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Safety and Efficacy of Radiation Dose Delivered via Iodine-125 Brachytherapy Mesh Implantation for Deep Cavity Sarcomas

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Radiation delivered as brachytherapy (BRT) via catheters placed during extremity soft tissue sarcoma (STS) resection results in acceptable local control rates; however, there are limitations in deep cavities. 125I seeds embedded in mesh provide a flexible BRT platform that may be contoured to irregular deep cavities surfaces, but the risks and benefits are unknown.

Methods

Patients with thoracic, abdominal, pelvic, retroperitoneal, and deep truncal STS undergoing resection and implantation of permanent 125I mesh BRT at our institution were reviewed. Local recurrence rates within the tumor bed covered by mesh (in field) and postoperative complications were analyzed.

Results

Between 2000 and 2010, a total of 46 patients were treated for primary (n = 8, 17 %) or recurrent (n = 38, 83 %) deep cavity STS (median follow-up 34.8 months); 74 % received external-beam radiotherapy for this or a prior presentation. In-field recurrences were observed in 9 patients (19.5 %). Crude cumulative incidences of in-field, regional, and distant recurrences at 5 years were 26.3, 54.2, and 54.1 %, respectively. 5-year overall survival rate was 47.2 %; median survival was 44.0 months. Twenty-two patients (48 %) experienced complications, half of whom (24 %) developed grade III/IV complications requiring percutaneous intervention (n = 6) or reoperation (n = 5) at a median of 35.5 days. There were no postoperative deaths.

Conclusions

To our knowledge, this is the first study to report safety and efficacy for permanent 125I mesh BRT implantation after resection of deep cavity STS. Local in-field recurrence rates were relatively low in this high-risk population. However, 24 % developed complications requiring intervention. 125I mesh BRT appears effective, but it should be used with caution.

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References

  1. Rosenberg SA, Tepper J, Glatstein E, et al. Prospective randomized evaluation of adjuvant chemotherapy in adults with soft tissue sarcomas of the extremities. Cancer. 1983;52:424–34.

    Article  CAS  PubMed  Google Scholar 

  2. Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16:197–203.

    CAS  PubMed  Google Scholar 

  3. Suit HD, Russell WO, Martin RG. Management of patients with sarcoma of soft tissue in an extremity. Cancer. 1973;31:1247–55.

    Article  CAS  PubMed  Google Scholar 

  4. Rosenberg SA, Tepper J, Glatstein E, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. 1982;196:305–15.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Lindberg RD, Martin RG, Romsdahl MM, Barkley HT Jr. Conservative surgery and postoperative radiotherapy in 300 adults with soft-tissue sarcomas. Cancer. 1981;47:2391–7.

    Article  CAS  PubMed  Google Scholar 

  6. Pisters PW, Leung DH, Woodruff J, Shi W, Brennan MF. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol. 1996;14:1679–89.

    CAS  PubMed  Google Scholar 

  7. Lewis JJ, Leung D, Woodruff JM, Brennan MF. Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg. 1998;228:355–65.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Heslin MJ, Lewis JJ, Nadler E, et al. Prognostic factors associated with long-term survival for retroperitoneal sarcoma: implications for management. J Clin Oncol. 1997;15:2832–9.

    CAS  PubMed  Google Scholar 

  9. Stoeckle E, Coindre JM, Bonvalot S, et al. Prognostic factors in retroperitoneal sarcoma: a multivariate analysis of a series of 165 patients of the French Cancer Center Federation Sarcoma Group. Cancer. 2001;92:359–68.

    Article  CAS  PubMed  Google Scholar 

  10. Gronchi A, Lo Vullo S, Fiore M, et al. Aggressive surgical policies in a retrospectively reviewed single-institution case series of retroperitoneal soft tissue sarcoma patients. J Clin Oncol. 2009;27:24–30.

  11. Bonvalot S, Miceli R, Berselli M, et al. Aggressive surgery in retroperitoneal soft tissue sarcoma carried out at high-volume centers is safe and is associated with improved local control. Ann Surg Oncol. 2010;17:1507–14.

    Article  PubMed  Google Scholar 

  12. Gronchi A, Miceli R, Shurell E, et al. Outcome prediction in primary resected retroperitoneal soft tissue sarcoma: histology-specific overall survival and disease-free survival nomograms built on major sarcoma center data sets. J Clin Oncol. 2013;31:1649–55.

