Facial deformation following treatment for pediatric head and neck rhabdomyosarcoma; the difference between treatment modalities. Results of a trans-Atlantic,multicenter cross-sectional cohort study |
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| Authors: | Marinka L. F. Hol Daniel J. Indelicato Olga Slater Frederic Kolb Richard J Hewitt Juling Ong Alfred G. Becking Jenny Gains Julie Bradley Eric Sandler Mark N. Gaze Bradley Pieters Henry Mandeville Raquel Dávila Fajardo Reineke Schoot Johannes H. M. Merks Peter Hammond Ludwig E. Smeele Michael Suttie |
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| Affiliation: | 1. Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands;2. Department of Radiation Oncology, University of Florida Proton Therapy Institute, Jacksonville, Florida, USA;3. Department of Pediatric Oncology, Great Ormond Street Hospital, NHS Foundation Trust, London, UK;4. Department of Plastic Surgery, Institute Gustave Roussy, Paris, France;5. Department of Head & Neck and Tracheal Surgery Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK;6. Department of Craniofacial, Plastic and Reconstructive Surgery, Chelsea and Westminster NHS Hospital Foundation Trust, London, UK;7. Department of Maxillofacial Surgery, Amsterdam UMC, Duivendrecht, The Netherlands;8. Department of Radiation Oncology, NHS Trust, London, UK;9. Division of Pediatric Oncology, Nemours Children's Specialty Clinic, Jacksonville, Florida, USA;10. Department or Radiation Oncology, Amsterdam UMC, Duivendrecht, The Netherlands;11. Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, and Institute of Cancer Research, Sutton, UK;12. Department of Radiation Oncology, University of Utrecht, Utrecht, The Netherlands;13. Big Data Institute, Oxford University, Oxford, UK;14. Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands Department of Maxillofacial Surgery, Amsterdam UMC, Duivendrecht, The Netherlands |
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| Abstract: | Background The four different local therapy strategies used for head and neck rhabdomyosarcoma (HNRMS) include proton therapy (PT), photon therapy (RT), surgery with radiotherapy (Paris-method), and surgery with brachytherapy (AMORE). Local control and survival is comparable; however, the impact of these different treatments on facial deformation is still poorly understood. This study aims to quantify facial deformation and investigates the differences in facial deformation between treatment modalities. Methods Across four European and North American institutions, HNRMS survivors treated between 1990 and 2017, more than 2 years post treatment, had a 3D photograph taken. Using dense surface modeling, we computed facial signatures for each survivor to show facial deformation relative to 35 age–sex–ethnicity-matched controls. Additionally, we computed individual facial asymmetry. Findings A total of 173 HNRMS survivors were included, survivors showed significantly reduced facial growth (p < .001) compared to healthy controls. Partitioned by tumor site, there was reduced facial growth in survivors with nonparameningeal primaries (p = .002), and parameningeal primaries (p ≤.001), but not for orbital primaries (p = .080) All patients were significantly more asymmetric than healthy controls, independent of treatment modality (p ≤ .001). There was significantly more facial deformation in orbital patients when comparing RT to AMORE (p = .046). In survivors with a parameningeal tumor, there was significantly less facial deformation in PT when compared to RT (p = .009) and Paris-method (p = .007). Interpretation When selecting optimal treatment, musculoskeletal facial outcomes are an expected difference between treatment options. These anticipated differences are currently based on clinicians’ bias, expertise, and experience. These data supplement clinician judgment with an objective analysis highlighting the impact of patient age and tumor site between existing treatment options. |
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| Keywords: | facial asymmetry facial deformation late effects protontherapy rhabdomyosarcoma surgery |
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