PEDIATRIC PARAMENINGEAL RHABDOMYOSARCOMA IN A DEVELOPING COUNTRY: TREATMENT OUTCOMES WITH CHEMOTHERAPY AND VMAT-BASED RADIOTHERAPY

Rhabdomyosarcoma is the most common soft tissue sarcoma in children and adolescents. It is a malignant mesenchymal tumor with skeletal muscle differentiation that can arise in almost any anatomical site, although head and neck, genitourinary, and extremity locations are among the most frequently described sites [1,2]. Among head and neck rhabdomyosarcomas, parameningeal tumors represent a particularly complex subgroup because of their proximity to the skull base, meninges, cranial nerves, orbit, nasopharynx, paranasal sinuses, infratemporal fossa, and central nervous system [3,4]. Parameningeal rhabdomyosarcoma is clinically challenging for several reasons. First, the initial symptoms may be nonspecific and may mimic benign ear, nose, throat, or orbital conditions, leading to diagnostic delay. Second, complete surgical resection is rarely feasible because of the deep anatomical location and the risk of major functional or cosmetic morbidity. Third, local progression may result in skull base invasion, cranial nerve palsy, meningeal extension, visual impairment, airway compromise, and severe treatment related toxicity [3,5].