Adverse events of local treatment in long-term head and neck rhabdomyosarcoma survivors after external beam radiotherapy or AMORE treatment

Reineke A Schoot, Olga Slater, Cécile M Ronckers, Aeilko H Zwinderman, Alfons J M Balm, Benjamin Hartley, Michiel W van den Brekel, Sanjeev Gupta, Peerooz Saeed, Eva Gajdosova, Bradley R Pieters, Mark N Gaze, Henry C Mandeville, Raquel Davila Fajardo, Yen Ch'ing Chang, Jennifer E Gains, Simon D Strackee, David Dunaway, Christopher Abela, Carol MasonLudi E Smeele, Julia C Chisholm, Gill A Levitt, Leontien C M Kremer, Martha A Grootenhuis, Heleen Maurice-Stam, Charles A Stiller, Peter Hammond, Huib N Caron, Johannes H M Merks

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38 Citations (Scopus)


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).

AIMS: (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.

CONCLUSION: 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.

Original languageEnglish
Pages (from-to)1424-34
Number of pages11
JournalEuropean journal of cancer (Oxford, England : 1990)
Issue number11
Publication statusPublished - May 2015
Externally publishedYes


  • Adolescent
  • Adult
  • Brachytherapy/adverse effects
  • Child
  • Female
  • Follow-Up Studies
  • Head and Neck Neoplasms/radiotherapy
  • Humans
  • Male
  • Quality of Life
  • Radiotherapy Dosage
  • Radiotherapy, Conformal/adverse effects
  • Rhabdomyosarcoma/radiotherapy
  • Survivors
  • Young Adult


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