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Importance of whole-body imaging with complete coverage of hands and feet in alveolar rhabdomyosarcoma staging

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Abstract

Background

Alveolar rhabdomyosarcoma commonly arises in the extremities and is characterized by aggressive biology and high frequency of metastases. Whole-body imaging is increasingly employed in pediatric oncology but not recommended as standard in the staging of soft-tissue sarcomas.

Objective

After observing patients with a large symptomatic alveolar rhabdomyosarcoma lesion and a smaller silent lesion in the more distal part of an extremity we sought to estimate the frequency of this constellation.

Materials and Methods

We retrospectively evaluated the data of prospectively registered paediatric patients (age <21 years) with alveolar rhabdomyosarcoma in the SoTiSaR (Soft Tissue Sarcoma Registry) of the Cooperative Weichteilsarkom Studiengruppe (CWS) 09/2011–04/2015 with regard to whole-body imaging.

Results

Seventy-five patients were eligible. Images of 57 patients had been submitted for reference consultation, including 80 whole-body examinations in 36 patients. Among them were 5 patients (14%, 95% confidence interval 3–25%) who had been diagnosed because of a symptomatic lesion while an additional silent lesion in the distal part of an extremity had remained unnoticed and had only been detected by later whole-body imaging. It is noteworthy that in 42 (53%) of all 80 whole-body examinations, the hands and feet had been only partially covered or completely excluded.

Conclusion

In alveolar rhabdomyosarcoma silent lesions can be overlooked when the distal parts of the limbs are not thoroughly examined and not completely covered by imaging. Missing them influences treatment decisions and prognosis. Our results should be considered when evaluating the potential role of whole-body imaging in rhabdomyosarcoma.

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Acknowledgements

We are indebted to the personnel of all participating institutions and thank all patients, parents and guardians for their willingness to participate in the CWS-trials.

The study was supported by the German Childhood Cancer Foundation, Bonn; German Cancer Aid, Bonn; Federal Ministry of Research and Technology, Bonn, and the Förderkreis Krebskranke Kinder e.V., Stuttgart, Germany.

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Authors and Affiliations

  1. Stuttgart Cancer Center, Peadiatric 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart-Olgahospital, Kriegsbergstrasse 62, D-70174, Stuttgart, Germany

    Monika Scheer, Tobias Dantonello, Simone Feuchtgruber, Monika Sparber-Sauer, Stefan S. Bielack & Ewa Koscielniak

  2. Department of Oncology, University Hospital Bonn, Bonn, Germany

    Peter Brossart

  3. Department of Paediatric Oncology, University Hospital Bonn, Bonn, Germany

    Dagmar Dilloo

  4. Department of Paediatric Oncology, Helios Klinikum, Buch, Berlin, Germany

    Lothar Schweigerer

  5. Kiel Peadiatric Tumour Registry, Department of Pediatric Pathology, University Hospital Kiel, Kiel, Germany

    Christian Vokuhl

  6. Department of Paediatric Hematology and Oncology, University Children’s Hospital, Muenster, Germany

    Stefan S. Bielack

  7. Department of Paediatric Oncology, University of Frankfurt (Main), Frankfurt, Germany

    Thomas Klingebiel

  8. Department of Paediatric Oncology, University of Tuebingen, Tuebingen, Germany

    Ewa Koscielniak

  9. Institute of Paediatric Radiology, Klinikum Stuttgart-Olgahospital, Stuttgart, Germany

    Thekla von Kalle

  10. Department of Radiology, Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany

    Thekla von Kalle

Authors
  1. Monika Scheer
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  2. Tobias Dantonello
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  3. Peter Brossart
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  4. Dagmar Dilloo
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  5. Lothar Schweigerer
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  6. Simone Feuchtgruber
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  7. Monika Sparber-Sauer
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  8. Christian Vokuhl
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  9. Stefan S. Bielack
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  10. Thomas Klingebiel
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  11. Ewa Koscielniak
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  12. Thekla von Kalle
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on behalf of the Cooperative Weichteilsarkom Studiengruppe (CWS)

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Correspondence to Monika Scheer.

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Scheer, M., Dantonello, T., Brossart, P. et al. Importance of whole-body imaging with complete coverage of hands and feet in alveolar rhabdomyosarcoma staging. Pediatr Radiol 48, 648–657 (2018). https://doi.org/10.1007/s00247-017-4066-8

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  • DOI: https://doi.org/10.1007/s00247-017-4066-8

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