    Article  PubMed  Google Scholar 

  13. Keung EZ, Hornick JL, Bertagnolli MM, Baldini EH, Raut CP. Predictors of outcomes in patients with primary retroperitoneal dedifferentiated liposarcoma undergoing surgery. J Am Coll Surg. 2014;218:206–17.

    Article  PubMed  Google Scholar 

  14. McBride SM, Raut CP, Lapidus M, et al. Locoregional recurrence after preoperative radiation therapy for retroperitoneal sarcoma: adverse impact of multifocal disease and potential implications of dose escalation. Ann Surg Oncol. 2013;20:2140–47.

    Article  PubMed  Google Scholar 

  15. Brennan MF, Hilaris B, Shiu MH, et al. Local recurrence in adult soft-tissue sarcoma. A randomized trial of brachytherapy. Arch Surg. 1987;122:1289–93.

    Article  CAS  PubMed  Google Scholar 

  16. Harrison LB, Franzese F, Gaynor JJ, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in the management of completely resected soft tissue sarcomas of the extremity and superficial trunk. Int J Radiat Oncol Biol Phys. 1993;27:259–65.

    Article  CAS  PubMed  Google Scholar 

  17. Pisters PW, Harrison LB, Woodruff JM, Gaynor JJ, Brennan MF. A prospective randomized trial of adjuvant brachytherapy in the management of low-grade soft tissue sarcomas of the extremity and superficial trunk. J Clin Oncol. 1994;12:1150–5.

    CAS  PubMed  Google Scholar 

  18. Pisters PW, Harrison LB, Leung DH, Woodruff JM, Casper ES, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol. 1996;14:859–68.

    CAS  PubMed  Google Scholar 

  19. Jones JJ, Catton CN, O’Sullivan B, et al. Initial results of a trial of preoperative external-beam radiation therapy and postoperative brachytherapy for retroperitoneal sarcoma. Ann Surg Oncol. 2002;9:346–54.

    Article  PubMed  Google Scholar 

  20. Rosenzweig KE, Fox JL, Zelefsky MJ, Raben A, Harrison LB, Rusch VW. A pilot trial of high-dose-rate intraoperative radiation therapy for malignant pleural mesothelioma. Brachytherapy. 2005;4:30–3.

    Article  PubMed  Google Scholar 

  21. d’ Amato TA, Galloway M, Szydlowski G, Chen A, Landreneau RJ. Intraoperative brachytherapy following thoracoscopic wedge resection of stage I lung cancer. Chest. 1998;114:1112–5.

    Article  PubMed  Google Scholar 

  22. Voynov G, Heron DE, Lin CJ, et al. Intraoperative (125)I Vicryl mesh brachytherapy after sublobar resection for high-risk stage I non-small cell lung cancer. Brachytherapy. 2005;4:278–85.

    Article  PubMed  Google Scholar 

  23. Chen A, Galloway M, Landreneau R, et al. Intraoperative 125I brachytherapy for high-risk stage I non-small cell lung carcinoma. Int J Radiat Oncol Biol Phys. 1999;44:1057–63.

    Article  CAS  PubMed  Google Scholar 

  24. Fernando HC, Santos RS, Benfield JR, et al. Lobar and sublobar resection with and without brachytherapy for small stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg. 2005;129:261–7.

    Article  PubMed  Google Scholar 

  25. Santos R, Colonias A, Parda D, et al. Comparison between sublobar resection and 125iodine brachytherapy after sublobar resection in high-risk patients with stage I non-small-cell lung cancer. Surgery. 2003;134:691–7.

    Article  PubMed  Google Scholar 

  26. Mutyala S, Stewart A, Khan AJ, et al. Permanent iodine-125 interstitial planar seed brachytherapy for close or positive margins for thoracic malignancies. Int J Radiat Oncol Biol Phys. 2010;76:1114–20.

    Article  PubMed  Google Scholar 

  27. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53(282):457–81.

  29. European Organisation for Research and Treatment of Cancer. A phase III randomized study of preoperative radiotherapy plus surgery versus surgery alone for patients with retroperitoneal sarcomas—STRASS. http://www.eortc.be/clinicaltrials/Details.asp?Protocol=62092&T=.

