Combination Chemotherapy and Radiation Therapy in Treating Patients With Newly Diagnosed Rhabdomyosarcoma

Inclusion Criteria:

   - Patients with newly diagnosed embryonal RMS, botryoid or spindle cell variants of
   embryonal RMS, ectomesenchymoma, or alveolar RMS are eligible for this study

   - Enrollment on COG-D9902 to confirm local histologic diagnosis with central pathology
   review is required for all patients

   - Patients may be enrolled on ARST0531 and start protocol treatment prior to receipt of
   central pathology review results

   - Patient must have Intermediate-risk RMS defined as:

      - Embryonal, botryoid, or spindle cell RMS, or ectomesenchymoma: stage 2 or 3 and
      group III OR

      - Alveolar RMS: stage 1-3 and group I-III

   - Staging ipsilateral retroperitoneal lymph node dissection (SIRLND) is required for all
   patients >= 10 years of age with paratesticular tumors and for patients < 10 years
   with clinically or radiographically involved lymph nodes (except when extensive lymph
   node involvement, defined as two or more lymph nodes > 2 cm in dimension, is
   identified by imaging studies)

   - Regional lymph node sampling or sentinel lymph node procedure is required for
   histologic evaluation in patients with extremity tumors

   - Clinically or radiographically enlarged nodes should be sampled for histologic
   evaluation

   - Detection of metastasis by optional FDG PET (not required for study enrollment); FDG
   PET may detect abnormalities suggestive of metastasis not identified by bone scan,
   computed tomography (CT), or bone marrow aspiration/biopsy; the prognostic
   significance of FDG PET-detected abnormalities is not clear; FDG PET-detected
   abnormalities MUST be confirmed to be metastases by an additional imaging modality
   (such as magnetic resonance imaging [MRI] or CT) OR pathologic confirmation; unless
   FDG PET abnormalities are confirmed by another imaging modality or biopsy, FDG PET
   abnormalities will NOT be considered evidence of metastasis

   - Patients must have a performance status of 0, 1, or 2; the Lansky performance score
   should be used for patients < 16 years and the Karnofsky performance score for
   patients >= 16 years

   - Patients who have received prior chemotherapy (excluding steroids) or radiation
   therapy, except for patients transferring from ARST0331 (low-risk study), are not
   eligible

   - Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70
   ml/min/1.73 m^2 or a serum creatinine based on age/gender as follows:

      - 1 month to < 6 months: 0.4 mg/dL

      - 6 months to < 1 year: 0.5 mg/dL

      - 1 to < 2 years: 0.6 mg/dL

      - 2 to < 6 years: 0.8 mgt/dL

      - 6 to < 10 years: 1 mg/dL

      - 10 to < 13 years: 1.2 mg/dL

      - 13 to < 16 years: 1.5 mg/dL (males) or 1.4 mg/dL (females)

      - >= 16 years: 1.7 mg/dL (males) or 1.4 mg/dL (females)

   - Patients with urinary tract obstruction by tumor must meet the renal function criteria
   AND must have unimpeded urinary flow established via decompression of the obstructed
   portion of the urinary tract

   - Total bilirubin =< 1.5 x upper limit of normal for age

   - Peripheral absolute neutrophil count (ANC) >= 750/uL

   - Platelet count >= 75,000/uL (transfusion independent)

   - No evidence of uncontrolled infection

   - Patients must be able to undergo radiation therapy, if necessary, as specified in the
   protocol

   - Female patients of childbearing potential must have a negative pregnancy test

   - Female patients who are breast feeding must agree to stop breast feeding

   - Sexually active patients of childbearing potential must be willing to use effective
   contraception during therapy and for at least 1 month after treatment is completed

   - All patients and/or their parents or legal guardians must sign a written informed
   consent

   - All institutional, Food and Drug Administration (FDA), and National Cancer Institute
   (NCI) requirements for human studies must be met