Surveillance Imaging May Not Benefit Pediatric Patients with Localized Rhabdomyosarcoma

A new study evaluated the effectiveness of radiological tumor surveillance in pediatric patients with localized rhabdomyosarcoma who have completed therapy.

“Pediatric patients treated for rhabdomyosarcoma (RMS) are subjected to intensive surveillance after therapy because up to one‐third of patients with localized disease at the initial diagnosis experience tumor relapse,” explained the study authors.

“However,” they went on, “no available evidence shows that current surveillance recommendations lead to earlier detection of relapse and, therefore, to improved survival for patients with relapsed RMS.” Repeated imaging at the hospital increases cost and radiation exposure, usually requires anesthesia, and could cause distress to the patient and family.

This study therefore sought to determine whether repeated imaging after completion of therapy successfully identifies patients with recurrent tumors more effectively than basing recurrence diagnosis on clinical symptoms.

This was a retrospective, multi-center study of patients with relapsed RMS after they completed therapy for localized RMS. Patients were treated in large pediatric oncology hospitals across France, the UK, Italy, and the Netherlands; patients were enrolled in the International Society of Paediatric Oncology Malignant Mesenchymal Tumor 95 (1995‐2004) study, the Italian Paediatric Soft Tissue Sarcoma Committee Rhabdomyosarcoma 96 (1996‐2004) study, or the European Paediatric Soft Tissue Sarcoma Study Group Rhabdomyosarcoma 2005 (2005‐2013) study. Survival times post-relapse were compared between patients in the imaging versus symptom groups.

Final analysis included 199 relapsed RMS patients, of whom 78 (39.2%) were in the imaging group and 121 (60.8%) were in the symptom group. Specifically, relapse was detected through routine imaging with clinical symptoms present at the time of imaging in 22 patients (11.1%), and in imaging without the presence of clinical symptoms in 56 patients (28.1%).

Among the 86 survivors, the median follow-up time after relapse was 7.4 years (interquartile range, 3.9 to 11.5 years); three years after relapse, the survival rate was 50% (95% CI, 38% to 61%) for the imaging group and 46% (95% CI, 37% to 55%) for the symptom group (P = 0.7).

The research was published in the journal Cancer.

The researchers concluded that based on their findings, “there is no evidence showing that current surveillance regimens after therapy for patients treated for localized RMS lead to improved survival after relapse. There is a need for risk‐adapted follow‐up strategies to improve the efficiency of follow‐up after RMS treatment, but the needs and preferences of patients and parents should also be taken into account.”

Kaitlyn D’Onofrio is a digital medical writer. She is interested in musculoskeletal health, the effect of exercise on health, and mental health awareness. When she’s not writing for DocWire, Kaitlyn is teaching yoga classes in her community, promoting wellness to her students.