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World J Obstet Gynecol. Feb 10, 2016; 5(1): 110-117
Published online Feb 10, 2016. doi: 10.5317/wjog.v5.i1.110
Overview of embryonal rhabdomyosarcoma of cervix in women over 40-year-old
Malala Razakanaivo, Nam P Nguyen, Juliette Thariat, Vincent Molinie, Anne-Therese Vlastos, Claire Verschraegen, Vincent Vinh-Hung
Malala Razakanaivo, Joseph Ravoahangy Andrianavalona University Hospital, Antananarivo 101, Madagascar
Nam P Nguyen, Radiation Oncology, Howard University Hospital, Washington, DC 20060, United States
Juliette Thariat, Antoine-Lacassagne Cancer Center, University Nice Sophia Antipolis, 06189 Nice Cedex, France
Juliette Thariat, Rare Cancer Network, Lausanne 1011, Switzerland
Vincent Molinie, Department of Pathology, University Hospital of Martinique, Fort-de-France 97200, Martinique
Anne-Therese Vlastos, Geneva Gynecology and Obstetrics, Place des Philosophes, 1205 Geneva, Switzerland
Claire Verschraegen, Division of Hematology Oncology, University of Vermont Cancer Center, Burlington, VT 05405, United States
Vincent Vinh-Hung, Radiation Oncology, University Hospital of Martinique, Fort-de-France 97200, Martinique
Vincent Vinh-Hung, Radiotherapy Department, UZ Brussel, Vrije Universiteit Brussel, 1090 Jette, Belgium
Nam P Nguyen, Juliette Thariat, Vincent Vinh-Hung, International Geriatric Radiotherapy Group (http://igrg.org/), Washington, DC 20060, United States
Author contributions: Original concept and design were developed by Nguyen NP, Thariat J and Vinh-Hung V; literature search was performed by Razakanaivo M, Nguyen NP, Verschraegen C and Vinh-Hung V; data revisions were carried out by Nguyen NP, Thariat J, Verschraegen C and Vinh-Hung V; statistical analyses were performed by Vinh-Hung V; Razakanaivo M, Molinie V and Vlastos AT contributed to the writing of the manuscript; all authors approved the final version.
Conflict-of-interest statement: The authors have no conflicts of interests to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Vincent Vinh-Hung, MD, PhD, Radiation Oncology, University Hospital of Martinique, Hôpital Clarac, Bd Pasteur, Fort-de-France 97200, Martinique. anhxang@gmail.com
Telephone: +596-696-542019 Fax: +596-596-632254
Received: June 27, 2015
Peer-review started: June 30, 2015
First decision: August 16, 2015
Revised: November 11, 2015
Accepted: December 13, 2015
Article in press: December 14, 2015
Published online: February 10, 2016
Abstract

The literature on cervical embryonal rhabdomyosarcoma (RMS) is reviewed here to identify management guidelines for middle-aged women diagnosed with this rare type of gynecologic cancer. Specifically, the PubMed, Web of Science and Google Scholar databases, were searched to find published case series on cervical embryonal RMS reporting on four or more patients, of whom at least one was > 40-year-old. The χ2 test was used to assess heterogeneity. Five articles published between 1986 and 2013 were identified, reporting on a total of 47 patients, of whom 22 (46.8%) were older and 25 (53.2%) younger than 40-year-old. Although the two age groups did not differ significantly by stage of disease or radiotherapy treatment, the older age group received less chemotherapy (55% vs 90%, P = 0.008) and had more hysterectomy (86% vs 43%, P = 0.009). Follow-up data was missing for 18/47 (38.3%) patients. Among the 29 patients with follow-up data, survival was shorter in the older group, with 8/12 (67%) alive and 3 with disease at a median follow-up of 2.6 years, as compared with the younger group that had 15/17 (88%) alive and none with disease at a median follow-up of 3.5 years. The longest survivals among the older women were observed in those who received radiotherapy, including one case with a resected lung metastasis. A prospective multi-institutional collaboration and better follow-up are needed to determine the optimal management of cervical embryonal RMS. Long-term survival appears feasible if management is accompanied by chemotherapy and radiotherapy.

Keywords: Embryonal rhabdomyosarcoma, Botryoid sarcoma, Cervix, Middle-aged adults, Chemotherapy, Radiotherapy, Review

Core tip: The present review of adult cervical embryonal rhabdomyosarcoma case series summarizes 5 studies reporting on 47 female patients, 22 of whom were > 40-year-old. Women over 40 had worse disease-free survival but also received less chemotherapy administration. Although radiotherapy was not often used, the longest survival in the > 40 age group was observed among those who received radiotherapy, including a case with resected lung metastasis. The review argues for multimodality management in this rare disease.