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"Distant metastatic disease consists of lung, liver, bones, bone marrow, brain, and distant muscle and nodes. The presence of positive cytology in CSF, pleural, or abdominal fluids, as well as implants on pleural or peritoneal surfaces, also constitutes stage IV disease.

From Mandell LR. Ongoing progress in the treatment of childhood rhabdomyosarcoma. Oncology 1993;7:71-84, with permission.

• Stage III: Localized disease of any unfavorable primary site (primary tumor greater than 5 cm in diameter and/or regional node involvement)

• Stage IV: Metastatic disease at diagnosis. The original grouping system, however, is retained to define the extent of radiation therapy.

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