Rhabdomyosarcomas: chemotherapy and limited supplementary treatment program to avoid mutilation.

A treatment program was set up to minimize mutilation in children with rhabdomyosarcomas (RMS) in the otorhinolaryngeal region, the urogenital tract, and other regions where surgery and radiotherapy (RT) could be mutilating. The primary treatment was chemotherapy with vincristine, dactinomycin, and cyclophosphamide, and each patient was assessed individually to determine whether supplementary treatment was needed. The initial results were so promising that a controlled clinical trial was undertaken by the International Society of Paediatric Oncology to compare the effects of chemotherapy alone versus chemotherapy and RT on the original tumor volume. At present, the place of irradiation in the treatment of RMS remains uncertain. It is unavoidable only in those patients who are likely to develop intracranial extension, because chemotherapeutic agents do not penetrate the blood-brain barrier.