A 38-year-old man, a chronic smoker, presented to us with a large left upper lobe mass lesion and left-sided pleural effusion. After resection, a residual mass remained. On histopathologic examination, a diagnosis of pleiomorphic rhabdomyosarcoma stage III of the lung was made. Chemotherapy using IRS (Intergroup Rhabdomyosarcoma Study) IV protocol with radiation therapy (RT) at week 9 was planned. The tumor progressed within 6 weeks of chemotherapy to involve the diaphragm and the pericardium (inoperable disease). Chemotherapy was abandoned, and we referred the patient to receive RT, which the patient refused; and he died of progressive disease 1 month later. The poor response to chemotherapy suggests that alternative treatment modalities including RT/second-look surgery or novel chemotherapeutic strategies should be tried in such a case.
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