The treatment of childhood rhabdomyosarcoma consists of a combination of chemotherapy with additional surgery and/or radiotherapy. Local therapy, i.e. surgery and/or radiotherapy, is essential to achieve local control. However, in patients with head-neck rhabdomyosarcoma (HNRMS) microscopically radical resection is often impossible, advocating the use of external beam radiotherapy (EBRT) in the majority of the cases.
In the ’90s an innovative new treatment protocol was developed in the Netherlands, called AMORE. This acronym stands for ABlative surgery, MOulage brachytherapy and surgical REconstruction. AMORE is equally effective compared to EBRT. Furthermore, moulage brachytherapy enables a focused dose delivery with relative sparing of the healthy tissues causing fewer adverse events compared to EBRT. This technique can also be used in other types of head-and-neck tumours than rhabdomyosarcoma.
AMORE is solely being performed in the Princess Máxima Center in Utrecht, the Netherlands.
AMORE-procedure starts with consultations of involved consultants (amongst others: pediatric oncologist, radiotherapist, head-and-neck surgeon, plastic surgeon, orbital surgeon) and pre-operative imaging.
AMORE1 is the first surgery during which the tumour will be resected and the mould with brachytherapy catheters will be placed. If necessary, patients will be transferred to the pediatric intensive care for post-operative care. During the following 3-4 days brachytherapy will be performed on the brachytherapy unit. Imaging will take place on several occasions to check whether the procedure is going according to plan.
Approximately a week after first surgery AMORE2 will take place, which consists of removal of the brachytherapy mould and reconstruction. Usually, patients need several days to a week to recover after this second surgery. After 2-3 weeks in total the whole AMORE procedure is finished and patients can be discharged.
More infomation about AMORE
- A novel local treatment strategy for advanced stage head and neck rhabdomyosarcomas in children: results of the AMORE protocol. Buwalda et al. Eur J Cancer. 2003;39(11):1594-602.
- AMORE treatment as salvage treatment in children and young adults with relapsed head-neck rhabdomyosarcoma. Vaarwerk et al. Radiother Onco.2019;131:21-26.
- Adverse events of local treatment in long-term head and neck rhabdomyosarcoma survivors after external beam radiotherapy or AMORE treatment. Schoot et al. Eur J Cancer.2015;51(11):1424-34.
The AMORE treatment team
- Drs. R.R.G. (Rutger) Knops, pediatric oncologist. Clinical lead AMORE
- Dr. J.H.M. (Hans) Merks, pediatric oncologist
- I. (Inge) Sieswerda, Nurse practioner