Purpose-To evaluate the incidence and prognostic factors for regional failure, with attention to in-transit pathways of spread, in children with non-metastatic rhabdomyosarcoma (RMS) of the extremity.Materials/Methods-Intergroup Rhabdomyosarcoma Studies III, IV-Pilot, and IV enrolled 226 children with RMS of the extremity. Failure at in-transit (epitrochlear/brachial and popliteal) and proximal (axillary/infraclavicular and inguinal/femoral) nodes were evaluated. Median follow-up for surviving patients is 10.4 years.Results-Fifty-five (24%) of 226 children had clinical or pathologic evidence of either in-transit and/or proximal lymph node involvement (LNI) at diagnosis. The actuarial 5-year risk of regional failure is 12%. The prognostic factors for poor regional control are female gender and LNI at diagnosis. In the 116 patients with a distal extremity primary tumor, 5% had in-transit LNI at diagnosis. The estimated 5-year incidences of in-transit and proximal nodal failure are 12% and 8%, respectively. The in-transit failure rate is 0% in patients who received radiation therapy and/or underwent lymph node sampling of the in-transit nodal site, but 15% in those who did not (p=0.07), although 5-year EFS did not differ between these two groups (64% vs. 55%, p=0.47). Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Conclusions-The
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