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).