title: Does surgery have a role in the treatment of local relapses of non-metastatic rhabdomyosarcoma?
abstract: OBJECTIVE
  Patients with non-metastatic rhabdomyosarcoma (RMS) have a cure rate of 50-90%, but up to one-third of them experience mostly a local recurrence. Second-line treatment is not standardized as for newly diagnosed tumors. We evaluated the role of surgery on local relapses in a series of patients with RMS.
  
  
  METHODS
  This retrospective analysis involves 70 patients enrolled in two consecutives Italian Studies, RMS88 and RMS96, who presented local recurrence. After relapse, 40/70 underwent a surgical excision (Surgery Group, SG), that was demolitive in 10/40; 24/40 had radiotherapy, 16/40 did not receive radiotherapy or data are not known. Thirty patients out of 70 did not receive any surgical treatment (No-Surgery Group, NSG), and 20/30 received radiotherapy.
  
  
  RESULTS
  Overall survival (OS) after local relapse was 41.6% (mean follow-up 59 months, range 1-226). OS of SG patients was 54% versus 24.7% of the NSG patients (P = 0.0117). Furthermore, OS among the SG was 61.4% with and 41.8% without radiotherapy, and 37.1% with and 0% without radiotherapy among the NSG (P < 0.0001). One patient developed a second local relapse after excision without radiotherapy for the first one, and was cured with further treatment. Demolitive surgery did not improve survival compared to conservative surgery (40% vs. 58.4%, P = 0.1462).
  
  
  CONCLUSIONS
  The treatment of recurrent RMS represents a challenge. In our experience, patients with local relapse had a poor prognosis. SG patients had a better outcome than NSG patients and those treated with resection plus radiotherapy had the best outcome; patients who did not receive any local treatment had an unfavorable outcome.
authors.affiliation: Pediatric Surgery Division, Pediatric Department, University-Hospital of Padova, Padova, Italy. federica.decorti@unipd.it
authors.forename: Federica
authors.initials: F
authors.lastname: De Corti
authors.forename: Gianni
authors.initials: G
authors.lastname: Bisogno
authors.forename: Patrizia
authors.initials: P
authors.lastname: Dall'Igna
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferrari
authors.forename: Piero
authors.initials: P
authors.lastname: Buffa
authors.forename: Angela
authors.initials: A
authors.lastname: De Paoli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cecchetto
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D049691:History, Medieval; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D055815:Young Adult