No additional benefit with intensive surveillance in relapsed rhabdomyosarcoma

December 2021 Clinical Practice Nalinee Pandey
Rhabdomyosarcoma, or RMS, is an aggressive and highly malignant form of cancer that develops from skeletal (striated) muscle cells that have failed to fully differentiate. It is generally considered to be a disease of childhood, as the vast majority of cases occur in those below the age of 18. It is commonly described as one of the "small, round, blue cell tumours of childhood" due to its appearance on an H&E stain.

Intensive surveillance after therapy is needed in pediatric patients treated for rhabdomyosarcoma (RMS). This is done as around a third of these patients experience relapse, and three-year survival after relapse is only 37%. The protocol for patient surveillance is done according to European Pediatric Soft Tissue Sarcoma Study Group Rhabdomyosarcoma 2005 (EpSSG-RMS 2005) protocol. This includes MRI with chest examination or CT scan of primary tumor site plus a chest X-ray. However, the usefulness of this protocol for patient benefit is unclear. A recent retrospective study has analyzed the clinical value of surveillance in relapsed RMS group.    

Retrospective Study

Data was collected from RMS patients treated in large pediatric oncology hospitals in France, UK, Italy, and the Netherlands, and enrolled in the International Society of Pediatric Oncology Malignant Mesenchymal Tumor 95 (1995-2004) study, the Italian Pediatric Soft Tissue Sarcoma Committee Rhabdomyosarcoma 96 (1996-2004) study, or the European Pediatric Soft Tissue Sarcoma Study Group Rhabdomyosarcoma 2005 (2005-2013) study. The value of off-therapy surveillance was analyzed by comparing survival in patients where relapse was either detected by routine imaging (imaging group) or by symptoms (the symptom group).


A retrospective study analyzed data from 199 relapsed RMS patients with 78 patients (39.2%) in the imaging group and 121 patients (60.8%) in the symptom group. The median follow-up time after relapse for survivors (n=86) was 7.4 years (3.9-11.5 years). The post relapse survival rate for imaging and survival group was 50% (95% confidence interval [CI], 38%-61% and 46% (95% CI, 37%-55%), respectively (P=.7).


The study found no survival advantage for RMS patients in intensive surveillance of clinical symptoms. The results show no benefit from off-therapy surveillance as repeated imaging can also harm the patient.


Vaarwerk B, Mallebranche C, Affinita MC, van der Lee JH, et al. Is surveillance imaging in pediatric patients treated for localized rhabdomyosarcoma useful? The European experience. Cancer. 2020 Feb 15;126(4):823-831. doi: 10.1002/cncr.32603. Epub 2019 Nov 21. PMID: 31750944; PMCID: PMC7027831.