April 2025: Local Control for Pediatric Rhabdomyosarcoma of the Extremities: Is Radiotherapy Always Required After Adequate Surgical Resection?

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and young adults. Typically, treatment involves a multimodal approach, with radiotherapy (RT) being a standard choice alongside surgical resection for local control, particularly in cases harboring fusions involving FOXO1. However, the long-term consequences of offering RT especially to the extremity in children can be significant including growth delay, contracture, arthritis, and secondary malignancy. Herein, we report the outcome of 10 consecutive patients with extremity RMS from two high-volume institutions who did not receive RT to primary site.  Despite the absence of adjuvant RT to the primary tumor site, 90 % of this cohort patients experienced no local failure and the single patient with local failure was subsequently salvaged with RT and further chemotherapy. By presenting this distinctive real-world data, our aim is to illustrate that in a select highvolume pediatric sarcoma center, extremity RMS can potentially be effectively managed through surgery and chemotherapy alone.