The surgical approach to pediatric localized bladder/prostate rhabdomyosarcoma may change due to a new radiotherapeutic modality. We assess the impact of brachytherapy used for local tumor control on surgery and report surgical procedures and outcome.
We retrospectively analyzed the records of all children who have undergone surgery for bladder/prostate rhabdomyosarcoma including for tumor relapse at our institution since 2009.
38 patients with a median age of 29 months (range 10-134) were operated on. 5-year overall survival was 92.8% (95% CI 72.9-98.1) and event free survival was 73.7% (95% CI 53.4-86.2) at a median follow-up of 12 months (range 3-111). Three treatment groups were defined: patients who underwent bladder preserving surgery combined with brachytherapy, bladder preserving surgery alone, or cystectomy. 5-year event free survival for the groups was 85.6% (95% CI 61.2-95.2), 66.7% (95% CI 27.2-88.2), and 50% (95% CI 5.8-84.5), respectively. Bladder preserving surgery was performed in 33 of 38 patients (87%), of whom 23 (70%) received a combination with brachytherapy, and cystectomy was performed in 5 of 38 patients (13%). Reconstructive procedures varied depending on tumor location and expansion.
Combining brachytherapy with surgery results in a high bladder preservation rate and improves event free survival compared to surgery only in pediatric bladder/prostate rhabdomyosarcoma. The combination is also effective in the treatment of a local tumor relapse and associated with less extensive reconstructive procedures due to exclusion of tumors of unfavorable size and location for brachytherapy.
The Journal of urology. 2020 May 07 [Epub ahead of print]
Andreas Schmidt, Steven W Warmann, Franziska Eckert, Verena Ellerkamp, Juergen Schaefer, Gunnar Blumenstock, Frank Paulsen, Joerg Fuchs
Departments of Paediatric Surgery and Paediatric Urology, University Children's Hospital, Tuebingen, Germany., Radiation Oncology, University Hospital, Tuebingen, Germany., Paediatric Radiology, University Hospital, Tuebingen, Germany., Department of Clinical Epidemiology and Applied Biometry, Eberhard Karls University Tuebingen, Tuebingen, Germany.