The AMORE Protocol for Advanced-Stage and Recurrent Nonorbital Rhabdomyosarcoma in the Head-and-Neck Region of Children: A Radiation Oncology View

Leo E. C. M. Blank, Kees Koedooder, Bradley R. Pieters, Hans N. B. van der Grient, Marlou van de Kar, Joeri Buwalda, Alfons J. M. Balm, Johannes H. M. Merks, Simon D. Strackee, Nicole J. Freling, Caro C. E. Koning

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Purpose: A multidisciplinary approach, consisting of consecutive Ablative Surgery, MOld technique with afterloading brachytherapy and immediate surgical REconstruction (AMORE) applied after chemotherapy, was designed for children with rhabdomyosarcoma in the head-and-neck region. Analysis of the first 42 patients was performed. Methods and Materials: After macroscopically radical tumor resection, molds were constructed for each individual to fit into the surgical defect. The molds, made of 5-mm-thick layers of thermoplastic rubber, consisted of different parts. Flexible catheters were positioned between layers. After brachytherapy, the molds were removed. Surgical reconstruction was performed during the same procedure. Results: Dose to the clinical target volume varied from 40 to 50 Gy for the primary treatment (31 patients) and salvage treatment groups (11 patients). There were 18 females and 24 males treated from 1993 until 2007. Twenty-nine tumors were located in the parameningeal region, and 13 were located in the nonparameningeal region. Patient age at the time of AMORE was 1.2-16.9 years (average, 6.5 years). Follow-up was 0.2-14.5 years (average, >5.5 years). Eleven patients died, 3 with local recurrence only, 6 with local and distant disease, 1 died of distant metastases only, and 1 patient died of a second primary tumor. Overall 5-year survival rates were 70% for the primary treatment group and 82% for the salvage group. Treatment was well tolerated, and acute and late toxicity were mild. Conclusions: The AMORE protocol yields good local control and overall survival rates, and side effects are acceptable. © 2009 Elsevier Inc. All rights reserved.
Original languageEnglish
Pages (from-to)1555-1562
JournalInternational Journal of Radiation Oncology Biology Physics
Volume74
Issue number5
DOIs
Publication statusPublished - 2009
Externally publishedYes

Cite this

Blank, Leo E. C. M. ; Koedooder, Kees ; Pieters, Bradley R. ; van der Grient, Hans N. B. ; van de Kar, Marlou ; Buwalda, Joeri ; Balm, Alfons J. M. ; Merks, Johannes H. M. ; Strackee, Simon D. ; Freling, Nicole J. ; Koning, Caro C. E. / The AMORE Protocol for Advanced-Stage and Recurrent Nonorbital Rhabdomyosarcoma in the Head-and-Neck Region of Children: A Radiation Oncology View. In: International Journal of Radiation Oncology Biology Physics. 2009 ; Vol. 74, No. 5. pp. 1555-1562.
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title = "The AMORE Protocol for Advanced-Stage and Recurrent Nonorbital Rhabdomyosarcoma in the Head-and-Neck Region of Children: A Radiation Oncology View",
abstract = "Purpose: A multidisciplinary approach, consisting of consecutive Ablative Surgery, MOld technique with afterloading brachytherapy and immediate surgical REconstruction (AMORE) applied after chemotherapy, was designed for children with rhabdomyosarcoma in the head-and-neck region. Analysis of the first 42 patients was performed. Methods and Materials: After macroscopically radical tumor resection, molds were constructed for each individual to fit into the surgical defect. The molds, made of 5-mm-thick layers of thermoplastic rubber, consisted of different parts. Flexible catheters were positioned between layers. After brachytherapy, the molds were removed. Surgical reconstruction was performed during the same procedure. Results: Dose to the clinical target volume varied from 40 to 50 Gy for the primary treatment (31 patients) and salvage treatment groups (11 patients). There were 18 females and 24 males treated from 1993 until 2007. Twenty-nine tumors were located in the parameningeal region, and 13 were located in the nonparameningeal region. Patient age at the time of AMORE was 1.2-16.9 years (average, 6.5 years). Follow-up was 0.2-14.5 years (average, >5.5 years). Eleven patients died, 3 with local recurrence only, 6 with local and distant disease, 1 died of distant metastases only, and 1 patient died of a second primary tumor. Overall 5-year survival rates were 70{\%} for the primary treatment group and 82{\%} for the salvage group. Treatment was well tolerated, and acute and late toxicity were mild. Conclusions: The AMORE protocol yields good local control and overall survival rates, and side effects are acceptable. {\circledC} 2009 Elsevier Inc. All rights reserved.",
author = "Blank, {Leo E. C. M.} and Kees Koedooder and Pieters, {Bradley R.} and {van der Grient}, {Hans N. B.} and {van de Kar}, Marlou and Joeri Buwalda and Balm, {Alfons J. M.} and Merks, {Johannes H. M.} and Strackee, {Simon D.} and Freling, {Nicole J.} and Koning, {Caro C. E.}",
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The AMORE Protocol for Advanced-Stage and Recurrent Nonorbital Rhabdomyosarcoma in the Head-and-Neck Region of Children: A Radiation Oncology View. / Blank, Leo E. C. M.; Koedooder, Kees; Pieters, Bradley R.; van der Grient, Hans N. B.; van de Kar, Marlou; Buwalda, Joeri; Balm, Alfons J. M.; Merks, Johannes H. M.; Strackee, Simon D.; Freling, Nicole J.; Koning, Caro C. E.

