New combined treatment of surgery, radiotherapy, and reconstruction in head and neck rhabdomyosarcoma in children: the AMORE protocol.

Abstract

If no complete remission on chemotherapy is reached in head and neck rhabdomyosarcoma (RMS) in children, adjuvant radiotherapy and/or surgery are indicated. This often causes severe mutilation, and the prognosis is poor. Ablative surgery, moulage technique with afterloading brachytherapy, and reconstructive surgery, called the AMORE protocol, is developed for residual or recurrent disease after chemotherapy. Ablative surgery with preservation of important structures is followed by the embedding of a gutta-percha mold in the created tissue defect. The wound bed is irradiated with Iridium192. Within 1 week, the defect is reconstructed with a muscle transplant. Fifteen children (mean age, 5.7 years) were treated accordingly. All patients were discharged within 4 weeks. Eleven patients are tumor-free, with a mean follow-up period of 2.8 years. No signs of radiation sequelae were observed. The preliminary results of this new, combined treatment are encouraging, if the advanced stage of disease is considered.