Strahlentherapie und Onkologie

, Volume 174, Issue 10, pp 522–528 | Cite as

Interstitial brachytherapy in soft tissue sarcomas

The tata memorial hospital experience
  • Ashok J. Chaudhary
  • Siddharth Laskar
  • Rajesh Badhwar
Originalarbeit

Abstract

Background

Soft tissue sarcomas are relatively rare tumors with an aggressive natural history associated with a high propensity for local recurrence following conservative surgery. It accounts for 1.8% of all cancers seen at the Tata Memorial Hospital, Mumbai. Organ preserving surgery and tumor bed brachytherapy have revolutionized the management of soft tissue sarcomas.

Patients and Methods

One hundred and seventy-seven patients with histologically proven non-metastatic cases of soft tissue sarcomas in the age group of 16 to 79 years (median 41 years) were treated at the Tata Memorial Hospital between January 1983 and December 1992. One hundred and fifty-one patients who had completed a minimum of 24 months of treatment were studied. There were 100 males (66%) and 51 females (33%). The majority had recurrent lesions (70.3%). Extremities were involved in 75% of patients. Spindle cell sarcoma was the major histologic variant (30%). The patients underwent function preserving surgery and temporary afterloading Ir-192 tumor bed brachytherapy with or without external radiotherapy.

Results

In patients receiving brachytherapy only, 25 out of 33 (75%) were locally controlled after a median follow-up of 30 months. After successful salvage of local failures the overall local control improved to 82%. Similarly in the patients who received both interstitial, brachytherapy and external irradiation, the local control rate after a median follow-up of 40 months was 71% which improved to 86% after successful salvage. The overall treatment related complication rate was less than 1%. The only marginally significant prognostic factor for local control was tumor grade (p=0.06).

Conclusion s

The sequential combination of limited surgery and tumor bed brachytherapy with or without external radiotherapy has been established as an effective alternative to more ablative procedures like amputation. Histologic grade has proven to be a significant factor determining local control.

Key Words

Soft tissue sarcomas Brachytherapy Organ preservation 

Interstitielle Brachytherapie von Weichteilsarkomen. Erfahrungen des Tata Memorial Hospitals

Zusammenfassung

Hintergrund

Weichteilsarkome sind relativ seltene Tumoren, die jedoch einen aggressiven natürlichen Verlauf mit hoher Lokalrezidivrate nach konservativer Chirurgie aufweisen. Etwa 1,8% aller Tumoren im Tata Memorial Hospital sind Weichteilsarkome. Die organerhaltende chirurgische Resektion und anschließende Brachytherapie des Tumorbettes haben die Behandlung der Weichteilsarkome revolutioniert.

Patienten und Methoden

177 Patienten mit histologisch nachgewiesenem, nichtmetastasierten Weichteilsarkom im Alter zwischen 16 und 79 Jahren (Median 41 Jahre) wurden zwischen 1983 und 1992 in unserem Hospital therapiert. 151 Patienten wiesen eine minimale Nachbeobachtungszeit von 24 Monaten auf und bildeten die Studiengruppe. Es handelte sich um 100 Männer (66%) und 51 Frauen (33%). Die Mehrzahl der Patienten hatte rezidivierte Läsionen (70%). Bei 75% der Patienten waren Extremitätensarkome vorhanden. Die häufigste histologische Typisierung war mit 30% das Spindelzellsarkom. Alle Patienten wurden funktionserhaltend operiert, anschließend mit einer temporären Ir-192-Brachytherapie des Tumorbettes und ggf. mit externer Radiotherapie nachbehandelt.

Ergebnisse

Nach alleiniger postoperativer Brachytherapie war bei 25 von 33 (75%) der Patienten eine anhaltende lokale Tumorkontrolle zu erreichen. Nach erfolgreicher Rettungschirurgie der Lokalrezidive erhöhte sich die lokale Tumorkontrolle auf 82%. Für Patienten, die eine kombinierte interstitielle und externe Radiotherapie postoperativ erhalten hatten, betrug die lokale Kontrollrate 71%, einschließlich Rettungschirurgie 86%. Die behandlungsbedingte Komplikationsrate lag bei unter 1%. Der einzige, marginal signifikante Prognosefaktor für den Endpunkt lokale Kontrolle war das Tumorgrading (p=0,06).

Schlußfolgerung

Die Kombination aus extremitätenerhaltender Chirurgie, Brachytherapie des Tumorbettes und externer Radiotherapie ist eine sichere und wirksame Alternative im Vergleich zur Amputation.

Schlüsselworter

Weichteilsarkom Brachytherapie Extremitätenerhalt 

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Copyright information

© Urban & Vogel 1998

Authors and Affiliations

  • Ashok J. Chaudhary
    • 1
  • Siddharth Laskar
    • 1
  • Rajesh Badhwar
    • 2
  1. 1.Department of Radiation OncologyTata Memorial HospitalMumbaiIndia
  2. 2.Department of Surgical OncologyTata Memorial HospitalMumbaiIndia

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