Moving the Needle Forward for Low-risk and Intermediate-risk Pediatric Rhabdomyosarcoma in LMIC: Outcomes From a Cancer Center in Pakistan

Pediatric rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. In low- and middle-income countries (LMIC) such as Pakistan, several challenges in the diagnosis and treatment of RMS may lead to poor outcomes. A retrospective chart review was conducted from January 1, 2017 to January 1, 2022, to identify patients with low-risk and intermediate-risk RMS at a tertiary cancer center in Pakistan. Curative treatment was given per the standard arms of the Children's Oncology Group (COG) studies ARST0331 and ARST1431 without maintenance chemotherapy. Forty-eight patients were eligible for survival analysis. The most common tumor region was parameningeal (31.3%). The 3-year overall survival (OS) was 92.9% for the 14 low-risk patients and 70.6% for the 34 intermediate-risk patients. Eleven patients died (~23%; 3 due to sepsis, 8 due to disease progression/relapse), 11 (23%) abandoned treatment, 16 (33%) had disease progression, and 3 had relapse. There was a preponderance of intermediate-risk RMS in this cohort, with 3-year OS approaching that of high-income countries but with a lower PFS and EFS. Sepsis-related deaths, treatment abandonment, and malnutrition remain significant challenges.