title: Focusing on organ preservation and function: paradigm shifts in the treatment of pediatric genitourinary rhabdomyosarcoma.
abstract: OBJECTIVE
  Pediatric genitourinary rhabdomyosarcoma (RMS) accounts for 25 % of all pediatric soft tissue sarcomas. The treatment of these tumors has shifted over time from debilitating radical exenteration to organ-sparing techniques using multimodal therapy. Our review aims to summarize recent relevant literature regarding the current treatment practices of pediatric genitourinary RMS and how these practices have shifted over time.
  
  
  METHODS
  PubMed database search was utilized to identify relevant literature from 1997 to 2015 relating to the treatment of pediatric genitourinary RMS with emphasis on organ preservation and maintaining organ function.
  
  
  RESULTS
  A total of 31 articles from 1997 through 2015 were identified relating to current management concepts in pediatric genitourinary sarcomas. Relevant articles were reviewed in detail and discussed.
  
  
  CONCLUSIONS
  The treatment of pediatric genitourinary RMS has shifted from debilitating pelvic exenteration to a multimodal treatment approach involving surgery, chemotherapy, and radiation therapy in an effort to preserve genitourinary organs and reduce treatment morbidity. Continued research is required to improve post-treatment organ function. Further studies utilizing objective urodynamic evaluation are necessary to better characterize bladder function after treatment for RMS. Exciting recent developments in RMS research of fusion proteins that induce cell transformation and inhibit apoptosis and myogenic differentiation may result in future management changes to treatment protocols.
authors.affiliation: Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, 3217 MFCB, 1685 Highland Ave, Madison, WI, 53705-2281, USA.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Shapiro
authors.affiliation: Division of Urology, Department of Surgery, Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Harel
authors.affiliation: Division of Urology, Department of Surgery, Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Ferrer
authors.affiliation: Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, 3217 MFCB, 1685 Highland Ave, Madison, WI, 53705-2281, USA. mckenna@urology.wisc.edu.
authors.forename: Patrick H
authors.initials: PH
authors.lastname: McKenna
mesh_terms: D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005834:Genital Neoplasms, Male / Q000401:mortality / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D020380:Needs Assessment; D059351:Organ Sparing Treatments / Q000379:methods*; D010372:Pediatrics; D011379:Prognosis; D012208:Rhabdomyosarcoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018570:Risk Assessment; D016019:Survival Analysis; D014565:Urogenital Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*
keywords: Chemotherapy; Genitourinary rhabdomyosarcoma; Organ sparing; Pediatric urology; Radiation