Amore protocol in pediatric head and neck rhabdomyosarcoma: Descriptive analysis of failure patterns

Background. The AMORE protocol is a local treatment for patients with nonorbital pediatric head and neck rhabdomyosarcoma (HNRMS). The objectives of this study were: (1) to assess the adequacy of the concept, and (2) to identify factors associated with relapse. Methods. We performed a retrospective...

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Bibliographic Details
Published in:Head & neck 2005-05, Vol.27 (5), p.390-396
Main Authors: Buwalda, Joeri, Freling, Nicole J., Blank, Leo E. C. M., Balm, Alfons J. M., Bras, Johannes, Voûte, Paul A., Caron, Huib N., Schouwenburg, Paul F., Merks, Johannes H. M.
Format: Article
Language:English
Subjects:
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Biological and medical sciences
brachytherapy
Brachytherapy - methods
Child
Child, Preschool
Clinical Protocols
Combined Modality Therapy
Dactinomycin - therapeutic use
Diseases of the osteoarticular system
head and neck neoplasms
Head and Neck Neoplasms - therapy
Humans
Infant
Iridium Radioisotopes - therapeutic use
Medical sciences
Muscle, Skeletal - transplantation
Neck Dissection - methods
Neoplasm Recurrence, Local
Netherlands
Otorhinolaryngology. Stomatology
Radiotherapy Dosage
Retrospective Studies
rhabdomyosarcoma
Rhabdomyosarcoma - therapy
surgery
Treatment Outcome
Tumors of striated muscle and skeleton
Vincristine - therapeutic use
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Summary:Background. The AMORE protocol is a local treatment for patients with nonorbital pediatric head and neck rhabdomyosarcoma (HNRMS). The objectives of this study were: (1) to assess the adequacy of the concept, and (2) to identify factors associated with relapse. Methods. We performed a retrospective multidisciplinary review of 22 children primarily treated according to the AMORE protocol, excluding two children with inadequate imaging data. Results. Seven patients had a local relapse, six within and one outside the residual tumor area. Five of the six patients with relapse in the residual area had gross total or debulking (incomplete) surgery, suboptimal position of the mold for brachytherapy, or both. In the 15 nonrecurrent cases, four patients had either incomplete surgery or suboptimal mold position. Both surgical and brachytherapeutic factors seem to be associated with relapse. Conclusions. AMORE is an adequate concept. More rigid preoperative imaging and intraoperative verification of the brachytherapy mold position might lead to a reduction in the number of local failures. © 2005 Wiley Periodicals, Inc. Head Neck 27: XXX–XXX, 2005
ISSN:1043-3074
1097-0347
DOI:10.1002/hed.20164