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Embryonal Rhabdomyosarcoma: Adjuvant and Ex Vivo Assay-Directed Chemotherapy
  1. Karen S. Ballard, DO*,
  2. Sean S. Tedjarati, MD,
  3. William R. Robinson, MD,,
  4. Howard D. Homesley, MD§ and
  5. Erin L. Thurston, MD
  1. *Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Greenville, NC;
  2. Texas Tech University Health Sciences Center;
  3. Harrington Cancer Center, Amarillo, TX;
  4. §Brody School of Medicine, East Carolina University, Greenville, NC; and
  5. Greenville Hospital System University Medical Center, Greenville, SC.
  1. Address correspondence and reprint requests to Karen S. Ballard, DO, Department of Obstetrics and Gynecology, Leo Jenkins Cancer Center, 2S-12 Brody Medical Sciences Bldg, Greenville, NC 27834. E-mail: carrieballard{at}hotmail.com.

Abstract

The aim of this retrospective study was to evaluate differences in treatment of embryonal rhabdomyosarcoma (RMS) of the uterus in 2 premenopausal women. We discuss adjuvant chemotherapy and use of ChemoFx Assay (Precision Therapeutics, Pittsburgh, PA) to guide choice of active chemotherapeutic agents. Two premenopausal patients were identified with a pathologic diagnosis of embryonal RMS of the uterus. Both met inclusion criteria for the study. A 21-year-old woman underwent a staging abdominal hysterectomy for a variant of embryonal RMS. Vincristine, actinomycin D, and cyclophosphamide were given adjunctively for a complete response. A 20-year-old woman underwent a diagnostic dilation and curettage revealing embryonal RMS. Initial treatment included an abdominal hysterectomy and nodal sampling. Presentation to a subsequent gynecologic oncologist 7 months later revealed recurrence. Carboplatin, doxorubicin, and paclitaxel provided a partial response. After a second surgical resection, ChemoFx Assay identified ifosfamide and mitomycin C as active agents and resulted in a complete response. Recommended treatment includes surgery and chemotherapy with possible radiation therapy if deemed necessary. The benefit of adding neoadjuvant or adjuvant chemotherapy and radiation therapy allows for a conservative surgical approach and improved survival. Choosing active chemotherapy agents can be aided by ChemoFx Assay. The chemotherapy most commonly used for treatment of embryonal RMS is a combination of vincristine, actinomycin D, and cyclophosphamide.

  • Embryonal rhabdomyosarcoma
  • Ex Vivo Assay
  • Adjuvant chemotherapy

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