PURPOSE: The current recommended practice for pediatric @entity1 with metastatic @entity980 includes full-dose radiotherapy to each metastatic site. We wished to question this practice, which can cause side-effects and is often logistically challenging, by studying the pattern of failure in our pediatric and teenage @entity1 population. METHODS AND MATERIALS: Our institution's @entity5 registry was queried for @entity1 diagnosed with @entity980 aged 18 or less from January 1990 until January 2014. Twenty-nine @entity1 were found and, of these, six had @entity3 . Five of the six were treated with standard chemotherapy together with radiotherapy to the primary and metastatic sites with doses and fractionation according to the site. Progression-free survival was calculated from the end of radiotherapy until radiological or pathological evidence of disease progression  or @entity204 . RESULTS: Median age was 13 years (range: 12-18).  Three were @entity1 . All had alveolar histology and unfavorable primary sites. Twelve metastatic sites were treated with radiotherapy. Doses used were 41.4 - 50.4 Gy in 1.8 Gy fractions for most sites, and 15 Gy in 1.5 Gy fractions for whole lung radiotherapy. The median number of sites treated per @entity1 was two (range: 1 - 6). Median time to progression was 10.1 months (range: 1.9 - 15.7).  Local control was 100% for all metastatic sites. Median overall survival (OS) was 31.8 months (range: 20.4 - 95.4 months). Three @entity1 developed @entity74 outside the treated field. One @entity1 died from a secondary @entity1583 without evidence of disease progression. One @entity1 remains progression-free at 88.6 months post-radiotherapy. CONCLUSIONS: Radiotherapy to @entity3 sites prevented in-field progression in all five @entity1 with metastatic @entity3943 . However, failure at sites outside of the radiotherapy volume occurred in three of five of @entity1 and overall survival was very poor despite aggressive treatment to all sites of disease. Radiotherapy has a role in @entity3 , although future studies evaluating dose and fractionation are needed.

Radiotherapy is Important for Local Control at Primary and Metastatic Sites in XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'girls'] @entity5 :: ('MESH:D009369', 'Disease') :: ['cancer'] @entity3943 :: ('MESH:D018232', 'Disease') :: ['alveolar rhabdomyosarcoma'] @entity74 :: ('MESH:D030342', 'Disease') :: ['progressive disease'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastatic disease'] @entity1583 :: ('MESH:D019337', 'Disease') :: ['hematological malignancy'] @entity980 :: ('MESH:D012208', 'Disease') :: ['rhabdomyosarcoma'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death']
@entity980 :: (MESH:D012208,Disease) :: ['Pediatric Rhabdomyosarcoma']
