EBRT

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EBRT
Financial Relationships
No relevant financial relationship(s) exist
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
Introduction
Rhabdomyosarcoma
40% in head
and neck are
Soft
Tissue
6%
Median age at diagnosis
4 years of age
Rhabdomyosarcoma
40%
Soft
Tissue
6%
Median age at diagnosis
4 years of age
Treatment options
External Beam
Radiotherapy
External Beam
Radiotherapy
Photons
Protons
EBRT
Surgery
+
Brachytherapy
AMORE
Surgery
+
EBRT
Brachytherapy
Chirurgie
AMORE
Treatment options
External Beam
Radiotherapy
External Beam
Radiotherapy
Photons
Protons
EBRT
Surgery
+
Brachytherapy
AMORE
Surgery
+
EBRT
Brachytherapy
Chirurgie
AMORE
AMORE
Surgery
+
Brachytherapy
AMORE
Ablative surgery
MOulage technique with after loading brachytherapy
REconstructive surgery
EBRT
Brachytherapy
Chirurgie
AMORE
Expected differences
EBRT Photon plan
AMORE Brachytherapy plan
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
Aim
Determine qualitative differences of the musculo-skeletal
deformities between EBRT (photons) and AMORE-based
patients.
Methods
Method
All patients treated between 1990 – 2014 for orbital RMS
AMORE
EBRT - photons
Method
All patients treated between 1990 - 2014
AMORE
EBRT – photons
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)
Results
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%
100%
Radiated
side of face
95%
83%
100%
Contralateral
side of face
100%
85%
100%
> 2 SD differences to healthy population
Curvature
Deformed Curvature
Normal Curvature
Curvature
Deformed Curvature
AMORE – based patients
EBRT – based patients
Normal Curvature
Conclusion
• Surface in EBRT patients and AMORE patients
affected at tumor side, however in EBRT the nonradiated side also affected
• Curvature in EBRT more affected in contralateral
and non-radiated side
• Growth disruption less severe in AMORE-based
patient
Next Step
• Include all head and neck RMS
• Include all treatment options
External Beam
Radiotherapy
External Beam
Radiotherapy
Photons
Protons
EBRT
Surgery
+
Brachytherapy
AMORE
Surgery
+
EBRT
Brachytherapy
Chirurgie
AMORE
Next Step
External Beam
Radiotherapy
External Beam
Radiotherapy
Photons
Protons
Surgery
+
Brachytherapy
AMORE
Surgery
+
EBRT
EBRT
Brachytherapy
Chirurgie
AMORE
Next Step
External Beam
Radiotherapy
External Beam
Radiotherapy
Photons
Protons
Surgery
+
Brachytherapy
AMORE
Surgery
+
EBRT
EBRT
Goal: Develop a prediction model to choose optimal
treatment considering patient and tumor characteristics
Brachytherapy
Chirurgie
AMORE
Thank you for your time and attention
T. Alderliesten
A.G. Becking
A. Bel
A. 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

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