Hsi-Yang Wu

Publication Details

• The surgical management of paediatric bladder and prostate rhabdomyosarcoma

  Wu HY, Arab J Urol. 2013; 11 (1): 40-47

  OBJECTIVES: The surgical management of pediatric bladder/prostate rhabdomyosarcoma (B/P RMS) continues to evolve, with a goal of maximizing organ preservation while achieving successful cancer control. The timing of radiotherapy and surgical excision to improve event-free survival (EFS) and overall survival (OS) remains controversial. METHODS: A review of the English language literature on B/P RMS over the past 15 years was carried out. We focused on studies comparing the effects of radiotherapy and surgery for local control, the impact of local control on OS, and improved means of diagnosing viable tumor after chemotherapy. RESULTS: The concept of lowering the “cost of cure” drives current protocols. Bladder sparing surgery is possible for 80% of patients after initial chemotherapy, with a mean 5 year OS of 85%. Overall, 50% of patients are continent of urine, and the addition of radiotherapy may increase the risk of incontinence. Previous studies suggesting that early radiotherapy achieved better EFS than delayed radiotherapy did not control for stage and size of tumor, which are the primary determinants of EFS. Improved local control does not automatically translate into improved OS. CONCLUSIONS: The current role for surgical management in B/P RMS is to achieve local control of tumors that do not respond to chemotherapy and radiotherapy. An improved means of detecting viable tumor after initial chemotherapy would improve our ability to decide when local therapy is necessary. The continuing challenge for urologists taking care of these children is knowing when bladder sparing surgery would be the best therapy.