BAOMS comments on the NHSE review into commissioning ablative surgery
04 October 2019
BAOMS comments on the NHSE review into commissioning ablative surgery, moulage technique brachytherapy and surgical reconstruction (AMORE) for head and neck soft tissue sarcoma in children and young people
Responding to the NHS England (NHSE) Specialised Services invite for comments, the British Association of Oral and Maxillofacial Surgery (BAOMS) has considered the policy proposition for ablative surgery, moulage technique brachytherapy and surgical reconstruction (AMORE) for head and neck soft tissue sarcoma in children and young people.
The BAOMS Oncology and Reconstruction Subspecialty Interest Groups reviewed the NHSE evidence, and these are their observations and comments:
The incidence of head and neck rhabdomyosarcoma in children is very low, estimated to be 23 per annum in the UK. They are managed by regional sarcoma multidisciplinary teams (MDTs). The potential role for AMORE lies in cases where there is extensive soft tissue disease with the involvement of the maxillofacial bony framework, which could be primary aggressive late presenting disease or recurrent disease. This further reduces the number of cases suitable for consideration per annum. Also, the extent of the disease and the volume will have a considerable impact on prognosis.
The current available evidence in the literature comparing AMORE and conventional management of head and neck rhabdomyosarcoma in children has not shown any significant differences in overall survival of locoregional disease control rates. Health-related quality of life scores were not significantly different between the treatment groups.
The main benefits of AMORE lie the issues around the frequency and severity of adverse effects of treatment side-effects and of long-term toxicity of conventional management i.e. facial asymmetry, pituitary dysfunction and hearing problems.
There have been no cost-effectiveness comparison reports. However, the impact of the longer-term toxic effects and their associated costs should be taken into consideration.
Comment
In view of the rarity of head and neck rhabdomyosarcoma in children in the UK, BAOMS agrees with the NHS England position that AMORE is not routinely commissioned. The rarity of suitable cases for management infers that there could be a lack of local specialists to deliver the technique consistently as part of their routine service. However, in cases where the sarcoma MDT feel that there might be a role for AMORE, there should be a streamlined referral pathway to a unit that carries out AMORE.
We would recommend that NHS England and the UK Sarcoma MDT establish a close partnership with a suitable unit so that appropriate patients can receive treatment in more experienced centres. This would be similar to arrangements available for treatment of paediatric cancers by Proton Beam Therapy.
Further information about the NHSE consultation into AMORE
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