Financial Relationships No relevant financial relationships exist Facial

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 Photons Protons EBRT Surgery + Brachytherapy AMORE Surgery + EBRT Brachytherapy Chirurgie AMORE

Treatment options 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 3 D 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 Photons Protons EBRT Surgery + Brachytherapy AMORE Surgery + EBRT Brachytherapy Chirurgie AMORE

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

Next Step External Beam Radiotherapy Photons Protons Surgery + Brachytherapy AMORE Surgery + 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