In the Netherlands, some 20-25 children are diagnosed each year with rhabdomyosarcoma, the most common childhood soft tissue tumor. Eight out of ten children survive their disease in the long term. Children stay in follow-up for years after treatment with a combination of chemotherapy, radiation and/or surgery.
Just as treatments for children with cancer change over time and are adapted thanks to new possibilities, so too does the post-treatment follow-up phase. An international study looked at the benefit of regular MRI scans in the period after the end of treatment in children treated for a rhabdomyosarcoma. The purpose of these scans was to pick up early signs of the tumor coming back. The investigation was featured in the Volkskrant newspaper today.
This research has shown that regular MRI scans in the time from two years after the end of treatment do not help improve survival, while they are a burden for the child and parents. After all, many of the children are young, which means that the MRI can only be performed under anesthesia. Follow-up MRI scans also often lead to significant stress for parents and children in the weeks surrounding the check-up: ‘will the disease still be gone?’
Based on the study results, the international guideline has now been changed for monitoring children with rhabdomyosarcoma. Previously, children received a total of 12 MRI scans after their treatment for 5 years; from now on, these MRI checks will be limited to the first two years after the end of treatment. In that time, children receive an MRI scan every four months in combination with a lung scan. After the initial two-year period, patients are still regularly seen in the outpatient clinic for a lung X-ray, but no routine MRI is performed. An MRI is only made if there are symptoms during that time that could indicate that the tumor has returned. As a result, the number of MRI scans that children have to undergo after the end of their treatment has been halved from 12 to 6 scans.
This treatment guideline change only applies to children with a rhabdomyosarcoma who started their treatment after September 2020. In the past, the guidelines for follow-up after treatment have also been adapted on the basis of research for a number of other forms of childhood cancer. For example, in children with leukemia: in the first year after the end of the therapy, follow-up included regularly taking tissue samples from bone marrow, a painful procedure that today takes place under anesthesia. These bone marrow biopsies did not to lead to a better survival and were phased out years ago, a change that was welcomed by patients and their parents.
The study on the basis of which the guideline was adapted was led by dr. Hans Merks, and was published last year in the journal Cancer. An opinion piece about the research was published yesterday in the Dutch Journal of Medicine. If you have any questions based on this publication, please contact: firstname.lastname@example.org.