Prognostic role of pleural effusion or ascites in localized rhabdomyosarcoma

Purpose: The presence of pleural effusion or ascites at the time of diagnosis is generally considered a poor prognostic factor for children with rhabdomyosarcoma (RMS), and treatment is usually intensified despite the fact that there are no published studies to support this decision. We investigated the prognostic role of the presence of pleural effusion or ascites at diagnosis in patients with localized RMS consecutively enrolled in the Italian Soft Tissue Sarcoma Committee protocols over a 30-year period. Methods: We reviewed the radiological reports at diagnosis of 150 children with supradiaphragmatic and infradiaphragmatic RMS, noting any presence of effusion and its extent (minimal, moderate, or massive). All patients received intensive chemotherapy, surgery, and standard or hyperfractionated radiotherapy. Results: Effusion was identified in 32 children (21.3%), 14 with pleural effusion and 18 with ascites. As for its extent, 13 children presented with minimal, 12 with moderate, and 7 with massive effusion. The 5-year progression-free survival (PFS) rate was 49.8% (confidence interval [CI] 31.7–65.5) and 49.5% (CI 40–58.2) for patients with and without effusion, respectively (P =.5). When only patients with moderate or massive effusion were considered, however, their PFS was 36.8% (CI 16.5–57.5) versus 51.2% (CI 42.2–59.5) in patients with minimal or no effusion (P =.01). On the whole, patients with pleural effusion had a very poor outcome with a 5-year PFS of 35.7% (CI 13–59.4). Conclusions: The presence of moderate or massive effusion seems to be an unfavorable prognostic factor in children with RMS, and justifies their inclusion in experimental studies.