Background In pediatric rhabdomyosarcoma (RMS), evaluation of lymph node involvement (N1) is an important staging aspect, but difficult to assess. The aim of our study was to evaluate the assessment of lymph node infiltration and impact on outcome in N1 RMS patients. Methods We identified 277 non-metastatic RMS patients diagnosed and treated between 1990 and 2008. Patients with recorded N1 disease were evaluated for their diagnostic procedures and outcome. Results In 13.7% N1 status was reported. In 19 of 34 N1 patients, lymph node biopsies were performed for histologically confirmation. Different treatment modalities were used to treat lymph node metastases. In total 23 of 31 patients received local treatment of the node (11/23 RT, 4/23 surgery, and 8/23 both). All patients received chemotherapy. Lymph node relapse occurred in 7 of 31 patients who were treated with one or two modalities. Only 1 (14%) of 8 patients treated with three modalities relapsed. In N0 patients 10 (4.2%) of 239 had a regional lymph node relapse, and 9 of 10 died. Conclusion Lymph node metastases are an essential part of staging. Node positivity contributes to relapse of disease. Nodal relapse is also associated with a high mortality rate. These data imply that nodal assessment needs to be optimal and standardized for improved staging.

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Journal of Pediatric Surgery
Department of Pediatric Surgery

Terwisscha van Scheltinga, S., Spronk, P., van Rosmalen, J., Wijnen, M., Heij, H. A., van Baren, R., … Wijnen, R. (2014). Diagnosis and treatment of lymph node metastases in pediatric rhabdomyosarcoma in the Netherlands: A retrospective analysis. Journal of Pediatric Surgery, 49(3), 416–419. doi:10.1016/j.jpedsurg.2013.08.002