Strahlentherapie und Onkologie

, Volume 186, Issue 4, pp 224–228

A New Modification of Combining Vacuum Therapy and Brachytherapy in Large Subfascial Soft –Tissue Sarcomas of the Extremities

  • Maximilian Rudert
  • Cornelia Winkler
  • Boris Michael Holzapfel
  • Hans Rechl
  • Peter Kneschaurek
  • Reiner Gradinger
  • Michael Molls
  • Barbara Röper
Original Article

Abstract

Purpose:

To present a modification of a technique combining the advantages of brachytherapy for local radiation treatment and vacuum therapy for wound conditioning after resection of subfascial soft -tissue sarcomas (STS) of the extremities.

Patients and Methods:

Between January and May 2008, four patients with large (> 10 cm) subfascial STS of the thigh underwent marginal tumor excision followed by early postoperative HDR (high -dose -rate) brachytherapy (iridium -192) and vacuum therapy as part of their interdisciplinary treatment. The sponge of the vacuum system was used to stabilize brachytherapy applicators in parallel positions and to allow for a maximal wound contraction in the early postoperative phase, thus preventing seroma and deterioration of local dose distribution as optimized in computed tomography -(CT -)based three -dimensional conformal treatment planning. In three patients this was followed by external -beam radiotherapy. Acute wound complications and late effects according to LENT -SOMA after 4–8 months of follow -up were recorded.

Results:

The combination of vacuum and brachytherapy was applicable in all patients. CT scans from the 1st postoperative day showed the shrinkage of the sponge located in the tumor bed with the brachytherapy applicators in the intended position and easily visible. 15–18 Gy in fractions of 3 Gy bid prescribed to 5 mm tissue depth were applied over the next days with removal of the sponge and applicators on days 5–8. No early or late toxicity exceeding grade 2 was observed. The mean Enneking Score for functional outcome was 63% (perfect function = 100%).

Conclusion:

The combination of vacuum and brachytherapy is applicable and safe in the treatment of large subfascial STS.

Key Words

Soft-tissue sarcoma Surgery Brachytherapy Vacuum therapy BrachyVac therapy 

Eine neue Modifikation der Kombinationsbehandlung aus Vakuum - und Brachytherapie bei großen, tief gelegenen Weichteilsarkomen der Extremitäten

Zusammenfassung

Ziel:

Vorstellung einer Modifikation der Technik der Brachytherapie nach Resektion subfaszialer Weichteilsarkome, die eine lokale Strahlentherapie und gleichzeitig eine Vakuumtherapie zur Wundversorgung ermöglicht.

Patienten und Methodik:

Zwischen Januar und Mai 2008 wurde bei vier Patienten mit einem Weichteilsarkom der unteren Extremität (> 10 cm) eine marginale Tumorresektion durchgeführt. Adjuvant erfolgten eine frühe postoperative HDR -(„high -do se -rate“ -)Brachytherapie (Iridium -192) und eine Vakuumtherapie der Wunde im Rahmen der interdisziplinären Tumortherapie. Der Polyurethanschwamm des Vakuumsystems diente dabei als Stabilisator für die parallel angeordneten Strahlenapplikatoren, gleichzeitig wurde eine maximale Wundkontraktion ermöglicht. Somit konnten die Entstehung eines Seroms verhindert und eine gleichmäßige Dosisverteilung gewährleistet werden. Bei drei Patienten schloss sich daran eine zusätzliche externe Strahlentherapie an. Entsprechend den LENT -SOMA -Kriterien wurden frühe und späte Strahlenschäden nach 4–8 Monaten erfasst.

Ergebnisse:

Die Kombination von Vakuum - und Strahlentherapie konnte bei allen vier Patienten komplikationslos durchgeführt werden. CT -(Computertomographie -)Scans am 1. postoperativen Tag bestätigten die korrekte Lage der Brachytherapieapplikatoren innerhalb des kontrahierten Schwammes. Anschließend wurden insgesamt 15–18 Gy in Fraktionen von jeweils 3 Gy b.i.d. verabreicht. Der Schwamm und die Applikatoren wurden nach 5–8 Tagen entfernt. Dabei konnten keine frühen oder späten Strahlenschäden > Grad 2 beobachtet werden. Das durchschittliche funktionelle Ergebnis entsprechend dem Enneking -Score lag bei 63% (perfekte Furnktion = 100%).

Schlussfolgerung:

Die Kombination von Vakuum - und Brachytherapie stellt ein geeignetes und komplikationsarmes Verfahren in der Behandlung von großen, subfaszial gelegenen Weichteilsarkomen dar.

Schlüsselwörter

Weichteilsarkom Chirurgie Brachytherapie Vakuumtherapie BrachyVac-Therapie 

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Copyright information

© Urban & Vogel, Muenchen 2010

Authors and Affiliations

  • Maximilian Rudert
    • 1
    • 2
    • 4
  • Cornelia Winkler
    • 3
  • Boris Michael Holzapfel
    • 1
    • 2
  • Hans Rechl
    • 2
  • Peter Kneschaurek
    • 3
  • Reiner Gradinger
    • 2
  • Michael Molls
    • 3
  • Barbara Röper
    • 3
  1. 1.Department of OrthopedicsUniversity of WürzburgWürzburgGermany
  2. 2.Department of Orthopedics and Traumatology, Klinikum München rechts der IsarTechnical University of MunichMunichGermany
  3. 3.Department of Radiation OncologyTechnical University of MunichMunichGermany
  4. 4.Orthopädische KlinikKönig Ludwig HausWürzburgGermany

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