1. Financial Relationships
No relevant financial relationship(s) exist

2. 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

3. Introduction

4. Rhabdomyosarcoma 40% in head and neck are Median age at diagnosis
4 years of age

5. Median age at diagnosis
Rhabdomyosarcoma
40%
Median age at diagnosis
4 years of age

6. Treatment options External Beam Radiotherapy Photons External Beam
Protons
Surgery +
Brachytherapy
AMORE
Surgery +
EBRT
Brachytherapy
Chirurgie
AMORE
EBRT

7. Treatment options External Beam Radiotherapy Photons External Beam
Protons
Surgery +
Brachytherapy
AMORE
Surgery +
EBRT
Brachytherapy
Chirurgie
AMORE
EBRT

8. AMORE Surgery + Brachytherapy AMORE Ablative surgery
MOulage technique with after loading brachytherapy
REconstructive surgery
Brachytherapy
Chirurgie
AMORE
EBRT

9. Expected differences
EBRT Photon plan
AMORE Brachytherapy plan

10. 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

11. Aim
Determine qualitative differences of the musculo-skeletal deformities between EBRT (photons) and AMORE-based patients.

12. Methods

13. All patients treated between 1990 – 2014 for orbital RMS
Method
All patients treated between 1990 – 2014 for orbital RMS
EBRT - photons
AMORE

14. All patients treated between 1990 - 2014
Method
All patients treated between
AMORE
EBRT – photons

15. 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)

16. Results

17. 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

18. 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

19. Curvature
Deformed Curvature
Normal Curvature

20. Curvature Deformed Curvature EBRT – based patients
AMORE – based patients
Normal Curvature

21. 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

22. 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

23. Next Step External Beam Radiotherapy Photons External Beam
Protons
Surgery +
Brachytherapy
AMORE
Surgery +
EBRT
EBRT
Brachytherapy
Chirurgie
AMORE

24. 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

25. 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.