title: Local therapy for rhabdomyosarcoma of the hands and feet: is amputation necessary? A report from the Children's Oncology Group.
abstract: OBJECTIVE
  To evaluate the outcome of children with rhabdomyosarcoma (RMS) of the hand or foot treated with surgery and/or local radiotherapy (RT).
  
  
  METHODS
  Forty-eight patients with nonmetastatic RMS of the hand or foot were enrolled on Intergroup Rhabdomyosarcoma Study III, IV-Pilot, and IV. Patients received multiagent chemotherapy with surgery and/or RT. Twenty-four patients (50%) underwent surgery without local RT, of whom 4 had complete resection and 20 had an amputation. The remaining 24 patients (50%) underwent local RT, of whom 2 required RT for microscopic residual disease after prior amputation. Median follow-up for surviving patients was 9.7 years.
  
  
  RESULTS
  Actuarial 10-year local control was 100%; 10-year event-free survival and overall survival rates were 62% and 63%, respectively. Poor prognostic factors for recurrence included gross residual (Group III) disease and nodal involvement (p = 0.01 and 0.05, respectively). More patients in the RT group had alveolar histology, Group III disease, and nodal involvement, as compared with the surgery group. There was no difference in 10-year event-free survival (57% vs. 66%) or overall survival (63% vs. 63%) between patients who underwent surgery or local RT. Among relapsing patients, there were no long-term survivors. No secondary malignancies have been observed.
  
  
  CONCLUSIONS
  Despite having high-risk features, patients treated with local RT achieved excellent local control. Complete surgical resection without amputation is difficult to achieve in the hand or foot. Therefore, we recommend either definitive RT or surgical resection that maintains form and function as primary local therapy rather than amputation in patients with hand or foot RMS.
authors.affiliation: Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA.
authors.forename: Trang H
authors.initials: TH
authors.lastname: La
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Wolden
authors.forename: Zheng
authors.initials: Z
authors.lastname: Su
authors.forename: Corinne
authors.initials: C
authors.lastname: Linardic
authors.forename: R Lor
authors.initials: RL
authors.lastname: Randall
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Hawkins
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Donaldson
mesh_terms: D000293:Adolescent; D000671:Amputation, Surgical; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods / Q000401:mortality; D005500:Follow-Up Studies; D005528:Foot / Q000601:surgery*; D006225:Hand / Q000601:surgery*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D011879:Radiotherapy Dosage; D012208:Rhabdomyosarcoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D015996:Survival Rate; D055815:Young Adult