Standards, Options and Recommendations (SOR) for clinical care of rhabdomyosarcoma (RMS) and other soft tissue sarcoma in children

The "Standards, Options and Recommendations" (SOR) project, started in 1993 , is a collaboration between the Federation of the French Cancer Centres (F NCLCC), the 20 French Cancer Centres and specialists from French Public Uni versities, General Hospitals and Private Clinics. For pediatric issues, thi s project is a collaboration between the FNCLCC and the French Society of P ediatric Oncology (SFOP). The main objective is the development of clinical practice guidelines to improve the quality of health care and outcomes for cancer patients. The methodology is based on literature review and critica l appraisal by a multidisciplinary group of experts, with feedback from spe cialists in cancer care delivery. Objectives: to develop a clinical practic e guideline according to the definitions of standards, Options and Recommen dations for the clinical care of rhabdomyosarcoma and other soft tissue sar coma in children and adolescents Methods: data have been identified by lite rature search using Medline (1985-may 1997) and experts group personal refe rences lists. The main criteria considered were incidence, risk factors, pr ognostic factors and efficacy of cancer treatment Once the guideline was de fined, the document was submitted for review to 14 national and internation al independent reviewers, and to the medical committees of the 20 French Ca ncer Centres and in particular the 4 which have expertise in pediatric canc er management for agreement. Results: the main recommendations for rhabdomy osarcoma management art: 1/ diagnosis is based on appropriate clinical and radiological findings; 2/ pathological and immunohistochemical studies are essential to confirm the diagnosis; 3/ surgery must be performed by an expe rienced surgeon. Surgery and radiotherapy must be as conservative as possib le; 4/ therapeutic strategies for rhabdomyosarcoma depend on location and e xtends and are based on chemotherapy, surgery and radiotherapy Inclusion of patients in SFOP, SIOP and IRS clinical trials is recommended; 5/ treatmen t of metastatic rhabdomyosarcoma is based an intensive chemotherapy, and su rgery with or without radiotherapy; 6/ the management of non-rhabdomyosarco ma is based on the likelihood of sensitivity to chemotherapy; 7/ at the-pre sent time, there are no clear data On which to base guidelines for timing a nd duration of follow-up studies in these conditions.