Adverse events of local treatment in long-term head and neck rhabdomyosarcoma survivors after external beam radiotherapy or AMORE treatment
Schoot RA., Slater O., Ronckers CM., Zwinderman AH., Balm AJM., Hartley B., Van Den Brekel MW., Gupta S., Saeed P., Gajdosova E., Pieters BR., Gaze MN., Mandeville HC., Fajardo RD., Chang YCI., Gains JE., Strackee SD., Dunaway D., Abela C., Mason C., Smeele LE., Chisholm JC., Levitt GA., Kremer LCM., Grootenhuis MA., Maurice-Stam H., Stiller CA., Hammond P., Caron HN., Merks JHM.
© 2015 Elsevier Ltd. All rights reserved.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 P5 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.