PARATESTICULAR RHABDOMYOSARCOMA - DELAYED-EFFECTS OF MULTIMODALITY THERAPY AND IMPLICATIONS FOR CURRENT MANAGEMENT

Background. The combined modalities of surgery, chemotherapy, and radi ation therapy have greatly improved the survival rate in childhood par atesticular rhabdomyosarcoma, but the incidence of complications and l ate side effects is a cause for concern. Methods. We reviewed the reco rds of 18 patients treated for paratesticular rhabdomyosarcoma at St. Jude Children's Research Hospital between 1962 and 1989. Patients with Group I disease were treated with orchiectomy, retroperitoneal lymph node dissection, and multiagent chemotherapy; more advanced cases also received radiation therapy with concurrent chemotherapy. Results. Seq uelae included esophageal and common bile duct stricture, inguinal ner ve entrapment syndrome, and small bowel obstruction. Short stature was found in all children whose spines were irradiated via para-aortic fi elds (34-37 Gy) prior to puberty. Two of 18 patients died from treatme nt complications and one from progressive disease. Conclusions. Multim odality treatment offers an excellent prognosis in paratesticular rhab domyosarcoma, but is associated with significant morbidity and mortali ty rates. A discussion of therapy components and their application to disease stages suggests possible appreaches to optimizing treatment fo r this therapy-sensitive malignancy.