SURGERY IN RHABDOMYOSARCOMA OF THE BLADDER, PROSTATE AND VAGINA

The treatment of bladder and prostate rhabdomyosarcoma (RMS) is highly controversial. Aside from chemotherapy, treatment modalities include conservative surgery, radical surgery, and pre-, intra-, or postoperat ive irradiation. Between 1968 and 1993, 78 children with RMS were trea ted at our institution. In all, 22 tumors were located in the urogenit al tract (bladder/prostate, 13; paratesticular, 5; vaginal, 2; others, 2). Altogether, 6 patients had stage II disease; 7, stage III disease ; and 2, stage IV disease. All 15 patients with RMS of the bladder, pr ostate, or vagina received chemotherapy, and 4 had additional radio-th erapy. Surgery was also done in 10 patients; parents refused an operat ion in 3 cases. In all, 3 patients in an advanced tumor stage died of their disease. All other children currently show no evidence of diseas e (mean follow-up, 6 years; range, from 2 months to 18 years). After c hemotherapy, radical operative intervention with multiple biopsies (en circling the tumor) - in contrast to local tumor excision or partial r esection - permits complete tumor resection followed by excellent long -term results. Following radiotherapy, often a consequence of organ-sp aring therapy, many complications ensued (60%); therefore, irradiation should be restricted to highly selected cases.