of rhabdomyosarcoma have recently been defined but their corresponding clinical characteristics are not well described. Also, these clinical phenotypes vary greatly by age and ethnicity but have not been profiled in Asian populations. Thus, we sought to determine the landscape of rhabdomyosarcoma subtypes in a national Asian cohort and compare clinical characteristics among age groups and molecular subtypes.

METHODS

We performed a retrospective population-based study of all rhabdomyosarcoma patients in Singapore public hospitals from 2004 to 2014 (n = 67), and assigned histomolecular subtypes according to the updated 2020 WHO classification of soft tissue tumors following central pathology review and molecular profiling.

RESULTS

Age-specific prevalence followed a tri-modal peak. There were significantly more embryonal and alveolar (p = 0.032) and genitourinary (non-bladder/prostate) tumors (p = 0.033) among children. Older age was associated with complete resection among spindle cell/sclerosing tumors (p = 0.027), with the omission of chemotherapy among embryonal tumors (p = 0.001), and with poorer survival among embryonal and alveolar tumors (p = 0.026, p = 0.022, respectively). Overall survival differed with stage, group, and surgical resection, adjusted for age group (p = 0.004, p = 0.001, p = 0.004, respectively). Spindle-cell/sclerosing tumors showed an indolent phenotype with a significantly lower incidence of nodal metastasis (p = 0.002), but two of 15 patients with MYOD1 mutations had a contrastingly aggressive disease.

CONCLUSION

Disease and treatment response profiles of rhabdomyosarcoma subtypes vary significantly between adults and children, especially surgical resectability. In our Asian population, poorer outcomes were observed in adults with embryonal and alveolar tumors, while activating mutations influence the behavior of otherwise favorable spindle cell/sclerosing tumors.

A rare case of metastatic prostatic rhabdomyosarcoma in a young adult: Clinical challenges and therapeutic perspectives

Embryonal rhabdomyosarcoma of the prostate in adults is rare and often diagnosed at an advanced stage, with metastases. We report the case of a 23-year-old young adult presenting with low back pain and dysuria, whose imaging revealed a voluminous metastatic prostate mass. Biopsy confirmed embryonal rhabdomyosarcoma. Treatment was initiated with chemotherapy, resulting in significant regression of the tumour mass and metastases after 3 courses. Pediatric advances suggest improved survival with a multimodal approach, but its efficacy in adults requires further investigation.

18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and 68Ga-prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Imaging in the Evaluation of Rare Entity Adult Embryonal Rhabdomyosarcoma of Prostate

A 21-year-old male with embryonal rhabdomyosarcoma of the prostate was referred for 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and 68Ga-prostate-specific membrane antigen (PSMA) PET/CT for initial disease staging. The PET scans revealed hypermetabolic and PSMA expressing lobulated mass involving both lobes of the prostate and weakly metabolic and PSMA expressing few bilateral pararectal and external iliac nodes, multiple bilateral lung nodules scattered over the lung parenchyma and multiple bone marrow lesions in both axial and appendicular skeleton. Magnetic resonance imaging prostate showed gross prostatomegaly with large lobulated T2 hyperintense heterogeneously enhancing mass lesion showing restricted diffusion, involving both lobes of the prostate with extraprostatic spread along anterior, posterior, and left lateral margins with evidence of lymph nodal and osseous metastases. The demonstration of increased uptake of 18F-FDG and 68Ga-PSMA in the primary as well as bilateral pararectal and external iliac nodes, multiple bilateral lung nodules, and multiple bone marrow lesions in both axial and appendicular skeleton indicates a potential role of 18F-FDG PET/CT and 68Ga-PSMA PET/CT in disease staging in this rare aggressive tumor of the prostate.

Embryonal rhabdomyosarcoma of the prostate in a young male: A rare case report

INTRODUCTION AND IMPORTANCE

Embryonal rhabdomyosarcoma (ERMS) of the prostate is a rare disease, and it has a poor prognosis. Mostly patient come with late stage thus with delayed diagnosis and worse outcomes.

