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Treatment for children and adolescents with soft-tissue sarcoma often entails surgery, followed by both chemotherapy and radiation therapy. Recently, German researchers reported that individuals who are at low risk to suffer a recurrence (return) of the cancer after surgery and/or chemotherapy may be given lower than usual doses of radiation therapy, without compromising survival.

Soft-tissue sarcoma, a rare cancer in children and adolescents, is characterized by the presence of cancer cells in the soft tissues of the body. The cancer can begin growing in a number of soft tissue types, including muscles, tendons, connective tissue (called

fibrous tissue), fat, blood vessels, nerves, and the tissue around the joints (called

synovial tissue). The cancer can develop in any part of the body, but in children and adolescents, it most often affects the arms, legs, or trunk area. There are many different types of childhood soft-tissue sarcomas, with rhabdomyosarcoma being the most common.

Treatment options for children and adolescents with soft-tissue sarcoma depend on the specific location, type, and

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stage of disease (extent of cancer at diagnosis). Usually, individuals with soft-tissue sarcoma first undergo surgery to remove as much of the cancer as possible. After surgery, they often receive an intensive combination of chemotherapy and radiation therapy to kill any remaining cancer cells and to help prevent a

recurrence (return) of the cancer later. However, some children and adolescents are at a higher risk to suffer a recurrence than others. Because radiation therapy can produce unwanted side effects in children, researchers have sought to determine which patients are at low risk for recurrence, so that the radiation therapy can be reduced in these individuals.

Researchers from Germany evaluated the treatment outcomes of 372 children and adolescents with soft-tissue sarcoma. The patients received a combination of chemotherapy and radiation therapy, with those at low risk for recurrence receiving a reduced dose of radiation therapy. Those who survived without any recurrence of the cancer included 83% of those who had stage I disease, 69% of those who had stage II disease, 57% of those who had stage III disease, and 19% of those who had stage IV disease. The most common problem for those in whom the treatment failed was a recurrence of cancer, with 14% having the recurrence at the original site of cancer development.

The researchers concluded that reducing the dose of radiation therapy for children and adolescents with soft-tissue sarcoma at low risk for a recurrence was effective, allowing avoidance of the side effects of higher dose therapy without compromising survival rates. Parents of children or adolescents with soft-tissue sarcoma may wish to talk with their doctor about the risks and benefits of receiving standard-dose versus reduced-dose radiation therapy or of participating in a clinical trial in which promising new chemotherapy/radiation therapy treatments are being studied. (

Journal of Clinical Oncology, Vol 17, No 12, pp 3706-3717, 1999)

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