**Question:** A 8 year old boy presented with swelling in the left eye of 3 months, examination revealed proptosis of left eye with preserved vision. Right eye is normal. CT scan revealed intraorbital extraconal mass lesion. Biopsy revealed embryonal rhabdomyosarcoma. Metastatic work up was normal. The standard line of treatment is -

A. Chemotherapy
B. Radiotherapy
C. Combination of Chemotherapy and Radiotherapy
D. Surgery

**Correct Answer:** C. Combination of Chemotherapy and Radiotherapy

**Core Concept:** Rhabdomyosarcoma is a malignant tumor that occurs in soft tissues, often involving the head and neck region. In this case, the tumor has invaded the orbit, causing left eye swelling, proptosis, and preserved vision.

**Why the Correct Answer is Right:** Rhabdomyosarcoma is a pediatric malignancy, meaning it primarily affects children and young adults. In this case, the tumor is localized in the orbit and has not caused distant organ involvement, as indicated by normal metastatic work up. Treatment for localized tumors involves a combination of chemotherapy and radiotherapy.

**Why Each Wrong Option is Incorrect:**

A. Chemotherapy alone may not adequately control the tumor, as it is a soft tissue sarcoma.
B. Radiotherapy alone may not adequately control the tumor, as it is a soft tissue sarcoma.
D. Surgery may be considered for tumor debulking or biopsy, but it is not the primary treatment modality for localized rhabdomyosarcoma.

**Clinical Pearl:** Combining chemotherapy and radiotherapy provides a higher chance of controlling the tumor and preserving vision, as well as preventing local recurrence and distant spread. This approach is essential for the treatment of localized rhabdomyosarcoma, ensuring optimal outcomes for the patient.