Non-metastatic pediatric head and neck rhabdomyosarcoma: a 24-year retrospective experience from Jordan.

Background: Pediatric head and neck rhabdomyosarcoma (HNRMS) is well characterized in Western cooperative group trials, but real-world outcomes from resource-constrained MENA settings are poorly documented. Whether the locally advanced-stage presentation typical of Middle Eastern referral centers precludes outcomes equivalent to international benchmarks is unknown. Methods: We conducted a retrospective analysis of pediatric patients younger than 18 years with non-metastatic HNRMS diagnosed between January 2001 and May 2025. We extracted demographic, pathological, treatment, and outcome data. Risk stratification and treatment planning followed COG protocols throughout, with local control decisions made via multidisciplinary team assessment. Results: Among 98 patients with HNRMS, 77 (79%) had non-metastatic disease and were included in the analysis. The male-to-female ratio was 1:1, with a median age at diagnosis of 5.9 years (range, 0.2-18). The parameningeal region ( Conclusion: Despite 93.5% IRS Clinical Group III and 71% tumors >5 cm-rates substantially exceeding Western cooperative group series-5-year OS of 70.1% was achieved. Parameningeal location was the only factor significantly associated with adverse survival outcomes in this cohort, driven by local failure. These findings demonstrate that outcomes equivalent to international benchmarks are attainable in a resource-constrained MENA setting, and identify local control intensification for parameningeal disease as the priority unmet need.