title: The AMORE protocol for advanced-stage and recurrent nonorbital rhabdomyosarcoma in the head-and-neck region of children: a radiation oncology view.
abstract: OBJECTIVE
  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
  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.
authors.affiliation: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Leo E C M
authors.initials: LE
authors.lastname: Blank
authors.forename: Kees
authors.initials: K
authors.lastname: Koedooder
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Pieters
authors.forename: Hans N B
authors.initials: HN
authors.lastname: van der Grient
authors.forename: Marlou
authors.initials: M
authors.lastname: van de Kar
authors.forename: Joeri
authors.initials: J
authors.lastname: Buwalda
authors.forename: Alfons J M
authors.initials: AJ
authors.lastname: Balm
authors.forename: Johannes H M
authors.initials: JH
authors.lastname: Merks
authors.forename: Simon D
authors.initials: SD
authors.lastname: Strackee
authors.forename: Nicole J
authors.initials: NJ
authors.lastname: Freling
authors.forename: Caro C E
authors.initials: CC
authors.lastname: Koning
mesh_terms: D000293:Adolescent; D001918:Brachytherapy / Q000379:methods; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003131:Combined Modality Therapy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D008953:Models, Anatomic; D018365:Neoplasm, Residual; D011879:Radiotherapy Dosage; D019651:Plastic Surgery Procedures / Q000295:instrumentation; D012208:Rhabdomyosarcoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D016879:Salvage Therapy / Q000379:methods; D015996:Survival Rate