What are the indications for RT for an alveolar FOX01 fusion positive, paratesticular rhabdomyosarcoma s/p radical inguinal orchiectomy and PLND showing pN0, group 1, stage 1 disease?

We have not radiated in this specific scenario. While there are still questions about the need and benefit for adjuvant RT in patients with completely resected alveolar histology or FOXO1+ disease, the absence of a clear target in patients with paratesticular primary involvement with complete resection has driven us to not radiate in this rare situation.

There is little data to answer this specific question in the molecular era. Two articles addressed this question across a broader group of patients treated on COG studies. Limitations included small numbers of patients with paratesticular site of involvement and small numbers of patients with FOXO1+ disease that weren't irradiated. 

Raney et al., PMID 20806360