Adjuvant local treatment for paediatric head and neck rhabdomyosarcoma: long-term results of the AMORE protocol

Abstract

Introduction. The objective was to evaluate the outcome of children with head and neck rhabdomyosarcoma (HNRMS) treated according to the AMORE protocol. Methods. The AMORE protocol is a combined modality treatment regimen consisting of ablative surgery, Moulage technique brachytherapy and surgical reconstruction. Total treatment is scheduled in 1 week. Children with residual or recurrent disease after prior multidrug chemotherapy for HNRMS were eligible for treatment when complete macroscopic surgery was technically feasible. Total and disease-free survivals were calculated and long-term complications were registered. Results. Eighteen children had a minimal follow-up of 2 years. The mean age at time of treatment was 5.3 years. To date, the median follow-up time is 5.8 years. Thirteen children are without evidence of disease and five patients have died: one because of distant metastases and four as a result of local recurrence. The mean total and disease-free survivals are 81.3 and 67.5 months respectively. Long-term complications are (partial) facial nerve palsy (n = 4), muscle transplant atrophy (n = 1), craniofacial asymmetry (n = 1), deglutition disorders (n = 1), rhinolalia aperta (n = 2) and epiphora (n = 1). Conclusion. The AMORE protocol proved to be a well-tolerated treatment for HNRMS with good local control rates and limited late sequelae.