CASE PRESENTATION

a 35-year-old Bangladeshi male presented with bladder outlet obstruction in an intermittent pattern. Patient was not complaining from any other urological symptoms, there was no hematuria or dysuria, even no constitutional symptoms, no history of weight loss, no anorexia or night rigors, also there was no history of fever. Patients have an only previous history of spinal screw without any other medical illnesses. Patient came to casualty with frequent visits without any inflammatory markers elevation even with normal biochemical labs. O/E he found to have a prostatic mass on PR examination of which patient admitted to urology department and underwent diagnostic cystoscopy which showed cauliflower mass at the prostatic urethra. Biopsies retrieved and showed embryonal rhabdomyosarcoma (RMS) of the prostate under the histopathological examination.

CLINICAL DISCUSSION

Embryonal rhabdomyosarcoma (ERMS) mostly care a poor prognosis and modalities vary according to the presentation and the stage. However distant metastasis is common at the time of presentation.

CONCLUSION

embryonal rhabdomyosarcoma of the prostate is a rare and aggressive tumor with a low survival rate in adults. However, more clinical data needed for a better outcome.

Cytoreductive robot-assisted prostatectomy for systemic prostate rhabdomyosarcoma presenting as urinary retention

INTRODUCTION

In adults, rhabdomyosarcoma of the prostate is extremely rare and has an unfavorable prognosis. These patients frequently experience urinary obstruction, and cysto-prostatectomy is a mainstay treatment for localized disease. In contrast, treatment strategies for the primary site for metastatic disease remain controversial. To our knowledge, robot-assisted surgery for the primary tumor has not been reported.

CASE PRESENTATION

A 26-year-old man complained of dysuria. Magnetic resonance imaging showed enlarged prostate and computed tomography revealed a pulmonary metastasis. Transurethral resection of the prostate led to the diagnosis of rhabdomyosarcoma. After chemotherapy, robot-assisted prostatectomy was performed to relieve obstructive urinary symptoms. Although disease progression in the metastatic site was observed after the surgery, urinary obstruction did not occur and quality of life was well maintained.

CONCLUSION

Robot-assisted prostatectomy may be beneficial both for local disease control and palliation of voiding impairment among selected patients with systemic rhabdomyosarcoma of the prostate.

Prostate rhabdomyosarcoma in a young adult: Case report and literature review

Primary rhabdomyosarcoma of the adult prostate is rare and associated with an aggressive clinical course. Combined modality therapy has resulted in marked improvement in survival rates and reduced surgical morbidity for children with these tumors. However, in adults the prognosis remains poor.We report on a case of prostate rhabdomyosarcoma in an adult approached with combined-modality treatment, with the administration of 9 courses of doxorubicin, vincristine and endoxan, and, subsequent radiotherapy to the prostaticbed. The patient remained free of progression of disease for about 1 year.

Embryonal Rhabdomyosarcoma of Prostate in Adult: A Rare Case Report

Rhabdomyosarcoma is the fifth most common type of soft tissue solid tumor in children and the most common in the last two decades. Rhabdomyosarcoma of the urogenital organ is a rare mesenchymal tumor, covering 22% of all Rhabdomyosarcoma cases. The two most common histologic types are alveolar and embryonal, whereas botryoid and spindle cells are rarely found. We reported a case of embryonal Rhabdomyosarcoma of the prostate. In this study, we improved the understanding of Embryonal Rhabdomyosarcoma of the prostate on 23 years old male who had a history of swelling in the perineal area and a history of falling from a height in the groin area 5 months before. The patient complains of the difficulty of urinating and hematuria one month after falling. We underwent drainage of the swelling area, found pus 100cc and took a sample for pathological examination. The result was embryonal rhabdomyosarcoma. Prostate volume was 122cc, PSA 5,32 and PSAD 0,04. The CT scan result was solid mass size 15x8x18 cm at perineum enhance to the pelvic cavity, push the bladder to the superior, rectum to posterior, and urethra posterior to the left side. We diagnosed this patient as Embryonal Rhabdomyosarcoma prostate T2bG1N0M0 (stage 3) group 3 and intermediate-risk group. The patient underwent VAC chemotherapy based on D.9803 (IRS V) protocol and planned radiotherapy, but it stopped at halfway because of profuse bleeding. Embryonal Rhabdomyosarcoma is an aggressive tumor, especially in adults. However, there was limited evidence and guideline to diagnose and manage the disease.

