title: Diagnosis and treatment of lymph node metastases in pediatric rhabdomyosarcoma in the Netherlands: a retrospective analysis.
abstract: BACKGROUND
  In pediatric rhabdomyosarcoma (RMS), evaluation of lymph node involvement (N1) is an important staging aspect, but difficult to assess. The aim of our study was to evaluate the assessment of lymph node infiltration and impact on outcome in N1 RMS patients.
  
  
  METHODS
  We identified 277 non-metastatic RMS patients diagnosed and treated between 1990 and 2008. Patients with recorded N1 disease were evaluated for their diagnostic procedures and outcome.
  
  
  RESULTS
  In 13.7% N1 status was reported. In 19 of 34 N1 patients, lymph node biopsies were performed for histologically confirmation. Different treatment modalities were used to treat lymph node metastases. In total 23 of 31 patients received local treatment of the node (11/23 RT, 4/23 surgery, and 8/23 both). All patients received chemotherapy. Lymph node relapse occurred in 7 of 31 patients who were treated with one or two modalities. Only 1 (14%) of 8 patients treated with three modalities relapsed. In N0 patients 10 (4.2%) of 239 had a regional lymph node relapse, and 9 of 10 died.
  
  
  CONCLUSIONS
  Lymph node metastases are an essential part of staging. Node positivity contributes to relapse of disease. Nodal relapse is also associated with a high mortality rate. These data imply that nodal assessment needs to be optimal and standardized for improved staging.
authors.affiliation: Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands. Electronic address: c.terwisschavscheltinga@erasmusmc.nl.
authors.forename: Cecilia E J
authors.initials: CE
authors.lastname: Terwisscha van Scheltinga
authors.affiliation: Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Pauline
authors.initials: P
authors.lastname: Spronk
authors.affiliation: Departement of Biostatistics, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: van Rosmalen
authors.affiliation: Department of Pediatric Surgery, UMCN, Nijmegen and AMC, Amsterdam, the Netherlands; Department of Pediatric Surgery, AMC, Amsterdam, the Netherlands.
authors.forename: Marc H W A
authors.initials: MH
authors.lastname: Wijnen
authors.affiliation: Department of Pediatric Surgery, UMCN, Nijmegen and AMC, Amsterdam, the Netherlands.
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Heij
authors.affiliation: Department of Pediatric Surgery, UMCG, Groningen, the Netherlands.
authors.forename: Robertine
authors.initials: R
authors.lastname: van Baren
authors.affiliation: Department of Pediatric Oncology, EKZ/AMC, Amsterdam, the Netherlands.
authors.forename: Johannes H M
authors.initials: JH
authors.lastname: Merks
authors.affiliation: Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands. Electronic address: m.vannoesel@erasmusmc.nl.
authors.forename: Max M
authors.initials: MM
authors.lastname: van Noesel
authors.affiliation: Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Rene M H
authors.initials: RM
authors.lastname: Wijnen
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001706:Biopsy / Q000379:methods; D001918:Brachytherapy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D007223:Infant; D007231:Infant, Newborn; D008197:Lymph Node Excision; D015182:Lymphatic Irradiation; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000532:radiotherapy; D008297:Male; D009367:Neoplasm Staging / Q000379:methods*; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D003609:Dactinomycin; D014750:Vincristine; D007069:Ifosfamide
keywords: Locoregional treatment; Lymph node; Metastases; Pediatric; Rhabdomyosarcoma; Surgery