Craniofacial growth of children with head and neck rhabdomyosarcoma treated according to the AMORE protocol: a quantitative analysis

Background. In the treatment of pediatric head and neck rhabdomyosarcoma (HNRMS), external beam radiation treatment (EBRT) is frequently applied. One of the most common and disturbing sequelae of EBRT is suppression of craniofacial growth, leading to clinically visible facial asymmetry in 59-97% of the irradiated children. The goal of this study was to quantify the growth of the craniofacial skeleton in children with HNRMS treated with AMORE (Ablative surgery, Moulage technique brachytherapy and surgical Reconstruction). Methods. Children with a follow-up of > 3 years after AMORE were eligible for clinical and quantitative assessment of the craniofacial skeleton. Quantification was performed by two observers, using 14 paired (3D) CT-derived measurements. The left-right differences within each patient were assessed. Results. Eleven patients were included. Two out of the 11 (18%) patients had visible craniofacial asymmetry as a consequence of bone surgery. The remaining nine patients (82%) had a symmetrical appearance of the craniofacial skeleton at clinical assessment. Three out of the nine patients had no CT asymmetry, whereas six had asymmetrical values. Only one of these six patients had severe CT asymmetry due to bone resection. The remaining five patients had 1-2 asymmetrical values. The majority of these values were secondary to mild growth suppression of the mandible at the side of the lesion. Conclusion. The AMORE protocol results in a low incidence of clinical relevant growth disturbance of the craniofacial skeleton.

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