[PRIMARY PROSTATIC RHABDOMYOSARCOMA WITH REPEATING CEREBRAL HEMORRHAGE FROM BRAIN METASTASES IN AN ADULT: A CASE REPORT]

A 28-year-old man visited a nearby doctor with a chief complaint of hematospermia. Magnetic resonance imaging showed a tumor 12-cm in diameter in his pelvis and he was introduced to our hospital. The tumor had replaced the prostate and infiltrated the rectum. He already had multiple lung, pelvic lymph, and bone metastases. He was diagnosed with embryonal rhabdomyosarcoma based on pathological findings after needle tumor biopsy. His disease was stage IV rhabdomyosarcoma according to the Intergroup Rhabdomyosarcoma Study, and he received a VAC (vincristine, actinomycin D, cyclophosphamide) chemotherapy regimen. Despite a partial response with 44% shrinkage in tumor diameter after seven cycles of chemotherapy, he experienced cerebral hemorrhage from small brain metastases during preparation for the eighth course. During gamma knife planning, the cerebral hemorrhage from small brain metastases repeated four times. The patient died 8 months after the introduction of chemotherapy.

Successful treatment of relapsed testicular embryonal rhabdomyosarcoma with Endostar and traditional chemotherapy: a case report

Embryonal rhabdomyosarcoma (ERMS) has a low prevalence, poor prognosis, and limited treatment efficacy. We report a case of an 18-year-old male whose disease relapsed in the abdominal cavity after a testicular ERMS curative resection. The patient received eight sequential cycles of rescue therapy using cisplatin and isocyclophosphamide in combination with a vascular targeted drug, Endostar. The therapeutic effect of the combination regimen has been evaluated for complete response. This is the first case to report using Endostar and chemotherapy in relapsed ERMS, and the curative effect results in complete response. Endostar, a new vascular targeted drug, combined with chemotherapy may play a synergistic role and provide a reference for the treatment of ERMS.

Management of Low and Intermediate Risk Adult Rhabdomyosarcoma: A Pooled Survival Analysis of 553 Patients

This is the second-largest retrospective analysis addressing the controversy of whether adult rhabdomyosarcoma (RMS) should be treated with chemotherapy regimens adopted from pediatric RMS protocols or adult soft-tissue sarcoma protocols. A comprehensive database search identified 553 adults with primary non-metastatic RMS. Increasing age, intermediate-risk disease, no chemotherapy use, anthacycline-based and poor chemotherapy response were significant predictors of poor overall and progression-free survival. In contrast, combined cyclophosphamide-based, cyclophosphamide + anthracycline-based, or cyclophosphamide + ifosfamide + anthracycline-based regimens significantly improved outcomes. Intermediate-risk disease was a significant predictor of poor chemotherapy response. Overall survival of clinical group-III patients was significantly improved if they underwent delayed complete resection. Non-parameningeal clinical group-I patients had the best local control, which was not affected by additional adjuvant radiotherapy. This study highlights the superiority of chemotherapy regimens –adapted from pediatric protocols- compared to anthracycline-based regimens. There is lack of data to support the routine use of adjuvant radiotherapy for non-parameningeal group-I patients. Nonetheless, intensive local therapy should be always considered for those at high risk for local recurrence, including intermediate-risk disease, advanced IRS stage, large tumors or narrow surgical margins. Although practically difficult (due to tumor’s rarity), there is a pressing need for high quality randomized controlled trials to provide further guidance.

Age-based disparities in treatment and outcomes of retroperitoneal rhabdomyosarcoma

BACKGROUND

Elderly patients (EPs) suffering from retroperitoneal rhabdomyosarcoma (RRMS) carry a considerably poorer prognosis compared to younger patients (YPs). We hypothesized that EPs received less aggressive and comprehensive treatment than YPs, resulting in poorer survival outcomes.

