Clinical Significance of Indeterminate Pulmonary Nodules at Diagnosis in Pediatric Rhabdomyosarcoma


Key Points

  • Overall, indeterminate pulmonary nodules were found at diagnosis in 21% of patients.
  • No difference in event-free or overall survival was observed for patients with indeterminate nodules vs no nodules.

In a study reported in the Journal of Clinical Oncology, Vaarwerk et al found that presence of indeterminate pulmonary nodules at diagnosis of pediatric rhabdomyosarcoma did not adversely affect treatment outcome in otherwise localized disease.

The study involved 316 patients from the European Paediatric Soft Tissue Sarcoma Study Group Rhabdomyosarcoma 2005 study with presumed nonmetastatic rhabdomyosarcoma treated in large pediatric oncology centers in the United Kingdom, France, Italy, and the Netherlands. Patients included in the current analysis received a diagnosis between September 2005 and December 2013 and had available chest computed tomography scans that were performed at time of diagnosis.

Indeterminate pulmonary nodules were defined as ≤ 4 nodules of < 5 mm or 1 nodule of ≥ 5 to < 10 mm. In the trial, chemotherapy treatment did not differ on the basis of presence of indeterminate pulmonary nodules.

Association With Outcome

Among the 316 patients, 67 (21.2%) had indeterminate pulmonary nodules on imaging and 249 patients (78.8%) had no pulmonary nodules at diagnosis. Median follow-up for survivors was 75.1 months. At 5 years, event-free survival was 77.0% among patients with indeterminate nodules vs 73.2% among those without nodules (P = .68) and overall survival was 82.0% vs 80.8% (P = .76).

The investigators concluded, “Our study demonstrated that indeterminate pulmonary nodules at diagnosis do not affect outcome in patients with otherwise localized rhabdomyosarcoma. There is no need to biopsy or upstage patients with rhabdomyosarcoma who have indeterminate pulmonary nodules at diagnosis.”

Johannes H.M. Merks, MD, PhD, of the Princess Máxima Center for Pediatric Oncology, Utrecht, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by Foundation KiKa. The study authors' full disclosures can be found at

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