# Rhabdomyosarcoma — GCMD Library living collection

Everything in the library about rhabdomyosarcoma — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 91 cited statements

## Episodes
### Surgical Management
- [Soft Tissue Sarcoma Rapid Fire: Update Course 2015](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980) — video · 8:27 · [machine version](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980.md)

### Case-Based Learning
- [Technical approaches to rhabdomyosarcoma management: APSA Cancer Committee case series](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301) — video · 17:35 · [machine version](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301.md)

### Long-Term Care
- [Oncofertility Ovarian Salvage](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292) — video · [machine version](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=0) Rhabdomyosarcoma staging and prognostic factors (Ep 1)
- [2:06](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=126) Case examples and sentinel lymph node biopsy requirement (Ep 1)
- [4:31](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=271) Lymphatic mapping rationale in rhabdomyosarcoma (Ep 1)
- [4:54](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=294) Non-rhabdomyosarcoma treatment paradigm (Ep 1)
- [6:54](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=414) Key surgical principles and Q&A (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=0) Introduction to oncofertility as a priority topic (Ep 2)
- [1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68) Case presentation and ovarian tissue cryopreservation (Ep 2)
- [7:26](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=446) Access to oncofertility services (Ep 2)
- [8:42](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=522) Male fertility preservation and tissue transplantation timing (Ep 2)
- [10:58](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=658) Storage logistics and cost considerations (Ep 2)
- [0:10](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=10) Introduction to APSA Cancer Committee Rhabdomyosarcoma Session (Ep 3)
- [1:34](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=94) Faculty Introductions and Session Format (Ep 3)
- [3:14](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=194) Extremity Rhabdomyosarcoma: Initial Biopsy Approach (Ep 3)
- [4:46](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=286) Sentinel Lymph Node Biopsy Techniques and Indications (Ep 3)
- [8:42](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=522) Staging, Risk Stratification, and Local Control Strategies (Ep 3)
- [10:45](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=645) Paratesticular Rhabdomyosarcoma: Prognostic Factors (Ep 3)
- [11:56](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=716) Imaging and Lymph Node Assessment in Paratesticular Disease (Ep 3)
- [13:41](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=821) Retroperitoneal Lymph Node Dissection: Indications and Technique (Ep 3)
- [16:12](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=972) Management of Scrotal Violation (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Half of soft tissue sarcomas are rhabdomyosarcomas, and the other half are non-rhabdomyosarcomas. — Andrea (epidemiological) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=0)
- Prognosis in rhabdomyosarcoma varies depending on site, with abdominal, pelvic, and retroperitoneal tumors having the worst survival and orbital rhabdomyosarcomas having the best survival. — Andrea (clinical) [Ep 1 · 0:25](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=25)
- Stage 1 rhabdomyosarcoma includes favorable sites (vaginal and paratesticular), while stages 2, 3, and 4 are unfavorable sites with various amounts of disease. — Andrea (clinical) [Ep 1 · 0:50](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=50)
- Even a small tumor in the extremity or abdomen can only achieve stage 2 at best. — Andrea (clinical) [Ep 1 · 1:02](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=62)
- Clinical grouping in rhabdomyosarcoma depends on surgical extent: group 1 is complete removal, group 2 is microscopic residual, and group 3 is biopsy only. — Andrea (clinical) [Ep 1 · 1:14](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=74)
- Group 1 and 2 rhabdomyosarcoma patients have an excellent prognosis, while group 3 patients do more poorly. — Andrea (clinical) [Ep 1 · 1:30](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=90)
- A large tumor that a surgeon cannot resect is a biologic determination, and attempting resection with high morbidity will not improve the patient's outcome. — Andrea (opinion) [Ep 1 · 1:45](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=105)
- Five centimeters is the cutoff for low-risk versus high-risk patients in soft tissue sarcoma. — Andrea (clinical) [Ep 1 · 2:09](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=129)
- Sentinel lymph node biopsies are now required for all rhabdomyosarcoma patients with trunk or extremity tumors. — Andrea (guideline) [Ep 1 · 3:18](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=198)
- In rhabdomyosarcoma, completion node dissection is not performed after sentinel lymph node biopsy; patients receive radiation therapy instead. — Andrea (guideline) [Ep 1 · 3:34](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=214)
