NEW COMBINED TREATMENT OF SURGERY, RADIOTHERAPY, AND RECONSTRUCTION IN HEAD AND NECK RHABDOMYOSARCOMA IN CHILDREN - THE AMORE PROTOCOL

Background. If no complete remission on chemotherapy is reached in hea d and neck rhabdomyosarcoma (RMS) in children, adjuvant radiotherapy a nd/or surgery are indicated. This often causes severe mutilation, and the prognosis is poor. Ablative surgery, moulage technique with afterl oading brachytherapy, and reconstructive surgery, called the AMORE pro tocol, is developed for residual or recurrent disease after chemothera py. Methods: Ablative surgery with preservation of important structure s is followed by the embedding of a gutta-percha mold in the created t issue defect. The wound bed is irradiated with Iridium(192). Within 1 week, the defect is reconstructed with a muscle transplant. Fifteen ch ildren (mean age, 5.7 years) were treated accordingly. Results. All pa tients were discharged within 4 weeks. Eleven patients are tumor-free. with a mean follow-up period of 2.8 years. No signs of radiation sequ elae were observed. Conclusion. The preliminary results oi this new, c ombined treatment are encouraging, ii the advanced stage of disease is considered. (C) 1998 John Wiley & Sons, Inc.