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Financial Relationships
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Facial deformation following treatment for orbital rhabdomyosarcoma in children The difference between treatment modalities Marinka Hol, MD Department of Head and neck surgery and Maxillofacial Surgery, AMC Amsterdam
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Introduction
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Rhabdomyosarcoma 40% in head and neck are Median age at diagnosis
4 years of age
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Median age at diagnosis
Rhabdomyosarcoma 40% Median age at diagnosis 4 years of age
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Treatment options External Beam Radiotherapy Photons External Beam
Protons Surgery + Brachytherapy AMORE Surgery + EBRT Brachytherapy Chirurgie AMORE EBRT
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Treatment options External Beam Radiotherapy Photons External Beam
Protons Surgery + Brachytherapy AMORE Surgery + EBRT Brachytherapy Chirurgie AMORE EBRT
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AMORE Surgery + Brachytherapy AMORE Ablative surgery
MOulage technique with after loading brachytherapy REconstructive surgery Brachytherapy Chirurgie AMORE EBRT
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Expected differences EBRT Photon plan AMORE Brachytherapy plan
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Late adverse events - Quantitative
Schoot et al.. Adverse events of local treatment in long-term head and neck rhabdomyosarcoma survivors after external beam radiotherapy or AMORE treatment. EJC 2015
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Aim Determine qualitative differences of the musculo-skeletal deformities between EBRT (photons) and AMORE-based patients.
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Methods
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All patients treated between 1990 – 2014 for orbital RMS
Method All patients treated between 1990 – 2014 for orbital RMS EBRT - photons AMORE
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All patients treated between 1990 - 2014
Method All patients treated between AMORE EBRT – photons
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Method Hol et al. Analyzing 3D stereophotographs: a new method for the automatic segmentation of the human face into facial esthetic units using the Coherent Point Drift algorithm (submitted)
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Results
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Orbital Rhabdomyosarcoma patients
AMORE- based (n=14) EBRT-based (n=15) Mean Age at Diagnosis 7.4 6.3 Male 60% 50% Mean Follow-Up 10.5 years 12.0 years Mean age at follow-up 18
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Surface area AMORE (n=14) EBRT (n=15) Healthy Population Treated Orbit
60% 70% 100% Contralateral orbit 98% 80% Radiated side of face 95% 83% Contralateral side of face 85% > 2 SD differences to healthy population
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Curvature Deformed Curvature Normal Curvature
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Curvature Deformed Curvature EBRT – based patients
AMORE – based patients Normal Curvature
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Conclusion Surface in EBRT patients and AMORE patients affected at tumor side, however in EBRT the non- radiated side also affected Curvature in EBRT more affected in contralateral and non-radiated side Growth disruption less severe in AMORE-based patient
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Next Step Include all head and neck RMS Include all treatment options
External Beam Radiotherapy Photons External Beam Radiotherapy Protons Surgery + Brachytherapy AMORE Surgery + EBRT Brachytherapy Chirurgie AMORE EBRT
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Next Step External Beam Radiotherapy Photons External Beam
Protons Surgery + Brachytherapy AMORE Surgery + EBRT EBRT Brachytherapy Chirurgie AMORE
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Next Step External Beam Radiotherapy Photons External Beam
Protons Surgery + Brachytherapy AMORE Surgery + EBRT EBRT Goal: Develop a prediction model to choose optimal treatment considering patient and tumor characteristics Brachytherapy Chirurgie AMORE
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Thank you for your time and attention
T. Alderliesten A.G. Becking A. Bel R. Dávila-Fajardo N.J. Freling L.C. Kremer J.H.M. Merks B.R. Pieters C.R.N. Rasch C.M. Ronckers P. Saeed R. Schoot L.E. Smeele S.D Strackee J. Wiersma J.C. Chrisholm M.N. Gaze H.C. Mandeville O. Slater All patients This study is a first step towards uncovering to which extent the choice of therapy is related to the severity of growth deformities, which is highly needed to enable well-informed individualized shared multimodal treatment decision making.
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