How do you approach a patient with metastatic rhabdomyosarcoma complicated by sinusoidal obstruction syndrome (SOS) after neoadjuvant chemotherapy and radiation therapy?

Stage 4/group 4 due to dissemination in peritoneal fluid. Translocation negative; treated per intermediate risk protocol on study arm ARST1431 VAC/VI + temsirolimus. After 9 weeks, proceeded with R0 resection (intra-abdominal disease), followed by 1 month of whole abdomen radiation. Developed SOS with 3 fractions left, taken off study, and recovered on defibrotide.