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.