Abstract
Appropriate imaging is essential in the treatment of children and adolescents with rhabdomyosarcoma. For adequate stratification and optimal individualised local treatment utilising surgery and radiotherapy, high-quality imaging is crucial. The paediatric radiologist, therefore, is an essential member of the multi-disciplinary team providing clinical care and research. This manuscript presents the European rhabdomyosarcoma imaging guideline, based on the recently developed guideline of the European Paediatric Soft Tissue Sarcoma Study Group (EpSSG) Imaging Committee. This guideline was developed in collaboration between the EpSSG Imaging Committee, the Cooperative Weichteilsarkom Studiengruppe (CWS) Imaging Group, and the Oncology Task Force of the European Society of Paediatric Radiology (ESPR). MRI is recommended, at diagnosis and follow-up, for the evaluation of the primary tumour and its relationship to surrounding tissues, including assessment of neurovascular structures and loco-regional lymphadenopathy. Chest CT along with [F-18]2-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET)/CT or PET/MRI are recommended for the detection and evaluation of loco-regional and distant metastatic disease. Guidance on the estimation of treatment response, optimal long-term follow-up, technical imaging settings and standardised reporting are described. This European imaging guideline outlines the recommendations for imaging in children and adolescents with rhabdomyosarcoma, with the aim to harmonise imaging and to advance patient care.
Highlights
Medical imaging has a primary role in the care of children and adolescents with rhabdomyosarcoma, the most common softtissue sarcoma in childhood [1, 2]
The treatment for paediatric patients with rhabdomyosarcoma is based on a multimodality approach: chemotherapy in combination with surgery or radiotherapy, in high-risk patient categories followed by maintenance chemotherapy
What is needed to perform further studies? We will only be able to perform large reliable validating studies by: (1) collaborating and extending the network of paediatric radiologists and nuclear medicine physicians actively involved in imaging research; (2) actively engaging in and sharing research interests; (3) creating willingness to tailor and harmonise protocols; (4) sharing data for central review and connecting with imaging researchers; (5) providing a platform suitable for systematic pseudonymised collection of standardised imaging data as part of prospective clinical trials; and (6) connecting the imaging data with clinically relevant output, to explore radiomics and methods like machine learning. This manuscript illustrates the European guideline for imaging of rhabdomyosarcoma in children and adolescents, on behalf of the European Paediatric Soft Tissue Sarcoma Study Group (EpSSG) Imaging Committee, the Cooperative Weichteilsarkom Studiengruppe (CWS) Imaging Group and the Oncology Task Force of the European Society of Paediatric Radiology (ESPR)
Summary
Medical imaging has a primary role in the care of children and adolescents with rhabdomyosarcoma, the most common softtissue sarcoma in childhood [1, 2]. Children with rhabdomyosarcoma of the extremities [29, 34, 35] and people age 10 years and older with paratesticular rhabdomyosarcoma [36,37,38,39] should receive surgical staging of nodes irrespective of imaging results This is strongly recommended, in line with current EpSSG and International Softtissue Sarcoma Database Consortium (INSTRuCT) surgery guidelines, because some clinically and radiologically normal-appearing lymph nodes show tumour cells on histological examination [29, 36, 38, 39]. What is needed to perform further studies? We will only be able to perform large reliable validating studies by: (1) collaborating and extending the network of paediatric radiologists and nuclear medicine physicians actively involved in imaging research; (2) actively engaging in and sharing research interests; (3) creating willingness to tailor and harmonise protocols; (4) sharing data for central review and connecting with imaging researchers; (5) providing a platform suitable for systematic pseudonymised collection of standardised imaging data as part of prospective clinical trials; and (6) connecting the imaging data with clinically relevant output, to explore radiomics and methods like machine learning
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