title: Progress in the surgical management of vaginal rhabdomyosarcoma: a 25-year review from the Intergroup Rhabdomyosarcoma Study Group.
abstract: OBJECTIVE
  During its 25 years of experience, the Intergroup Rhabdomyosarcoma Study Group (IRSG) has completed four sequential prospective clinical trials to improve survival and decrease morbidity rates in childhood rhabdomyosarcoma (RMS). Surgical management of vaginal RMS has changed dramatically.
  
  
  METHODS
  The records of 72 patients with localized vaginal RMS were reviewed to assess surgical therapy, chemotherapy, and radiotherapy and their relation to outcome.
  
  
  RESULTS
  Each successive IRSG trial resulted in decreased need for surgical resection (IRS-I, 100%; IRS-II, 70%; IRS-III, 30%; IRS-IV, 13%) and excellent disease-free survival using increasingly effective multiagent chemotherapy.
  
  
  CONCLUSIONS
  Primary chemotherapy after initial biopsy provides excellent tumor control. Local resection may be appropriate, but removal of organs (ie, complete vaginectomy/hysterectomy) has no role except in persistent or recurrent disease. Mature, residual rhabdomyoblasts may be evidence of a chemotherapy response, and further surveillance and biopsy without surgical resection is adequate treatment.
authors.affiliation: Intergroup Rhabdomyosarcoma Study Group, Mayo Clinic, Rochester, MN, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Andrassy
authors.forename: E S
authors.initials: ES
authors.lastname: Wiener
authors.forename: R B
authors.initials: RB
authors.lastname: Raney
authors.forename: D M
authors.initials: DM
authors.lastname: Hays
authors.forename: C A
authors.initials: CA
authors.lastname: Arndt
authors.forename: T E
authors.initials: TE
authors.lastname: Lobe
authors.forename: W
authors.initials: W
authors.lastname: Lawrence
authors.forename: J R
authors.initials: JR
authors.lastname: Anderson
authors.forename: S J
authors.initials: SJ
authors.lastname: Qualman
authors.forename: W M
authors.initials: WM
authors.lastname: Crist
mesh_terms: D000465:Algorithms; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002648:Child; D005260:Female; D006801:Humans; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome; D014625:Vaginal Neoplasms / Q000188:drug therapy / Q000601:surgery*
chemical_list: D000970:Antineoplastic Agents