- Alveolar rhabdomyosarcoma patients should receive chemotherapy after biopsy, which typically reduces the tumor to approximately 1 centimeter, making resection with negative margins easier. — Andrea (clinical) [Ep 1 · 3:53](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=233)
- Sentinel lymph node mapping should be performed at the time of re-excision in rhabdomyosarcoma. — Andrea (guideline) [Ep 1 · 4:07](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=247)
- Forty to fifty percent of biopsied lymph nodes are positive in rhabdomyosarcoma. — Andrea (epidemiological) [Ep 1 · 4:39](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=279)
- Clinically negative lymph nodes may be positive in rhabdomyosarcoma, which is why sentinel node biopsy is performed. — Andrea (clinical) [Ep 1 · 4:39](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=279)
- Positive lymph nodes in rhabdomyosarcoma have a worse prognosis and require radiation therapy. — Andrea (clinical) [Ep 1 · 4:39](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=279)
- In non-rhabdomyosarcoma soft tissue sarcoma, histological grade is now critical for treatment planning. — Andrea (guideline) [Ep 1 · 4:54](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=294)
- Large soft tissue sarcoma tumors should be biopsied first and treated with chemotherapy before resection. — Andrea (guideline) [Ep 1 · 4:54](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=294)
- Soft tissue sarcomas have been identified as chemotherapy-sensitive or chemotherapy-insensitive, which changes treatment approach. — Andrea (clinical) [Ep 1 · 5:13](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=313)
- Low-grade soft tissue sarcoma tumors require only resection and observation, with no need for radiation or chemotherapy. — Andrea (guideline) [Ep 1 · 5:21](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=321)
- If a low-grade soft tissue sarcoma is resected with positive margins, the patient will receive adjuvant radiation therapy. — Andrea (guideline) [Ep 1 · 5:38](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=338)
- Unresectable large soft tissue sarcomas should be treated with preoperative radiation therapy and preoperative chemotherapy (previously only chemotherapy was recommended). — Andrea (guideline) [Ep 1 · 5:52](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=352)
- Small soft tissue sarcoma tumors less than 5 centimeters should be resected with attempts to achieve negative margins. — Andrea (guideline) [Ep 1 · 6:10](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=370)
- Chemotherapy-sensitive soft tissue sarcomas include synovial sarcoma and undifferentiated sarcoma. — Andrea (clinical) [Ep 1 · 6:10](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=370)
- Chemotherapy-insensitive soft tissue sarcomas include alveolar soft part sarcoma, malignant epithelioid sarcoma, and clear cell sarcoma, all of which are high-grade tumors. — Andrea (clinical) [Ep 1 · 6:28](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=388)
- For chemotherapy-insensitive soft tissue sarcomas, the surgeon and radiation therapist are the primary treaters. — Andrea (clinical) [Ep 1 · 6:28](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=388)
- High-risk soft tissue sarcoma patients receive preoperative radiation and chemotherapy. — Andrea (guideline) [Ep 1 · 6:48](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=408)
- Sentinel lymph node biopsy should always be performed if lymph nodes are clinically negative by imaging. — Andrea (guideline) [Ep 1 · 7:15](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=435)
- Positive lymph nodes receive radiation to the lymph node basin, and completion node dissection is not required. — Andrea (guideline) [Ep 1 · 7:15](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=435)
- Non-rhabdomyosarcoma tumors with negative margins after resection do not need chemotherapy if they are low-grade. — Andrea (guideline) [Ep 1 · 7:25](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=445)
- Chemotherapy-insensitive soft tissue sarcomas require aggressive surgical extirpation as much as possible. — Andrea (guideline) [Ep 1 · 7:37](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=457)
- Core biopsies are acceptable for soft tissue sarcoma diagnosis if 3 or 4 good cores that are not necrotic are obtained, with the pathologist checking the core before the interventional radiologist finishes. — Andrea (clinical) [Ep 1 · 8:10](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=490)
- Cyclophosphamide equivalent dose (CED) over 15 grams per meter squared puts pediatric patients at high risk for ovarian failure. — Julie Rios (clinical) [Ep 2 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- The patient's CED was 30.8 grams per meter squared, placing her at high risk for primary ovarian insufficiency. — Julie Rios (clinical) [Ep 2 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- Ovarian transposition may not provide adequate distance from scatter radiation in young patients receiving pelvic radiation. — Julie Rios (clinical) [Ep 2 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- GnRH agonist therapy has not demonstrated clear fertility preservation benefit in pediatric patients and is not recommended as first-line by ASCO. — Julie Rios (guideline) [Ep 2 