not-yet-known not-yet-known not-yet-known unknown Panel deliberation. Early preoperative radiation therapy is used in selected sites (excluding extremities and para-meningeal) for initially unresectable tumors prior to second look surgery33. However, this strategy is not associated with a significantly improved outcome. Preoperative radiotherapy may be utilized particularly if this approach facilitates complete resection with preservation of form and function. The risks of operating in a radiated field should be weighed carefully against the benefit of RT-induced preoperative tumor response. RT is often used after surgical resection in cases with positive resection margin, those who underwent delayed primary resection, and for regional and distant metastatic sites. Multimodality therapy as a combination of chemotherapy, surgery, and radiation therapy is indicated for most RMS patients. Early referral to a radiation oncologist should be performed to avoid delaying radiation therapy after resection. Radiation therapy is utilized in RMS management as the primary local control modality for sites that are usually not amenable to effective and function-preserving surgical options; local control of most parameningeal RMS is accomplished with radiotherapy without resection34-36. Local treatment for vaginal tumors typically involves a combination of chemotherapy, radiation therapy, and surgery. In many cases, delayed surgery is limited to biopsy or polypectomy without resecting the vaginal wall. More extensive surgical procedures are generally discouraged due to the favorable outcomes achieved with RT, especially brachytherapy37. The panel suggests resection with a 0.5 cm margin of normal tissue for patients with RMS at the time of surgical local control. (Weak recommendation, Certainty of evidence: Very Low) We found no comparative studies that assessed resection with a margin of 0.5 cm versus a 2 cm margin.