Paraaortic lymphadenectomy is not necessary in the treatment of localized paratesticular rhabdomyosarcoma

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Abstract
Paraaortic lymphadenectomy is routinely recommended to treat paratesticular rhabdomyosarcoma (RMS) because of the high incidence of lymph node involvement. Taking into account the effectiveness of chemotherapy to sterillize micrometastases and aiming to reduce short-term and long-term side effects due to lymph node dissection, the RMS Group of the SIOP decided to avoid lymphadenectomy in Stage I paratesticular RMS defined by (1) complete tumor removal with negative cord section and (2) negative pedal lymphangiography. A series of 19 children (mean age 5 years, 6 months), treated between 1971 and 1981, were analyzed. Eighteen of 19 patients received adjuvant chemotherapy, using vincristine, actinomycin, cyclophosphamide, singly or alternately with vincristine, Adriamycin (doxorubicin) every 3 weeks. Duration was either 18 months (7 cases) or 8 months (11 cases). Fourteen patients are in first remission with a follow-up of more than 3 years (median 5 years); three are disease-free 35, 23, and 20 months since diagnosis; two patients are alive without evolutive disease, 32 and 56 months after an abdominal relapse. Results obtained in this series demonstrate the ineffectiveness of systematic paraaortic lymphadenectomy in Stage I paratesticular RMS and the effectiveness of chemotherapy to eradicate occult micrometastases, which obviously may exist in paraaortic lymph nodes in spite of apparently normal lymphographic findings.