title: New combined treatment of surgery, radiotherapy, and reconstruction in head and neck rhabdomyosarcoma in children: the AMORE protocol.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The preliminary results of this new, combined treatment are encouraging, if the advanced stage of disease is considered.
authors.affiliation: Department of ENT/Head and Neck Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: P F
authors.initials: PF
authors.lastname: Schouwenburg
authors.forename: D
authors.initials: D
authors.lastname: Kupperman
authors.forename: F P
authors.initials: FP
authors.lastname: Bakker
authors.forename: L E
authors.initials: LE
authors.lastname: Blank
authors.forename: H B
authors.initials: HB
authors.lastname: de Boer
authors.forename: T A
authors.initials: TA
authors.lastname: Voûte
mesh_terms: D001918:Brachytherapy; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006171:Gutta-Percha; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D011879:Radiotherapy Dosage; D012208:Rhabdomyosarcoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D006171:Gutta-Percha