Feasibility report of conservative surgery, perioperative high-dose-rate brachytherapy (PHDRB), and low-to-moderate dose external beam radiation therapy (EBRT) in pediatric sarcomas

Abstract

Purpose: This study was undertaken to determine the feasibility of perioperative highdose-rate brachytherapy (PHDRB) as an accelerated boost in patients with pediatric sarcomas. Methods and materials:Five pediatric patients (ages 7-16) with soft tissue sarcomas (STS) or soft tissue recurrences of previously treated osteosarcomas were treated with surgical resection and PHDRB (16-24 Gy) for R0-R1 resections. Patients with STS and osteosarcomas received 27 Gy and 45 Gy of EBRT postoperatively.Results: After a median follow-up of 27 months (range, 12-50) all the patients remain locally controlled. Only 1 patient developed regrowth of pulmonary metastases and died of distant disease at 16 months. Conclusions:The use of PHDRB is safe in the short-term in this pediatric population. Only 1 patient suffered a partial wound dehiscence that may not be entirely related to PHDRB. Patients withrecurrent osteosarcomas canbe treatedinafashion similartotheir adultsoft tissuecounterpartsand avoid limb amputation. Younger patients with STS may achieve local control and prevent growth retardation with a combination of PHDRB and moderate doses of EBRT.

New techniques in irradiation: clinical implications of perioperative high-dose rate brachytherapy

“…This was mainly due to a programmed reduction in the EBRT dose in growing individuals [6], as well as the need to decrease the overall target dose in some paravertebral locations where the prescription dose would ii76 have exceeded the spinal cord tolerance. In addition, the PHDRB dose was reduced to the closest lower level, owing to excessive toxicity in oropharyngeal and previously irradiated pelvic tumors.…”

“…Although this approach is still experimental, initial results published worldwide report efficacy similar to standard EBRT with the advantage of reducing treatment time from 6 weeks to only 5 days [4]. Brachytherapy also plays an important role in the treatment of skin cancer [5], pediatric malignancies [6], and malignant obstruction due to lung [7], esophageal [8] and biliary duct cancer [9].…”

American Society for Radiation Oncology (ASTRO) and American College of Radiology (ACR) Practice Guideline for the Performance of High-Dose-Rate Brachytherapy

“…It plays an important role in the multidisciplinary management of soft tissue sarcoma. It can be a part of definitive therapy (77)(78)(79)(80), postoperative adjuvant therapy (81)(82)(83), intraoperative radiotherapy (79,(84)(85)(86), and palliative treatment (87).…”

Perioperative high-dose-rate brachytherapy in soft tissue sarcomas of the extremity and superficial trunk in adults: Initial results of a pilot study

“…The details of the implantation techniques used have been described elsewhere (21). Briefly, the surgical and the radiation oncology teams used the preoperative physical examination and imaging tests, surgical findings, frozen sections where necessary, and gross examination of the surgical specimen to jointly determine the area to be implanted, although, in most cases, the entire surgical bed was implanted (7).…”