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- GnRH agonist therapy may have some benefit in older patients with breast cancer, though studies conflict. — Julie Rios (clinical) [Ep 2 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- Ovarian tissue cryopreservation is experimental and followed by future ovarian tissue transplantation, allowing about 30% of patients to have fertility. — Julie Rios (clinical) [Ep 2 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- Most fertility data from ovarian tissue transplantation comes from post-pubertal patients, but studies show visible follicles in tissue from pediatric patients. — Julie Rios (clinical) [Ep 2 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- Ovarian tissue is typically cryopreserved within the same day of harvest to minimize egg loss from lack of vascular supply. — Julie Rios (clinical) [Ep 2 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- Orthotopic transplantation involves placing tissue back where the ovary was removed, either sewn to the contralateral ovary or in a peritoneal pocket near the fallopian tube. — Julie Rios (clinical) [Ep 2 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- Meta-analysis data shows 37-50% of patients with transplants had live births, with 30-40% achieving fertility preservation (some requiring multiple transplants). — Julie Rios (epidemiological) [Ep 2 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- 60-90% of patients with ovarian tissue transplants achieve restoration of ovarian endocrine function. — Julie Rios (epidemiological) [Ep 2 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- Ovarian tissue cryopreservation requires both a surgeon to remove tissue and facilities to freeze it on-site. — Julie Rios (clinical) [Ep 2 · 7:26](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=446)
- Ovarian tissue cryopreservation became standard of care first in the Netherlands. — Julie Rios (clinical) [Ep 2 · 7:26](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=446)
- Sperm banking is only an option for post-pubertal males, typically Tanner stage 3 and above. — Julie Rios (clinical) [Ep 2 · 8:42](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=522)
- For prepubertal males receiving high-dose treatment, testicular tissue cryopreservation is available through protocols such as at University of Pittsburgh. — Julie Rios (clinical) [Ep 2 · 8:42](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=522)
- Testicular tissue preservation typically involves a wedge biopsy rather than full orchiectomy. — Julie Rios (clinical) [Ep 2 · 8:42](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=522)
- Ovarian tissue transplantation is typically performed only when pregnancy is desired because the graft lasts only 2-5 years. — Julie Rios (clinical) [Ep 2 · 8:42](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=522)
- Hormone replacement medication is used for pubertal induction and hormone support until pregnancy is desired. — Julie Rios (clinical) [Ep 2 · 8:42](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=522)
- Most centers now use long-term storage facilities with three or four mechanisms for detecting tank dysfunction to prevent tissue loss. — Julie Rios (clinical) [Ep 2 · 10:58](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=658)
- Hospital fees and anesthesia fees can often be covered by insurance when ovarian tissue harvest is combined with other oncology procedures like bone marrow biopsy or central line placement. — Julie Rios (clinical) [Ep 2 · 10:58](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=658)
- Tissue storage costs are income-dependent: $75 per year for oncology patients below income threshold, $275 per year above threshold. — Julie Rios (clinical) [Ep 2 · 10:58](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=658)
- Incisional biopsy or image-guided core needle biopsy is recommended for extremity rhabdomyosarcoma, taking into account tumor location and relationship to neurovascular structures. — Emily Christison-Lagay (guideline) [Ep 3 · 3:26](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=206)
- Small superficial tumors may undergo primary excision provided negative margins can be achieved and lymph function will not be compromised, but this represents a minority of situations. — Emily Christison-Lagay (guideline) [Ep 3 · 3:39](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=219)
- The biopsy tract should be incorporated into any subsequent resection, and incorrect or poorly planned biopsy may contaminate uninvolved compartments and compromise local control, limb salvage likelihood, and overall outcome. — Emily Christison-Lagay (clinical) [Ep 3 · 3:56](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=236)
- Multiple large caliber cores verified by real-time involvement of a pathologist are recommended for core needle biopsy to ensure adequate viable tissue for complete assessment of biological markers. — Emily Christison-Lagay (guideline) [Ep 3 · 4:24](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=264)
- Nodal involvement occurs in nearly a quarter of patients with rhabdomyosarcoma and is most common in fusion positive patients, those with tumors greater than 5 cm, those with extremity or trunk tumors, and those with paratesticular tumors who are older than 10 years of age. — Emily Christison-Lagay (epidemiological) [Ep 3 · 5:03](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=303)
