Biopsy or debulking surgery as initial surgery for locally advanced rhabdomyosarcomas in children?: the experience of the Italian Cooperative Group studies.
BACKGROUND
The purpose of the current study was to analyze the influence of the initial surgical approach (biopsy vs resection with macroscopic residual tumors) on the outcome of patients with localized Intergroup Rhabdomyosarcoma Study (IRS) Group III rhabdomyosarcoma (RMS) enrolled in the Italian studies between 1979 and 2003.


METHODS
Among the 394 patients evaluated, 323 underwent biopsy, as recommended by the protocols, and 71 patients underwent surgical resection with macroscopic residual tumors (debulking operation [DO]), although this procedure was discouraged. All these patients were classified at the same risk group and received the same treatment. The different characteristics (patient age, tumor site, T classification and size, histology) and outcome in the 2 groups were considered.


RESULTS
The estimated 5-year overall survival (OS) rates were 68.4% and 72.6%, respectively, after biopsy and DO (P=.38), and the rates of progression-free survival (PFS) were 56.5% and 61.7%, respectively, after biopsy and DO (P=.41). The outcome did not differ significantly when considering other variables such as tumor site, size, and histology. Age>10 years appeared to have little benefit in patients with DO; the OS was 62% after biopsy and 83.1% after DO (P=.06); the PFS was 49.7% and 72.8%, respectively after biopsy and DO (P=.04). No surgical complications due to the 2 procedures were reported, but in 2 cases the initial DO resulted in a mutilation.


CONCLUSIONS
No significant advantages of DO versus biopsy were detected with regard to patient outcome. Biopsy, which is less aggressive, appears to be thebest option for patients with IRS Group III RMS.
Cecchetto
Giovanni
G
Division of Pediatric Surgery, Department of Pediatrics, University Hospital of Padua, Italy. giovanni.cecchetto@unipd.it
Bisogno
Gianni
G
De Corti
Federica
F
Dall'Igna
Patrizia
P
Inserra
Alessandro
A
Ferrari
Andrea
A
Garaventa
Alberto
A
Scagnellato
Angela
A
Carli
Modesto
M
D000293:Adolescent; D001706:Biopsy; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D012208:Rhabdomyosarcoma / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate