Would you recommend radiation therapy for an adult patient with rhabdomyosarcoma (embryonal) of the upper extremity s/p amputation with multiple lymph node involvement and ENE on pathology?

Yes, I would treat the involved nodal region. This patient has what appears to be stage III, group 2c intermediate-risk disease. If treating per ARST0531 dose to involved nodal region would be 41.4 Gy in 1.8 Gy per fraction, though with ENE, I would consider escalating that specific area to 50.4 Gy ...