Treatment Options for Childhood Rhabdomyosarcoma

Previously Untreated Childhood Rhabdomyosarcoma
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 child's doctor for clinical trials that are not listed here but may be right for your child.

The treatment of childhood rhabdomyosarcoma often includes surgery, radiation therapy, and chemotherapy. The order that these treatments are given depends on where in the body the tumor started, the size of the tumor, the type of tumor, and whether the tumor has spread to lymph nodes or other parts of the body. See the Treatment Option Overview section of this summary for more information about surgery, radiation therapy, and chemotherapy used to treat children with rhabdomyosarcoma.

Rhabdomyosarcoma of the brain and head and neck

• For tumors of the brain: Treatment may include surgery to remove the tumor, radiation therapy, and chemotherapy.
• For tumors of the head and neck that are in or near the eye: Treatment may include 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 are near the brain and spinal cord but not in or near the eye: Treatment may include radiation therapy and chemotherapy.
• For tumors of the head and neck that cannot be removed by surgery: Treatment may include chemotherapy and radiation therapy.
• For tumors of the larynx (voice box): Treatment may include chemotherapy and radiation therapy. Surgery to remove the larynx is usually not done, so that the voice is not harmed.

Rhabdomyosarcoma of the arms or legs

• Surgery to remove the tumor. If the tumor was not completely removed, a second surgery to remove the tumor may be done.
• For tumors of the hand or foot, radiation therapy and chemotherapy may be given. The tumor may not be removed because the function of the hand or foot would be lessened.
• Lymph node dissection (one or more lymph nodes are removed and a sample of tissue is checked under a microscope for signs of cancer).
  • 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.
• Chemotherapy.
• Radiation therapy.

Rhabdomyosarcoma of the chest, abdomen, or pelvis

• For tumors in the chest or abdomen (including the chest wall or abdominal wall): Surgery (wide local excision) may be done. If the tumor is large, chemotherapy, and sometimes radiation therapy, is given to shrink the tumor before surgery.
• For tumors of the pelvis: Surgery (wide local excision) may be done. If the tumor is large, chemotherapy, and sometimes radiation therapy, is given to shrink the tumor before surgery. Some pelvic tumors may be treated with biopsy, rather than wide local excision, followed by radiation therapy.
• For tumors of the diaphragm: A biopsy of the tumor is followed by chemotherapy and radiation therapy to shrink the tumor. Surgery may be done later to remove any remaining cancer cells.
• For tumors of the gallbladder or bile ducts: Surgery is done to remove as much of the tumor as possible, followed by chemotherapy and radiation therapy.
• 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 and radiation therapy.

Rhabdomyosarcoma of the kidney

• Surgery to remove as much of the tumor as possible.

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 bladder (other than the top of the bladder):
  • Chemotherapy and radiation therapy are given first to shrink the tumor. If cancer cells remain after chemotherapy and radiation therapy, the tumor is removed by surgery. 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).
  • Chemotherapy is given first to shrink the tumor. Surgery to remove the tumor, but not the bladder or prostate, is done. Internal radiation therapy is given after surgery.

Rhabdomyosarcoma of the area near the testicles

• Rhabdomyosarcoma of the testicular area is usually treated with surgery to remove the testicle and spermatic cord.
• The lymph nodes in the back of the abdomen may be checked for cancer, especially if the lymph nodes are enlarged or the child is older than 9 years. Radiation therapy may be given if the tumor cannot be completely removed by surgery. CT scans may be done every 3 months after surgery to see if the cancer is growing in nearby lymph nodes.

Rhabdomyosarcoma of the vulva, vagina, uterus or ovary

• For tumors of the vulva and vagina: Treatment may include chemotherapy followed by surgery to remove the tumor. Internal or external radiation therapy may be given after surgery.
• For tumors of the uterus: Treatment may include chemotherapy with or without radiation therapy. Sometimes surgery may be needed to remove any remaining cancer cells.
• For tumors of the cervix: Treatment may include chemotherapy followed by surgery to remove any remaining tumor.
• For tumors of the ovary: Treatment may include combination chemotherapy followed by surgery to remove any remaining tumor.

Metastatic rhabdomyosarcoma

• Radiation therapy may be given for tumors that have spread to the brain, spinal cord, or lungs.

  Treatment is also given to the site where the tumor first formed.

Some of the treatments being studied for rhabdomyosarcoma include the following:

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

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 new anticancer drugs.
• A clinical trial of targeted therapy.
• A clinical trial of combination chemotherapy and 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.