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

Cancer in children is a rare and terrifying reality, but among the many types that can strike, a specific group of tumors known as soft tissue sarcomas stands out for its complexity. These cancers do not start in the bone or the organ itself, but in the soft tissues that support the body, such as the muscles. One of the most common of these is rhabdomyosarcoma, a disease that arises from cells meant to become muscle. In wealthy nations, doctors have developed a sophisticated playbook for fighting this enemy. They use a combination of powerful medicines to attack the cancer throughout the body, surgery to remove the tumor if possible, and targeted radiation to zap any remaining cells. When this full team of treatments is used together, outcomes vary significantly by risk: low-risk patients have an expected event-free survival of 70–85% or greater, intermediate-risk patients 50–70%, and high-risk patients less than 30%. However, in many parts of the world where resources are scarce, accessing this complete team of therapies is a daily struggle. Hospitals may lack the machines for radiation, the supply of medicines, or the specialized teams needed to coordinate care. This gap between what is known to work and what is actually available creates a stark difference in who lives and who dies, a reality that doctors in Ethiopia are working to understand and change.

A team of researchers at a major hospital in Addis Ababa, Ethiopia, set out to map this difficult landscape. They looked back at the records of 94 children under the age of 18 who had been diagnosed with rhabdomyosarcoma between 2021 and 2025. Their goal was not just to count how many children were sick, but to trace exactly what happened to them: what treatments they received, how long they had to wait for care, and how long they survived. The study focused on a single, large hospital that serves as a primary center for cancer care in the country, offering a rare window into the reality of treating this disease in a resource-limited setting.

The children in this study were very young, with half of them being between one and five years old when they were diagnosed. Most had large tumors, and the cancer had already spread to nearby lymph nodes or other parts of the body in the majority of cases. When the doctors first looked at these children, they classified them into risk groups based on how aggressive the cancer appeared and how much of it could be removed. About a quarter were considered low-risk, nearly two-thirds were intermediate-risk, and a small portion were high-risk. In an ideal world, every child would receive a tailored plan involving chemotherapy, surgery, and radiation. In this hospital, the reality was more fragmented. While the vast majority of children started on chemotherapy, only about 60 percent of them received the full combination of treatments. Some received only chemotherapy, and a small number received no treatment at all, often because their families had to stop coming to the hospital or the necessary resources were unavailable. Notably, while low-risk patients often received curative treatment, no high-risk patients in this study received curative or multimodal therapy.

The timing of care also presented a significant hurdle. For the children who did receive radiation therapy, the wait was often much longer than medical guidelines recommend. The study found that the median time from the initial surgery or biopsy to the start of radiation was 35.5 weeks, with some waits stretching over nine months. In contrast, standard protocols suggest this should happen within a few months to ensure the best chance of a cure. This delay, combined with the fact that many children did not complete their full course of chemotherapy, meant that the cancer often had more time to grow or return.

The results of these treatment patterns were clear and sobering. The children who received the full combination of treatments—chemotherapy, surgery, and radiation—had the best chance of survival. For this group, the researchers could not even calculate a median survival time because so many of them were still alive at the end of the study period. In stark contrast, children who received only chemotherapy or no treatment at all faced a much shorter survival time, with many passing away within a year. The study showed that the specific type of treatment a child received was a stronger predictor of their outcome than the initial risk group assigned at diagnosis. In the statistical analysis, the risk group itself was not found to be a significant independent factor for survival once treatment delivery was accounted for, suggesting that the ability to receive and complete the full course of therapy was the most critical determinant of whether a child survived.

Despite these challenges, the outcomes in this Ethiopian cohort were not the worst possible scenario. The researchers found that one year after diagnosis, 70 percent of the children were still alive, and 42 percent were alive two years later. These numbers are lower than those seen in high-income countries, where survival rates for similar groups can exceed 90 percent, but they are higher than some reports from other parts of Africa. The study suggests that while the system is struggling to deliver the complete standard of care, the effort to provide even partial treatment is saving lives that might otherwise be lost. The researchers emphasized that the key to improving these numbers lies in fixing the bottlenecks that prevent children from getting surgery and radiation on time, and in finding ways to ensure families can stay in treatment until it is finished.

This work serves as a crucial baseline, offering the first detailed look at how rhabdomyosarcoma is managed and how children survive it in Ethiopia. It highlights that the gap in survival is not necessarily due to the cancer being different in this region, but rather due to the gaps in the delivery of care. By showing that the full combination of treatments works even in this setting, the study provides a clear target for future improvements. The authors conclude that to save more children, the focus must shift to ensuring that every child who starts treatment can finish it, and that the critical pieces of surgery and radiation are delivered without the long delays that currently plague the system.