儿童头颈部横纹肌肉瘤手术、放疗和重建的新联合治疗：AMORE方案
New combined treatment of surgery, radiotherapy, and reconstruction in head and neck rhabdomyosarcoma in children: the AMORE protocol.
作者信息
Schouwenburg P F, Kupperman D, Bakker F P, Blank L E, de Boer H B, Voûte T A
机构信息
Department of ENT/Head and Neck Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
出版信息
Head Neck. 1998 Jul;20(4):283-92. doi: 10.1002/(sici)1097-0347(199807)20:4<283::aid-hed1>3.0.co;2-v.
BACKGROUND
If no complete remission on chemotherapy is reached in head and neck rhabdomyosarcoma (RMS) in children, adjuvant radiotherapy and/or surgery are indicated. This often causes severe mutilation, and the prognosis is poor. Ablative surgery, moulage technique with afterloading brachytherapy, and reconstructive surgery, called the AMORE protocol, is developed for residual or recurrent disease after chemotherapy.
METHODS
Ablative surgery with preservation of important structures is followed by the embedding of a gutta-percha mold in the created tissue defect. The wound bed is irradiated with Iridium192. Within 1 week, the defect is reconstructed with a muscle transplant. Fifteen children (mean age, 5.7 years) were treated accordingly.
RESULTS
All patients were discharged within 4 weeks. Eleven patients are tumor-free, with a mean follow-up period of 2.8 years. No signs of radiation sequelae were observed.
CONCLUSION
The preliminary results of this new, combined treatment are encouraging, if the advanced stage of disease is considered.
背景
如果儿童头颈部横纹肌肉瘤（RMS）化疗后未达到完全缓解，则需进行辅助放疗和/或手术。这通常会导致严重的毁容，且预后较差。针对化疗后残留或复发的疾病，开发了一种名为AMORE方案的切除手术、后装近距离放疗的模型技术和重建手术。
方法
在保留重要结构的情况下进行切除手术后，在形成的组织缺损处嵌入一个牙胶模型。用铱192对创面进行照射。在1周内，用肌肉移植对缺损进行重建。15名儿童（平均年龄5.7岁）接受了相应治疗。
结果
所有患者均在4周内出院。11名患者无肿瘤，平均随访期为2.8年。未观察到放射后遗症的迹象。
结论
如果考虑到疾病的晚期阶段，这种新的联合治疗的初步结果令人鼓舞。
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