not-yet-known not-yet-known not-yet-known unknown Background: Timely diagnosis is critical in pediatric oncology to optimize treatment outcomes. Diagnostic delays may impact tumor extension and prognosis, necessitating analysis of diagnostic intervals across different neoplasms. Methods: We analyzed data from 749 pediatric patients diagnosed with rhabdomyosarcoma between 1996 and 2016. Diagnostic interval (DI) was defined as days from symptom onset to diagnosis, and treatment interval (TI) from symptom onset to treatment initiation. Factors influencing DI and TI were collected, including patient age, histology, tumor characteristics, and protocol of treatment. Survival outcomes were assessed using Kaplan-Meier analysis. Results: Median DI was 32 days, decreasing insignificantly from 1996-2004 to 2005-2016. Longer DI was associated with metastatic disease (p=0.0021). The proportion of patients diagnosed within one month increased over time, but remained lower for metastatic cases. Median TI was 48 days, unchanged over time. Longer TI correlated with larger tumors (p<0.0001). Adolescents had prolonged DI (>2 months) more frequently. The quantile regression models showed that on univariate analysis DI was associated with age at diagnosis, unfavourable histology and metastatic diaeses, but not confirmed in multivariate Five-year event-free survival (EFS) and overall survival (OS) were 59.7% and 69.3%, respectively. Conclusions: This study evaluated the role of timely diagnosis and treatment initiation in pediatric patients with rhabdomyosarcoma . Our data highlights that DI and TI are crucial in adolescents and often longer in metastatic patients. Future efforts should focus on streamlining access to diagnostic facilities and improving processes to ensure timely interventions, especially for patients presenting with more advanced disease.

Aims: This study aims to evaluate the knowledge and referral practices regarding pediatric palliative radiotherapy (PRT) among Radiation Oncologists (ROs) and Pediatric Oncologists (POs) in Italy, focusing on identifying knowledge gaps, referral patterns, and barriers to the optimal utilization of PRT in pediatric oncology. Methods: A national survey, initiated by AIRO and AIEOP, was conducted from September 2022 to February 2023. Separate questionnaires for ROs and POs were developed and distributed, focusing on the indications for PRT, current utilization practices, and perceived barriers. The data collected were analyzed using the SPSS software, employing Chi-square tests for statistical significance and univariate analysis to explore correlations between respondent characteristics and their perspectives on pediatric PRT. Results: Out of 70 ROs and 23 POs who responded, 24.3% of ROs and 91.3% of POs treated between one to five pediatric patients with PRT annually. A significant gap was found in the self-assessed knowledge of pediatric PRT, with 57% of ROs considering their understanding inadequate, in contrast to 30% of POs. The survey highlighted a perceived underutilization of PRT, with 70% of ROs and 65% of POs advocating for its more frequent application. Barriers identified included logistical challenges, with 78% of POs citing distance to the RT department as a primary obstacle, and concerns over potential side effects, particularly among ROs (60%). Conclusion: The survey underscores a critical need for enhanced education and interdisciplinary collaboration to improve the understanding and utilization of pediatric PRT. Addressing identified knowledge gaps, standardizing patient selection methods, and overcoming logistical and perceived barriers could significantly advance the quality of pediatric palliative care.

Accurate staging of nodal involvement in pediatric sarcoma patients is important to determine correct systemic and local therapy, with the goal to reduce subsequent recurrences. However, differences in lymph node staging strategies, definitions, and treatment protocols between the Children’s Oncology Group (COG), European Pediatric Soft Tissue Sarcoma Study Group (EpSSG), and the Cooperative Weichteil Sarkom Studiengruppe (CWS), complicate comparisons. In this article we try to establish internationally recognized recommendations for lymph node assessment and treatment of children and adolescents diagnosed with RMS and NRSTS according to the Consensus Conference Standard Operating Procedure methodology.