- Current COG protocols recommend cross-sectional imaging and FDG PET to detect distant metastatic and local regional nodal disease, with lymph nodes greater than 1 cm in short axis or PET SUV max greater than 2.5 times baseline suggesting nodal involvement. — Emily Christison-Lagay (guideline) [Ep 3 · 5:24](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=324)
- Both sensitivity and specificity of PET for nodal metastasis is less than sentinel lymph node biopsy, with imaging failing to detect nodal disease in approximately half of cases for extremity and other sites, and demonstrating false positivity in other instances. — Emily Christison-Lagay (clinical) [Ep 3 · 5:24](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=324)
- Patients with extremity rhabdomyosarcomas should have a sentinel lymph node biopsy regardless of what imaging shows. — Emily Christison-Lagay (guideline) [Ep 3 · 6:04](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=364)
- Sentinel lymph node biopsy is more accurate than random lymph node sampling. — Emily Christison-Lagay (clinical) [Ep 3 · 6:14](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=374)
- There is no clinical benefit to completion nodal dissection for patients found to have positive sentinel nodes, as nodal basins found to be positive will receive radiation therapy. — Emily Christison-Lagay (clinical) [Ep 3 · 6:20](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=380)
- Dual use of technetium-99m and blue dye (isosulfan blue/lymphazurin or methylene blue) is preferred for sentinel lymph node biopsy, with technetium injected 2-4 hours prior in four quadrants around the tumor, followed by lymphoscintigraphy. — Emily Christison-Lagay (clinical) [Ep 3 · 6:32](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=392)
- Intraoperatively, 2-3 milliliters of blue dye should be injected at the beginning using the same four quadrant technique, with handheld gamma probe used to identify maximal counts and visual identification of blue nodes. — Emily Christison-Lagay (clinical) [Ep 3 · 7:06](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=426)
- Simultaneous use of both technetium and blue dye improves the success rate of sentinel node biopsy by providing both auditory and visual clues for lymph nodes. — Emily Christison-Lagay (clinical) [Ep 3 · 7:32](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=452)
- All lymph nodes in the nodal basin with counts greater than 10% of the first identified lymph node should be removed. — Emily Christison-Lagay (guideline) [Ep 3 · 7:45](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=465)
- Indocyanine green (ICG) is a water-soluble green dye with near-infrared fluorescent properties that binds to plasma proteins and tracks through the lymphovascular system, allowing sentinel node mapping with laser-assisted imaging after dermal injection in four quadrants with real-time lymphangiography. — Emily Christison-Lagay (clinical) [Ep 3 · 7:53](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=473)
- Studies in adult tumors have demonstrated excellent sensitivity and specificity using ICG with equivalent or superior results to other methods of sentinel lymph node detection, though this is still being actively investigated in children. — Emily Christison-Lagay (clinical) [Ep 3 · 8:27](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=507)
- A patient with extremity rhabdomyosarcoma at an unfavorable site with node-positive disease and upfront biopsy only is classified as stage 3, group 3, and if fusion positive, represents intermediate risk disease treated with VAC, VI plus or minus temus for 42 weeks. — Emily Christison-Lagay (guideline) [Ep 3 · 8:51](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=531)
- If complete resection appears possible without compromising function or causing significant anatomic distortion after neoadjuvant chemotherapy, delayed primary excision can be performed. — Emily Christison-Lagay (clinical) [Ep 3 · 9:41](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=581)
- Delayed primary excision with negative margins allows reduction of radiation therapy to 36 gray for R0 resection, while microscopic margins allow reduction to 41.4 gray. — Emily Christison-Lagay (guideline) [Ep 3 · 9:53](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=593)
- If delayed primary excision would not be possible with negative margins on re-imaging, there is no role for debulking and the patient would receive definitive radiation therapy with 50.4 gray. — Emily Christison-Lagay (guideline) [Ep 3 · 10:08](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=608)
- In patients who receive definitive radiation therapy, there is no role for excision of residual mass at the end of planned therapy, as these excisions frequently fail to find viable tumor, are incomplete, and engender significant morbidity. — Emily Christison-Lagay (clinical) [Ep 3 · 10:26](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=626)
- Paratesticular location for rhabdomyosarcoma is a favorable site with overall five-year survival exceeding 94% and progression-free survival exceeding 87%. — Daniel Rhee (epidemiological) [Ep 3 · 11:13](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=673)
