Does the presence of anaplasia in embryonal rhabdomyosarcoma change your treatment approach?  

No. While there was concern in the past that ERMS with anaplasia may demonstrate a worse prognosis, more recent analyses have shown that isn't the case. A recent publication of the Children's Oncology Group experience by Shenoy et al. nicely summarizes the data from 5 recent RMS trials involving bot...

The only thing I would add is that I have a low threshold for genetics referral/genetic testing in those patients as they have high rates of Li-Fraumeni Syndrome (Hettmer et al., PMID 24382691). Additionally, somatic p53 mutations within the tumor occur in about 25% of anaplastic rhabdomyosarcoma. T...