title: Alveolar rhabdomyosarcoma of the extremity and nodal metastasis: Is the in-transit lymphatic system at risk?
abstract: Alveolar rhabdomyosarcoma (RMS) of the extremity is not infrequently associated with regional node metastasis. Knowledge of lymphatic drainage of extremity RMSs is important to determine radiotherapy fields. In this report we describe two patients with alveolar RMS of the lower extremity with inguinal metastasis at presentation. Both the distal lower extremity and inguinal region received local therapy consisting of surgery and postoperative radiotherapy. Both patients later developed in-transit lymphatic metastasis outside of the irradiated field. The in-transit lymphatics can be a site of failure in children with alveolar RMS of the extremity and nodal involvement.
authors.affiliation: Department of Radiation Oncology, The Methodist Hospital, Houston, Texas 77030, USA. apaulino@tmhs.org
authors.forename: Arnold C
authors.initials: AC
authors.lastname: Paulino
authors.forename: Alberto
authors.initials: A
authors.lastname: Pappo
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001557:Benzenesulfonates / Q000008:administration & dosage; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D002648:Child; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives; D003609:Dactinomycin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D005528:Foot; D006119:Groin; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D000077146:Irinotecan; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000503:physiopathology*; D008208:Lymphatic System / Q000033:anatomy & histology; D008297:Male; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D011725:Pyridines / Q000008:administration & dosage; D018714:Radiotherapy, Adjuvant; D011882:Radiotherapy, High-Energy; D018232:Rhabdomyosarcoma, Alveolar / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D016879:Salvage Therapy; D012983:Soft Tissue Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D000077157:Sorafenib; D000077204:Temozolomide; D013848:Thigh; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D001557:Benzenesulfonates; D010671:Phenylurea Compounds; D011725:Pyridines; D003609:Dactinomycin; C406143:cositecan; D009536:Niacinamide; D014750:Vincristine; D005047:Etoposide; D000077146:Irinotecan; D003606:Dacarbazine; D003520:Cyclophosphamide; D000077157:Sorafenib; D007069:Ifosfamide; D002166:Camptothecin; D000077204:Temozolomide