- Children greater than 10 years of age, those with tumors greater than 5 cm in size, and those with retroperitoneal lymph node involvement comprise a subset of paratesticular rhabdomyosarcoma patients with poor prognosis. — Daniel Rhee (clinical) [Ep 3 · 11:31](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=691)
- Cross-sectional imaging of chest, abdomen, and pelvis is needed for paratesticular rhabdomyosarcoma, with chest CT to evaluate for pulmonary metastasis and abdomen/pelvis imaging with CT or MRI. — Daniel Rhee (guideline) [Ep 3 · 12:00](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=720)
- The absence of PET positivity does not rule out nodal involvement and positive findings on PET CT do not guarantee nodal involvement in paratesticular rhabdomyosarcoma. — Daniel Rhee (clinical) [Ep 3 · 12:42](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=762)
- In studies comparing PET to sentinel lymph node biopsy, of seven patients with biopsy-proven disease, three had normal FDG PET scans; of 14 patients with PET findings concerning for disease, only four had proven nodal disease, yielding positive predictive value of 30%, sensitivity of 57%, and specificity of 52%. — Daniel Rhee (clinical) [Ep 3 · 12:53](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=773)
- Histological confirmation is required to determine regional lymph node involvement in paratesticular rhabdomyosarcoma. — Daniel Rhee (guideline) [Ep 3 · 13:33](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=813)
- Paratesticular rhabdomyosarcoma requires inguinal orchiectomy with early and high ligation of the spermatic cord and retroperitoneal lymph node assessment. — Daniel Rhee (guideline) [Ep 3 · 13:47](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=827)
- Historically, routine surgical evaluation of retroperitoneal nodes was not recommended under most European protocols. — Daniel Rhee (clinical) [Ep 3 · 14:13](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=853)
- Current COG and North American approach is to perform ipsilateral retroperitoneal lymph node assessment in all patients greater than 10 years of age and for patients less than 10 who have enlarged lymph nodes on cross-sectional imaging, based on high known percentages of nodal involvement in older patients. — Daniel Rhee (guideline) [Ep 3 · 14:20](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=860)
- In SIOP studies using non-surgical strategy for evaluating retroperitoneal lymph node involvement based on cross-sectional imaging, a third of patients greater than 10 years of age experienced retroperitoneal recurrence compared to only 8% in patients less than 10. — Daniel Rhee (epidemiological) [Ep 3 · 14:40](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=880)
- Pooled analysis of European and North American studies found that patients greater than 10 years of age with tumors larger than 5 cm who underwent retroperitoneal lymph node assessment had superior outcomes compared to those who did not undergo surgical assessment. — Daniel Rhee (clinical) [Ep 3 · 15:09](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=909)
- The optimal number of nodes for retroperitoneal lymph node dissection is 8 to 12 to accurately capture nodal disease. — Daniel Rhee (clinical) [Ep 3 · 15:41](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=941)
- There is a potential role for sentinel lymph node biopsy using ICG in paratesticular tumors. — Daniel Rhee (opinion) [Ep 3 · 15:48](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=948)
- Transcrotal biopsy or excision has been reported in up to 25% of paratesticular rhabdomyosarcoma cases. — Daniel Rhee (epidemiological) [Ep 3 · 16:20](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=980)
- Historically, scrotal violation would mandate a hemiscrotomy. — Daniel Rhee (clinical) [Ep 3 · 16:24](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=984)
- Recent small data sets found that event-free survival for fusion negative patients who underwent transcrotal biopsy with subsequent inguinal radical orchiectomy was equivalent to those who underwent inguinal orchiectomy, challenging the notion that hemiscrotomy is needed to prevent increased risk of local recurrence. — Daniel Rhee (clinical) [Ep 3 · 16:31](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=991)
- Current COG recommendation is to avoid hemiscrotomy unless there is direct evidence of scrotal invasion. — Daniel Rhee (guideline) [Ep 3 · 16:53](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=1013)
- In the relatively rare group of fusion positive patients with paratesticular rhabdomyosarcoma, there may be a role for more aggressive management of scrotal violation, with the hemiscrotum potentially receiving radiation treatment and requiring contralateral transposition of the testicles. — Daniel Rhee (clinical) [Ep 3 · 17:04](https://library.globalcastmd.com/watch/technical-approaches-to-rhabdomyosarcoma-management-apsa-cancer-committee-case-s-16301?t=1024)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- An Italian study showed that a 5 centimeter tumor in a child less than 3 years old is equivalent to a 3 centimeter tumor in larger patients, suggesting 3 centimeters as the cutoff for excision versus biopsy in toddlers. — Andrea summarizing the discussion [Ep 1 · 6:54](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=414)

## Changelog
- Oct 31: 3 items added automatically

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