Recommendations for Radiation Treatment in Pediatric Patients With Metastatic Rhabdomyosarcoma: Expert Consensus From the International Soft Tissue SaRcoma ConsorTium (INSTRuCT).

PURPOSE: The International Soft Tissue Sarcoma Database Consortium is a collaboration of the North American and European pediatric oncology cooperative groups that aims to provide treatment recommendations for pediatric patients' sarcoma diagnoses.

METHODS AND MATERIALS: The International Soft Tissue Sarcoma Database Consortium radiation oncology committee has developed international consensus guidelines for the use of radiation for local therapy in pediatric patients with metastatic rhabdomyosarcoma (RMS) based on grade and quality of evidence. Specifically, the guidelines address management based on disease burden, disease location, and local therapy options that focus on radiation techniques.

RESULTS

Patients who present with metastatic RMS at initial diagnosis should be strongly considered for definitive therapy to the primary site and radiation to involved regional lymph nodes after neoadjuvant chemotherapy. When feasible, local treatment of all sites of disease is recommended. Evaluation of the location, size, and extent of disease and patient prognosis should be used when deciding which radiation dose and modality therapy is most appropriate for metastatic disease.

CONCLUSIONS

Although the evidence is limited, these consensus guidelines highlight consensus positions regarding the best practice treatment to assist providers as they navigate treatment decisions for their pediatric patients with metastatic RMS.