Optimizing rhabdomyosarcoma treatment: Assessing the role of imaging and local treatment in pediatric rhabdomyosarcoma

This thesis is focused on pediatric patients with rhabdomyosarcoma. The first part is focused on questions around the value of imaging techniques and measurements performed at time of diagnosis, during treatment and during follow-up. The second part is focused on local therapy in patients with head-neck rhabdomyosarcoma.
Radiological and functional imaging play an important role in the diagnosis, during treatment and during follow-up in pediatric patients with rhabdomyosarcoma, however the evidence for decision-making based on these images was ambiguous at best. The first part of this thesis consist of three cohort studies assessing the following aspects; 1. The significance of small pulmonary nodules in newly diagnosed patients, 2. The value of early radiological response to chemotherapy on survival, 3. The value of surveillance imaging after end-of-treatment. Furthermore, it contained two systematic reviews assessing current available evidence on the prognostic value of early radiological response on survival and the accuracy of ¹⁸F-FDG-PET/CT for the detection of distant metastases in newly diagnosed patients. Finally, the views and experiences of parents during the follow-up period was evaluated.
Around 40% of all rhabdomyosarcoma cases occur in the head-neck area. Patients treated for head-neck rhabdomyosarcoma frequently suffer from adverse events, mainly caused by local therapy. In the second part of this thesis we evaluated the psychosocial well-being of survivors of head-neck rhabdomyosarcoma. Furthermore, we reported on the results of our local experience with a local therapy approach combining surgery, brachytherapy and reconstructive surgery in patients with relapsed head-neck rhabdomyosarcoma after prior radiotherapy.