Panel deliberation.
Twenty percent of RMS are metastatic at presentation and outcomes are dismal except for younger patients with embryonal RMS. Local treatment of all metastatic deposits improves event free survival and overall survival49. Evidence supports aggressive local treatment to both primary tumor and metastatic sites50. However, upfront resection of metastatic deposits at the time of diagnosis is generally not indicated and should be avoided.
The panel suggests resection of relapsed disease for the management of relapsed RMS. (Weak recommendation; Certainty of evidence: Very Low, Supplemental Table S8 )
We identified seven retrospective studies assessing resection versus no resection of relapsed disease. However, of the seven, only six retrospective cohort studies had extractable data and enrolled 446 patients. The overall certainty of evidence is very low. The pooled overall mortality was significantly lower in those with resection of relapsed disease compared to no resection (OR 0.15, 95% CI 0.06 to 0.39).