title: Embryonal rhabdomyosarcoma: adjuvant and ex vivo assay-directed chemotherapy.
abstract: The aim of this retrospective study was to evaluate differences in treatment of embryonal rhabdomyosarcoma (RMS) of the uterus in 2 premenopausal women. We discuss adjuvant chemotherapy and use of ChemoFx Assay (Precision Therapeutics, Pittsburgh, PA) to guide choice of active chemotherapeutic agents. Two premenopausal patients were identified with a pathologic diagnosis of embryonal RMS of the uterus. Both met inclusion criteria for the study. A 21-year-old woman underwent a staging abdominal hysterectomy for a variant of embryonal RMS. Vincristine, actinomycin D, and cyclophosphamide were given adjunctively for a complete response. A 20-year-old woman underwent a diagnostic dilation and curettage revealing embryonal RMS. Initial treatment included an abdominal hysterectomy and nodal sampling. Presentation to a subsequent gynecologic oncologist 7 months later revealed recurrence. Carboplatin, doxorubicin, and paclitaxel provided a partial response. After a second surgical resection, ChemoFx Assay identified ifosfamide and mitomycin C as active agents and resulted in a complete response. Recommended treatment includes surgery and chemotherapy with possible radiation therapy if deemed necessary. The benefit of adding neoadjuvant or adjuvant chemotherapy and radiation therapy allows for a conservative surgical approach and improved survival. Choosing active chemotherapy agents can be aided by ChemoFx Assay. The chemotherapy most commonly used for treatment of embryonal RMS is a combination of vincristine, actinomycin D, and cyclophosphamide.
authors.affiliation: Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA. carrieballard@hotmail.com
authors.forename: Karen S
authors.initials: KS
authors.lastname: Ballard
authors.forename: Sean S
authors.initials: SS
authors.lastname: Tedjarati
authors.forename: William R
authors.initials: WR
authors.lastname: Robinson
authors.forename: Howard D
authors.initials: HD
authors.lastname: Homesley
authors.forename: Erin L
authors.initials: EL
authors.lastname: Thurston
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D012074:Remission Induction; D012189:Retrospective Studies; D018233:Rhabdomyosarcoma, Embryonal / Q000188:drug therapy* / Q000473:pathology; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult