Is there a role for surgical resection in parameningeal rhabdomyosarcoma either at diagnosis or following initial therapy w/ VAC at week 12?

Not really. For rhabdomyosarcomas outside of the head and neck region, surgical resection often plays an important role in the treatment paradigm. However, given the anatomical constraints with paramenigneal tumors, gross total resection is often not possible without resulting in significant morbidity such as cranial nerve damage and cosmetic defects including disfigurement of the facial skeleton. RT is thus the preferred treatment modality to preserve form and function. In addition, all patients with fusion-positive rhabdomyosarcoma will require adjuvant RT, regardless of the extent of resection at diagnosis (on IRS I and II, the 10-year overall survival of patients with alveolar or undifferentiated RMS who received adjuvant RT after compl...