  30. Fernando HC, Landreneau RJ, Mandrekar SJ, et al. The impact of adjuvant brachytherapy with sublobar resection on pulmonary function and dyspnea in high-risk patients with operable disease: preliminary results from the American College of Surgeons Oncology Group Z4032 trial. J Thorac Cardiovasc Surg. 2011;142:554–62.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Fernando HC, Landreneau RJ, Mandrekar SJ, et al. Thirty- and ninety-day outcomes after sublobar resection with and without brachytherapy for non-small cell lung cancer: results from a multicenter phase III study. J Thorac Cardiovasc Surg. 2011;142:1143–51.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Fernando HC, Landreneau RJ, Mandrekar SJ, et al. Impact of brachytherapy on local recurrence rates after sublobar resection: results from ACOSOG Z4032 (Alliance), a phase III randomized trial for high-risk operable non-small-cell lung cancer. J Clin Oncol. 2014;32:2456–62.

    Article  PubMed  Google Scholar 

  33. Paryani NN, Zlotecki RA, Swanson EL, et al. Multimodality local therapy for retroperitoneal sarcoma. Int J Radiat Oncol Biol Phys. 2012;82:1128–34.

    Article  PubMed  Google Scholar 

  34. Feng M, Murphy J, Griffith KA, et al. Long-term outcomes after radiotherapy for retroperitoneal and deep truncal sarcoma. Int J Radiat Oncol Biol Phys. 2007;69:103–10.

    Article  PubMed  Google Scholar 

  35. O’Sullivan B, Davis AM, Turcotte R, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002;359(9325):2235–41.

    Article  PubMed  Google Scholar 

  36. Baldini EH, Lapidus MR, Wang Q, et al. Predictors for major wound complications following preoperative radiotherapy and surgery for soft-tissue sarcoma of the extremities and trunk: importance of tumor proximity to skin surface. Ann Surg Oncol. 2013;20:1494–9.

    Article  PubMed  Google Scholar 

  37. Zlotecki RA, Katz TS, Morris CG, Lind DS, Hochwald SN. Adjuvant radiation therapy for resectable retroperitoneal soft tissue sarcoma: the University of Florida experience. Am J Clin Oncol. 2005;28:310–6.

    Article  PubMed  Google Scholar 

  38. Caudle AS, Tepper JE, Calvo BF, et al. Complications associated with neoadjuvant radiotherapy in the multidisciplinary treatment of retroperitoneal sarcomas. Ann Surg Oncol. 2007;14:577–82.

    Article  PubMed  Google Scholar 

  39. Erzen D, Sencar M, Novak J. Retroperitoneal sarcoma: 25 years of experience with aggressive surgical treatment at the Institute of Oncology, Ljubljana. J Surg Oncol. 2005;91:1–9.

    Article  PubMed  Google Scholar 

  40. Strauss DC, Hayes AJ, Thway K, Moskovic EC, Fisher C, Thomas JM. Surgical management of primary retroperitoneal sarcoma. Br J Surg. 2010;97:698–706.

    Article  CAS  PubMed  Google Scholar 

  41. DiBiase SJ, Rosenstock JG, Shabason L, Corn BW. Tumor bed brachytherapy with a mesh template: an accessible alternative to intraoperative radiotherapy. J Surg Oncol. 1997;66:104–9.

    Article  CAS  PubMed  Google Scholar 

  42. Nag S, Shasha D, Janjan N, Petersen I, Zaider M; American Brachytherapy Society. The American Brachytherapy Society recommendations for brachytherapy of soft tissue sarcomas. Int J Radiat Oncol Biol Phys. 2001;49:1033–43.

    Article  CAS  PubMed  Google Scholar 

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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Mark Fairweather MD, Jiping Wang MD, PhD, Monica M. Bertagnolli MD & Chandrajit P. Raut MD, MSc

  2. Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, USA

    Phillip M. Devlin MD, Jorgen Hansen MS & Elizabeth H. Baldini MD, MPH

  3. Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    John E. Ready MD

  4. Division of Thoracic Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    David J. Sugarbaker MD

  5. Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Phillip M. Devlin MD, Elizabeth H. Baldini MD, MPH, John E. Ready MD, Monica M. Bertagnolli MD & Chandrajit P. Raut MD, MSc

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  1. Mark Fairweather MD
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  2. Jiping Wang MD, PhD
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Correspondence to Mark Fairweather MD.

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Fairweather, M., Wang, J., Devlin, P.M. et al. Safety and Efficacy of Radiation Dose Delivered via Iodine-125 Brachytherapy Mesh Implantation for Deep Cavity Sarcomas. Ann Surg Oncol 22, 1455–1463 (2015). https://doi.org/10.1245/s10434-014-4171-y

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  • DOI: https://doi.org/10.1245/s10434-014-4171-y

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