In: International Journal of Radiation Oncology Biology Physics, Vol. 74, No. 5, 2009, p. 1555-1562.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - The AMORE Protocol for Advanced-Stage and Recurrent Nonorbital Rhabdomyosarcoma in the Head-and-Neck Region of Children: A Radiation Oncology View

AU - Blank, Leo E. C. M.

AU - Koedooder, Kees

AU - Pieters, Bradley R.

AU - van der Grient, Hans N. B.

AU - van de Kar, Marlou

AU - Buwalda, Joeri

AU - Balm, Alfons J. M.

AU - Merks, Johannes H. M.

AU - Strackee, Simon D.

AU - Freling, Nicole J.

AU - Koning, Caro C. E.

PY - 2009

Y1 - 2009

N2 - Purpose: A multidisciplinary approach, consisting of consecutive Ablative Surgery, MOld technique with afterloading brachytherapy and immediate surgical REconstruction (AMORE) applied after chemotherapy, was designed for children with rhabdomyosarcoma in the head-and-neck region. Analysis of the first 42 patients was performed. Methods and Materials: After macroscopically radical tumor resection, molds were constructed for each individual to fit into the surgical defect. The molds, made of 5-mm-thick layers of thermoplastic rubber, consisted of different parts. Flexible catheters were positioned between layers. After brachytherapy, the molds were removed. Surgical reconstruction was performed during the same procedure. Results: Dose to the clinical target volume varied from 40 to 50 Gy for the primary treatment (31 patients) and salvage treatment groups (11 patients). There were 18 females and 24 males treated from 1993 until 2007. Twenty-nine tumors were located in the parameningeal region, and 13 were located in the nonparameningeal region. Patient age at the time of AMORE was 1.2-16.9 years (average, 6.5 years). Follow-up was 0.2-14.5 years (average, >5.5 years). Eleven patients died, 3 with local recurrence only, 6 with local and distant disease, 1 died of distant metastases only, and 1 patient died of a second primary tumor. Overall 5-year survival rates were 70% for the primary treatment group and 82% for the salvage group. Treatment was well tolerated, and acute and late toxicity were mild. Conclusions: The AMORE protocol yields good local control and overall survival rates, and side effects are acceptable. © 2009 Elsevier Inc. All rights reserved.

AB - Purpose: A multidisciplinary approach, consisting of consecutive Ablative Surgery, MOld technique with afterloading brachytherapy and immediate surgical REconstruction (AMORE) applied after chemotherapy, was designed for children with rhabdomyosarcoma in the head-and-neck region. Analysis of the first 42 patients was performed. Methods and Materials: After macroscopically radical tumor resection, molds were constructed for each individual to fit into the surgical defect. The molds, made of 5-mm-thick layers of thermoplastic rubber, consisted of different parts. Flexible catheters were positioned between layers. After brachytherapy, the molds were removed. Surgical reconstruction was performed during the same procedure. Results: Dose to the clinical target volume varied from 40 to 50 Gy for the primary treatment (31 patients) and salvage treatment groups (11 patients). There were 18 females and 24 males treated from 1993 until 2007. Twenty-nine tumors were located in the parameningeal region, and 13 were located in the nonparameningeal region. Patient age at the time of AMORE was 1.2-16.9 years (average, 6.5 years). Follow-up was 0.2-14.5 years (average, >5.5 years). Eleven patients died, 3 with local recurrence only, 6 with local and distant disease, 1 died of distant metastases only, and 1 patient died of a second primary tumor. Overall 5-year survival rates were 70% for the primary treatment group and 82% for the salvage group. Treatment was well tolerated, and acute and late toxicity were mild. Conclusions: The AMORE protocol yields good local control and overall survival rates, and side effects are acceptable. © 2009 Elsevier Inc. All rights reserved.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/19250759

U2 - 10.1016/j.ijrobp.2008.10.029

DO - 10.1016/j.ijrobp.2008.10.029

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EP - 1562

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

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