Soft tissue sarcomas of the paraspinal region comprised 3.3% (56 of 1,688) of 
the patients entered and eligible on Intergroup Rhabdomyosarcoma Studies I 
(IRS-I) and II (IRS-II) (1972 to 1984). These lesions tended to be greater than 
5 cm in diameter at diagnosis, invaded the spinal extradural space, and were of 
the extraosseous Ewing's sarcoma or undifferentiated sarcoma subtype in 55% (30 
of 56) of the cases. Patients with tumors in clinical groups II, III, and IV 
were treated with radiotherapy (XRT) and vincristine-dactinomycin (VA) or VA 
plus cyclophosphamide (VAC) +/- doxorubicin. Clinical group I patients treated 
on IRS-II did not receive XRT, while those on IRS-I were randomized to receive 
VAC +/- XRT. Forty-four of the paraspinal patients (79%) achieved a complete 
response (CR) compared with 77% (1,260 of 1,632) for patients with disease in 
other sites. Twenty-seven patients (55%) subsequently relapsed (five local, 
three regional, four local and distant, and 14 distant). The proportion of 
patients surviving 5 years by clinical group (stage) from I to IV were 50%, 50%, 
62%, and 27%, respectively. Paraspinal patients had somewhat poorer survival 
than patients with disease in other sites, both in IRS-I and IRS-II; the 
percentage of paraspinal patients surviving 5 years was 50% and 52% for IRS-I 
and IRS-II, respectively, whereas these percentages were 55% and 63% for 
patients with disease in other sites. Histology did not influence the CR rate, 
but unexpectedly, patients who had embryonal rhabdomyosarcoma (RMS) had the 
poorest overall survival rate. We concluded that patients with paraspinal 
lesions may require extended-field radiation therapy to reduce the high local 
failure rate and more intensive chemotherapy to achieve better local and 
systemic tumor control.