What is the role of surgery in the treatment of rhabdomyosarcoma?

Updated: Feb 01, 2019
  • Author: Amelia F Drake, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Unlike other regions of the body where rhabdomyosarcoma can occur, the head and neck region is limited by anatomic constraints; therefore, surgical treatment in this area must be altered accordingly. For superficial nonorbital lesions, wide excision is recommended. A cuff of normal tissue is always resected with the neoplastic tissue; however, narrow margins are accepted because of the anatomic restrictions.

Rhabdomyosarcoma of the orbit does not require surgical exenteration at the time of initial resection. Initial surgery is aimed only at biopsy for diagnosis. Exenteration is reserved for recurrent or locally persistent disease. If evidence suggests microscopic residual disease after initial surgical resection of head and neck rhabdomyosarcoma, a second operation with wide margins before chemotherapy may also improve the prognosis.

Surgery plays a limited role in the treatment of metastatic disease. It is indicated only in the context of persistent pulmonary metastases after chemotherapy and irradiation, and it is considered an option only if pulmonary function can be adequately maintained.

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