Panel deliberation.
Titanium clips should be used in the tumor bed to identify the site of any probable microscopic or gross residual tumor. Radiation oncologists use these clips to precisely target the area where the tumor was located, minimizing radiation exposure to surrounding healthy tissues. Overall, the use of titanium clips for marking the resection bed in RMS surgery is a standard practice that enhances precision in further local control planning. Techniques to mitigate postoperative clip migration include ensuring the clip is placed exactly at the area of the tissue of interest, placing clips in a series or at multiple points along corners of the resection bed, and applying clips between two knots of a securely placed Prolene suture.
The panel does not suggest late resection after completion of therapy in patients with RMS. (Weak recommendation; Certainty of evidence: Very Low, Supplemental Table S7)
We identified eight comparative studies (seven retrospective cohort studies and one prospective nested cohort study) enrolling 939 patients assessing late resection after completion of therapy versus no resection. The overall certainty of evidence is very low. Pooled results showed no significant difference in overall mortality, relapse, need for additional intensive therapy, or non-relapse mortality.