Abstract
Background
This study evaluated the role of pulsed dose-rate (PDR) brachytherapy (BRT), delivered alone or as a boost to external beam radiotherapy, as adjuvant therapy for the local control of soft tissue sarcomas of the extremities and skeletal muscles of the trunk that have undergone surgical treatment.
Methods
Between July 1998 and January 2002, 42 patients were treated with a combination of surgery and BRT alone (18 patients) or BRT/external beam radiotherapy (24 patients) for the treatment of primary (n = 32) and recurrent (n = 10) soft tissue sarcomas located in the proximal extremity (n = 17), distal extremity (n = 17), and trunk (n = 8). Tumor size was <5 cm in 20 cases and >5 cm in 22 cases, with histological grading of 1 (n = 7), 2 (n = 18), or 3 (n = 17). The median BRT dose delivered was 15 Gy, and the median external beam irradiation dose was 50 Gy.
Results
With a median follow-up of 34 months, the 36-month survival was 83.9% (SE, 6.1%), and the local control was 89%.
Conclusions
PDR interstitial BRT for soft tissue sarcoma is an effective, well-tolerated adjuvant radiation treatment that offers several practical advantages, among which are low acute and late toxicity with maximum normal tissue and critical structure sparing and overall shorter radiotherapy and hospital stay.
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References
Rosenberg SA, Tepper J, Glastein F, et al. The treatment of soft tissue sarcomas of the extremities: prospective randomized evaluation of: (1) limb sparing surgery plus radiotherapy compared with amputation and (2) the rate of adjuvant chemotherapy. Ann Surg 1982;136:305–15
Crownover RL, et al. The radiobiology and physics of brachytherapy. Hematol Oncol Clin North Am 1999;13:477–87.
Chen CZ, Huang Y, Hall EJ, Brenner DJ. Pulsed brachytherapy as a substitute for continuous low dose rate: an in vitro study with human carcinoma cells. Int J Radiat Oncol Biol Phys 1997;37:137–43
Veninga T, Visser A, Van den Berg AP, Van Hooije CM, Van Geel CA, Levendag PC. Equivalence of hyperfractionated and continuous brachytherapy in a rat tumor model and remarkable effectiveness when preceded by external irradiation. Int J Radiat Oncol Phys 2001;49:1351–60
Swift PS, Purser P, Roberts LW, Pickett B, Powell B, Phillips TL. Pulsed low dose rate brachytherapy for pelvic malignancies. Int J Radiat Oncol Biol Phys 1997;37:811–7
Levendag PC, Schmitz PIM, Jansen PP, et al. Fractionated high-dose-rate and pulsed-dose-rate brachytherapy: first clinical experience in squamous cell carcinoma of the tonsillar fossa and soft palate. Int J Radiat Oncol Biol Phys 1997;38:497–506
Roed H, Engelholm SA, Svendsen LB, Rosendal F, Olsen KJ. Pulsed dose rate (PDR) brachytherapy of anal carcinoma. Radiother Oncol 1996;41:131–4
Fritz P, Berns C, Anton HW, et al. PDR brachytherapy with flexible implants for interstitial boost after breast-conserving surgery and external beam radiation therapy. Radiother Oncol 1997;45:23–32
Jensen PT, Roed H, Engelholm SA, Rosendal F. Pulsed dose rate (PDR) brachytherapy as salvage treatment of locally advanced or recurrent gynecologic cancer. Int J Radiat Oncol Biol Phys 1998;42:1041–7
Strnad V, Lotter M, Grabenbauer G, Sauer R. Early results of pulsed-dose-rate interstitial brachytherapy for head and neck malignancies after limited surgery. Int J Radiat Oncol Biol Phys 2000;46:27–30
Nag S, Shasha D, Janjan N, Petersen I, Zaider M. The American Brachytherapy Society recommendations for brachytherapy of soft tissue sarcomas. Int J Radiat Oncol Biol Phys 2001;49:1033–43
Nag S, Dobelbower R, Glasgow G, Gustafson G, Syed N, Thomadsen B, Willamson JW. Inter-society standards for the performance of brachytherapy: a joint report from ABS, ACMP, and ACRO. Crit Rev Oncol Hematol 2003;48:1–17
Enzigher FM, Weiss SW. Soft Tissue Tumors. 2nd ed. St. Louis: Mosby, 1988
Wambersie A, Dutreix A, Pierquin B, Dardenne JC. Dosimétrie prévisionnelle en thérapie interstitielle au moyen de fils d’iridium 192 (le ‘‘Système de Paris’’): application dans un plan. J Belge Radiol 1972;55:197–206
Arbeit JM, Hilaris BS, Brennan MF. Wound complications in the multimodality treatment of extremity and superficial truncal sarcomas. J Clin Oncol 1987;5:480–8
Marubini E, Valsecchi MG. Analyzing Survival Data From Clinical Trials and Observational Studies. Chichester: Wiley, 1995
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–81
Hilaris B, Shiu M, Nori D. Limb-sparing therapy for locally advanced soft tissue sarcomas. Endocur Hypertherm Oncol 1985;1:17–24
Pisters P, Harrison L, Leung D, Woodruff J, Casper E, Brennan M. Long term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 1996;14:859–68
Harrison LB, Franzese F, Gaynor JJ, Brennan MF. Long term results of prospective randomized trial of adjuvant brachytherapy in the management of completely resected soft tissue sarcoma of the extremity and superficial trunk. Int J Radiat Oncol Biol Phys 1992;27:259–65
de Pree C, Popowski Y, Weber D, Nouet P, Rouzaud M, Kurtz JM. Feasibility and tolerance of pulsed dose rate interstitial brachytherapy. Int J Radiat Oncol Biol Phys 1999;43:971–6
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The authors thank William Russel, European Institute of Oncology, for his help in the preparation of this manuscript.
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Lazzaro, G., Lazzari, R., Pelosi, G. et al. Pulsed Dose-Rate Perioperative Interstitial Brachytherapy for Soft Tissue Sarcomas of the Extremities and Skeletal Muscles of the Trunk. Ann Surg Oncol 12, 935–942 (2005). https://doi.org/10.1245/ASO.2005.11.004
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DOI: https://doi.org/10.1245/ASO.2005.11.004