Would you offer whole abdominal irradiation to a pelvic recurrence of rhabdomyosarcoma with tumor rupture / spillage?

I would be less inclined to use a large field / volume approach like whole abdominal RT in the setting of recurrent disease. While I don't know if prior RT was delivered or not, the outcome for children with a pelvic recurrence (especially is a local recurrence) is overall very poor with only 20-30%...

I agree with Dr. Krasin as well. My only real inclination to use whole abdomen in the recurrent setting would be in the setting of clear peritoneal dissemination with additional metastatic deposits where the whole abdomen may have a clearer benefit in providing durable palliation.

I agree with Drs. Eaton and Krasin. I am particularly worried about marrow toxicity impeding systemic therapy in this setting.