DISCUSSION
This study convened a diverse international panel to develop
evidence-based recommendations for the surgical management of
rhabdomyosarcoma (RMS). Our effort underscores the importance of
standardizing surgical practices in a condition where treatment
approaches can significantly vary across different regions and
healthcare systems. The panel formulated ten recommendations aimed at
addressing critical questions identified by experts in the field,
reflecting both clinical significance and the practical needs of diverse
healthcare settings.
A notable limitation highlighted was the scarcity of robust evidence
addressing the prioritized questions. Many existing studies were of low
certainty, primarily retrospective cohort designs, which inherently have
suboptimal rigor. This gap indicates a pressing need for well-designed
and comprehensive international prospective studies to elucidate the
true impact of various surgical interventions on outcomes in RMS. Future
research should focus on generating higher-quality evidence that can
more definitively guide surgical practices.
Despite the limitations in the evidence base, the recommendations
provided by the panel are grounded in practical considerations. Most
suggested interventions are consistent with standard care practices
across various resource settings and do not impose additional risks to
patients. For instance, the recommendation for regional lymph node
evaluation is crucial, as our analysis indicates a potential survival
benefit in patients with extremity and paratesticular RMS who are more
than 10 years old. This is particularly relevant given the varied
surgical approaches currently employed worldwide.
Moreover, the emphasis on pre-treatment re-excision for incompletely
resected RMS reflects a growing understanding of the importance of
achieving negative margins to minimize recurrence risk. Similarly, the
suggestion for early preoperative radiation therapy in cases of
unresectable RMS acknowledges the need for alternative strategies to
enhance resectability and highlight the utility of radiation therapy as
the primary local control modality when surgery is not feasible.
The global nature of this guideline development effort highlights its
potential applicability across different healthcare settings. The
recommendations aim to provide a framework for improving surgical
outcomes in RMS, which can be adapted to local resources and practices.
By promoting standardization, we hope to reduce disparities in care and
outcomes for children with RMS worldwide.
As we look to the future, we encourage ongoing dialogue and
collaboration among pediatric cancer care providers to refine these
guidelines further. Regular updates, planned every four years, will
ensure that our recommendations evolve alongside advancements in
surgical management and evidence.
In conclusion, our panel’s recommendations for the surgical management
of RMS are designed to bridge existing gaps in care and provide a
foundation for enhancing surgical outcomes across diverse healthcare
environments. By fostering a shared understanding and application of
these guidelines, we aim to improve the prognosis for children affected
by this challenging disease.