Abstract
Objective
Conservative surgery in combination with local radiation therapy is considered a standard approach for soft tissue sarcomas (STS) leading to high local control rates and widely replacing the need for amputations. A close relationship exists between total radiation dose and local control probability. Combination of external beam radiotherapy and perioperative brachytherapy represents a moderate dose escalation that could contribute to improve local control.
Material and methods
From May 2015 to October 2018, 23 patients with histologically proven STS of various locations were prospectively entered into a data registry of perioperative HDR brachytherapy (PoBT) combined with external beam radiotherapy (EBRT). Multidisciplinary treatment comprised wide surgical excision, PoBT (16.5 Gy delivered in 3 fractions of 5.5 Gy twice daily with a gap time of at least 6 h between fractions), and EBRT delivered either pre- or postoperatively (median dose 47 Gy, range 40–57.5 Gy) up to a total accumulated radiotherapy equivalent dose for tumor of 69.5 to 86.5 Gy (median, 76.1 Gy), representing a moderate total dose escalation over the 66 Gy traditionally used.
Results
With a median follow-up of 13.4 months (range, 1–35.4 months), 22 patients (96%) remain alive without evidence of local or distant recurrence, 1 patient (4%) is alive with local relapse, and no patient has died because of tumor progression. Treatment-related adverse effects were mild or moderate. No cases of grades 4–5 late toxicity have been observed during the follow-up period.
Conclusions
HDR PoBT is safe, feasible, and well tolerated and allows for a moderate radiation dose escalation with acceptable rates of tumor control. Further follow-up is necessary to confirm impact on final outcomes.
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Xin Chen and Angel Montero. The first draft of the manuscript was written by Xin Chen and Angel Montero and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Chen-Zhao, X., Montero, A., De las Heras, J. et al. Perioperative high-dose-rate brachytherapy (PoHDR) in the multidisciplinary management of adult soft tissue sarcomas: a realistic alternative for a moderate radiotherapy dose escalation. J Radiat Oncol 9, 15–24 (2020). https://doi.org/10.1007/s13566-020-00421-3
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DOI: https://doi.org/10.1007/s13566-020-00421-3