Lymph node management in patients with paratesticular rhabdomyosarcoma

A population-based analysis

Authors

  • Nguyen D. Dang MD,

    1. Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas
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  • Phuong-Thanh Dang BS,

    1. Tulane School of Medicine, New Orleans, Louisiana
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  • Jason Samuelian DO,

    1. Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas
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  • Arnold C. Paulino MD

    Corresponding author
    1. Department of Radiation Oncology, The Methodist Hospital and The Methodist Hospital Research Institute, Houston, Texas
    2. Department of Pediatrics, Pediatric Hematology/Oncology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
    • Corresponding author: Arnold C. Paulino, MD, Department of Radiation Oncology, The Methodist Hospital, 6565 Fannin St, DB1-077, Houston, TX 77030; Fax: (713)-441-4493; apaulino@tmhs.org

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Abstract

BACKGROUND

Paratesticular rhabdomyosarcoma (PTRMS) is the most common primary solid tumor arising from the mesenchymal tissue of the testis. Traditionally, retroperitoneal lymph node dissection is not recommended for children aged <10 years because of the morbidity of the procedure and low risk of retroperitoneal lymph node involvement. In the current study, the authors analyzed the patient and tumor characteristics of PTRMS as well as survival outcomes associated with lymph node dissection status.

METHODS

A total of 255 cases of PTRMS were identified from the patient data reported by the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute from 1973 through 2009.

RESULTS

Among 173 patients aged ≥10 years, lymph node dissection was found to improve the 5-year overall survival (OS) rate from 64% to 86% (P < 0.01). Conversely, patients aged <10 years fared extremely well regardless of lymph node dissection status; the 5-year OS rate was 100% and 97%, respectively, for patients who did versus those who did not undergo lymph node dissection (P = .37). The yield of positive lymph nodes was approximately ≥ 20% when < 11 lymph nodes were removed. The incidence of lymph node involvement was also higher in older patients compared with younger patients (40% vs 8%). Radiotherapy improved the OS rate in patients with lymph node involvement (5-year OS rate: 90% with vs 36% without radiation; P < .0001).

CONCLUSIONS

Lymph node dissection is recommended in patients aged ≥10 years. Radiotherapy is beneficial in patients with lymph node-positive disease. Cancer 2013;119:3228–3233. © 2013 American Cancer Society.

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