Treatment patterns and outcomes of pediatric rhabdomyosarcoma in a resource-limited setting: A retrospective study from a tertiary hospital in Ethiopia

Background: Rhabdomyosarcoma (RMS) is the most common pediatric soft tissue sarcoma. Despite excellent survival in high-income countries, data on treatment and outcomes remain limited in resource-limited settings. The aim of this study was to assess treatment patterns and survival outcomes of pediatric RMS in Ethiopia. Methods: We conducted a retrospective study of newly diagnosed pediatric RMS patients evaluated at Tikur Anbessa Specialized Hospital from January 2021 to September 2025. Data were extracted from medical records, and treatment patterns and survival were assessed using descriptive and Kaplan–Meier analyses. Results: A total of 94 pediatric patients with rhabdomyosarcoma were included. The median age at diagnosis was 4.0 years (IQR: 3.0–6.3 years). Of these patients, 23.4% were classified as low-risk, 61.7% as intermediate-risk, and 14.9% as high-risk. Multimodality treatment was delivered to 59.6% of patients, while 33.0% received chemotherapy alone and 7.4% received no treatment. At diagnosis, curative treatment intent was planned for 83% of patients, but only 71.8% ultimately received it. Treatment received varied by risk group: most (90.0%) low-risk patients got curative treatment, while only 64.3% of intermediate-risk patients got curative treatment intent. No high-risk patients received curative treatment.At a median follow-up of 21.0 months (95% CI: 17.6–24.4 months), median overall survival and event-free survival were 23.0 and 15.0 months, respectively. The 1-year and 2-year overall survival rates were 70% and 42%, respectively, while the corresponding event-free survival rates were 59% and 33%. In multivariable Cox regression, treatment modality (p < 0.001) and total chemotherapy cycles (p =0.001) remained independently associated with overall survival, while risk group was not significant (p =0.14). Conclusion: Pediatric rhabdomyosarcoma in Ethiopia presents with a high rate of high-risk disease. Multimodality therapy and completion of chemotherapy cycles are key determinants of improved survival. These findings highlight the urgent need for early detection, improved access to multimodal treatment, and strategies to reduce treatment abandonment and improve treatment completion rates in resource-limited settings. Larger prospective studies are warranted to validate these findings and guide evidence-based practice.