小児前立腺横紋筋肉腫再発の1例

Abstract

A rare case of prostatic rhabdomyosarcoma in a 3-year-old child is presented. He received a multimodal treatment of chemotherapy including vincristine, cyclophosphamide, actinomycin-D plus adriamycin, and linac irradiation followed by total prostatectomy with segmental resection of bladder. Despite no viable sarcoma cells in the surgical specimen, he showed relapse 4 months later. By the combination of cisplatin, vinblastine and peplomycin (PVP therapy), the bulky mass in the pelvis rapidly reduced by 95%. Furthermore, cisplatin, etoposide and peplomycin (PEP therapy), instead of PVP therapy, were administered to the refractory disease. Although the residual tumor was salvaged after 7 courses of PEP therapy, abdominal dissemination and liver metastasis occurred 2 months postoperatively. The combined modality of vincristine, peplomycin, ifosfamide, methotrexate, adriamycin, melphalan plus nimustine, and irradiation of microtron were effective for the abdominal dissemination, but he died of cerebral hemorrhage 31 months after the start of treatment. We emphasize that more aggressive chemotherapy including cisplatin, etoposide and so on is required to manage the advanced, relapsed, or resistant cases compared to the usual modality of rhabdomyosarcoma.