title: Adverse events of local treatment in long-term head and neck rhabdomyosarcoma survivors after external beam radiotherapy or AMORE treatment.
abstract: BACKGROUND
  Radiotherapy is a well-known cause of adverse events (AEs). To reduce AEs, an innovative local treatment was developed in Amsterdam: Ablative surgery, MOuld brachytherapy and surgical REconstruction (AMORE).
  
  
  OBJECTIVE
  (1) to determine the prevalence of AEs in HNRMS survivors and (2) to compare AEs between survivors treated with the international standard: external beam radiotherapy (EBRT-based: London) and survivors treated with AMORE if feasible, otherwise EBRT (AMORE-based: Amsterdam).
  
  
  METHODS
  All HNRMS survivors, treated in London or Amsterdam between January 1990 and December 2010 (n = 153), and alive ⩾ 2 years post-treatment were eligible (n = 113). A predefined list of AEs was assessed in a multidisciplinary clinic and graded according to the Common Terminology Criteria for Adverse Events.
  
  
  RESULTS
  Eighty HNRMS survivors attended the clinic (median follow-up 10.5 years); 63% experienced ⩾ 1 severe or disabling event, and 76% had ⩾ 5 AEs (any grade). Survivors with EBRT-based treatment were, after adjustment for site, age at diagnosis, and follow-up duration, at increased risk to develop any grade 3/4 event or ⩾ 5 AEs (any grade) compared with survivors with AMORE-based treatments (p = 0.032 and 0.01, respectively). Five year overall survival (source population) after EBRT-based treatment was 75.0%, after AMORE-based treatment 76.9%, p = 0.56.
  
  
  CONCLUSIONS
  This study may serve as a baseline inventory and can be used in future studies for prospective assessments of AEs following the introduction of novel local treatment modalities. AMORE-based local treatment resulted in similar overall survival and a reduction of AEs secondary to local treatment.
authors.affiliation: Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Reineke A
authors.initials: RA
authors.lastname: Schoot
authors.affiliation: Department of Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors.forename: Olga
authors.initials: O
authors.lastname: Slater
authors.affiliation: Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Cécile M
authors.initials: CM
authors.lastname: Ronckers
authors.affiliation: Department of Clinical Epidemiology and Bio-Statistics, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Aeilko H
authors.initials: AH
authors.lastname: Zwinderman
authors.affiliation: Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Oral and Maxillofacial surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Alfons J M
authors.initials: AJ
authors.lastname: Balm
authors.affiliation: Department of Otorhinolaryngology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hartley
authors.affiliation: Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Oral and Maxillofacial surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Michiel W
authors.initials: MW
authors.lastname: van den Brekel
authors.affiliation: Department of Otorhinolaryngology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Orbital centre, Department of Ophthalmology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Peerooz
authors.initials: P
authors.lastname: Saeed
authors.affiliation: Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors.forename: Eva
authors.initials: E
authors.lastname: Gajdosova
authors.affiliation: Department of Radiation Oncology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Pieters
authors.affiliation: Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Mark N
authors.initials: MN
authors.lastname: Gaze
authors.affiliation: Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Mandeville
authors.affiliation: Department of Radiation Oncology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Raquel Davila
authors.initials: RD
authors.lastname: Fajardo
authors.affiliation: Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Yen Ch'ing
authors.initials: YC
authors.lastname: Chang
authors.affiliation: Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Gains
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Simon D
authors.initials: SD
authors.lastname: Strackee
authors.affiliation: Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Dunaway
authors.affiliation: Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Abela
authors.affiliation: Dental and Maxillofacial department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors.forename: Carol
authors.initials: C
authors.lastname: Mason
authors.affiliation: Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Oral and Maxillofacial surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Ludi E
authors.initials: LE
authors.lastname: Smeele
authors.affiliation: Children and Young People's Department, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Chisholm
authors.affiliation: Department of Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors.forename: Gill A
authors.initials: GA
authors.lastname: Levitt
authors.affiliation: Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Leontien C M
authors.initials: LC
authors.lastname: Kremer
authors.affiliation: Paediatric Psychosocial Department, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Martha A
authors.initials: MA
authors.lastname: Grootenhuis
authors.affiliation: Paediatric Psychosocial Department, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Heleen
authors.initials: H
authors.lastname: Maurice-Stam
authors.affiliation: The Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Stiller
authors.affiliation: Molecular Medicine Unit, UCL Institute of Child Health, London, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Hammond
authors.affiliation: Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Huib N
authors.initials: HN
authors.lastname: Caron
authors.affiliation: Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands. Electronic address: j.h.merks@amc.uva.nl.
authors.forename: Johannes H M
authors.initials: JH
authors.lastname: Merks
mesh_terms: D000293:Adolescent; D000328:Adult; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D008297:Male; D011788:Quality of Life; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D012208:Rhabdomyosarcoma / Q000532:radiotherapy* / Q000601:surgery*; D017741:Survivors; D055815:Young Adult
keywords: Adverse events; Brachytherapy; Head and neck; Paediatric oncology; Quality of life; Radiotherapy; Rhabdomyosarcoma