MATERIALS AND METHODS

All patients diagnosed with RRMS since 1998 in the National Cancer Data Base (NCDB) were reviewed for patient demographics, tumor characteristics, treatment modalities and survival outcomes.

RESULTS

Of the 100 patients identified, 35 % were ≥65 years of age. EPs (aged ≥65 years), when compared to YPs (aged <65), were less likely to receive systemic chemotherapy (20 % EPs vs 71 % YPs, p < 0.001) and treatment at an academic center (34 % EPs vs 60 % YPs, p = 0.05), although the frequency of radiation (23 % EPs vs 31 % YPs, p = 0.40) and radical surgery (26 % EPs vs 22 % YPs, p = 0.55) were similar. EPs received treatment more frequently at comprehensive community cancer programs (57 %) and had a shorter median distance of travel for care (6.4 vs 13 miles, p = 0.009). After adjusting for gender and tumor size, EPs had a hazard ratio of 3.6 (95 % CI 1.8-7.2, p < 0.001), with a median survival of 2 months (interquartile range [IQR] 1-8 months) versus 17 months for YPs (IQR 8-43 months).

CONCLUSION

Altered practice patterns exist for EPs and include reduced use of systemic chemotherapy which may contribute to poorer outcomes for RRMS patients. Although regionalization of care poses challenges, this may offer benefit to the EP group.

Management and outcome of 239 adolescent and adult rhabdomyosarcoma patients

Adult rhabdomyosarcoma (RMS) is a rare tumor that has inferior outcome compared to younger patient population. The present work aims to study the age-related differences in management of adolescents and adults with RMS. Under an institutional review board-approved protocol, we retrospectively analyzed 239 patients, 10 years of age and greater, diagnosed with RMS at MD Anderson Cancer Center from 1957 through 2003. Of the 239 patients, 163 patients were nonmetastatic with a median overall survival (OS) of 3.8 years (95% CI 2.8-7.6). In the multivariate analysis, age >50 was significantly associated with shorter OS and recurrence-free survival (RFS) for primary patients. Metastases were present in 76 patients, the median OS was 1.4 years. Approximately 13% of metastatic patients <50 years old had a long-term survival exceeding 15 years. Multimodality therapy, including surgery, radiotherapy, and chemotherapy was significantly associated with longer OS in primary and metastatic patients. Use of bi- and triple modality treatment decreased in metastatic patients over 50 years of age compared to younger patients. RMS in adolescents and adults has a poor outcome compared with younger individuals. Increased use of multidisciplinary therapy may improve older patient clinical outcome.

Prostate embryonal rhabdomyosarcoma in adults: Case report and review of literature

INTRODUCTION

Prostate embryonal rhabdomyosarcoma (ERMS) is a common tumour in infants and children, with a median occurrence age of 5 years, but it is rare in adults. It is characterized by a high degree of malignancy, both local rapid growth with formation of large pelvic masses, often leading to renal failure due to urethral obstruction, and systemic spread, commonly to the lungs, liver and bone. Several therapeutic approaches have been employed in the effort to treat prostate ERMS, but all of them have failed to gain a significant survival benefit in adult patients.

CASE REPORT

We report on a case of a stage IV prostate ERMS, approached with combined-modality treatment, with the administration of 5 courses of doxorubicin, ifosfamide and 2-mercaptoethane sulfonate sodium (mesna), and, subsequent radiotherapy to the prostatic bed (60 Gy/30 fxs). The patient remained free of progression of disease for about 1 year to finally experience a systemic relapse with multiple lung metastases and pleural effusion. The patient died for metastatic disease 27 months following the initial diagnosis.

CONCLUSION

While it remains questionable which therapeutic approach for prostate ERMS in adults is the most appropriate, our report demonstrates that a chemo-radiation combined treatment can control the prostate disease, reducing the symptoms and improving the quality of life of these patients, for the most part destined to die for systemic progression of disease.

Pediatric bladder rhabdomyosarcoma: report of organ sparing treatment of two cases

Pediatric rhabdomyosarcoma cases require multimodality therapy. Here, we present two cases treated by tumor resection followed by chemotherapy, and discuss the bladder preserving treatment of this uncommon disease.