Twenty years experience of interstitial iridium brachytherapy in the management of soft tissue sarcomas

Habrand, Jean‐Louis; Gerbaulet, A.; Pejovic, M.H.; Contesso, G.; Durand, Sylvère; Haie, C.; Genin, J; Schwaab, G; Flamant, F; Albano, M.; Sarrazin, D.; Spielmann, M.; Chassagne, D.

doi:10.1016/0360-3016(91)90049-a

Cited by 89 publications

(18 citation statements)

References 24 publications

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“…In recent years some centres have changed from the conventional practice of irradiating the entire anatomical department to the use of planning margins of 4-5 cm around the GTV in the transverse plane. This is partly because high local control rates have been achieved with brachytherapy, despite tighter margins around the tumour [12][13][14]. Alektiar et al [12] determined the target region by adding 2.0 cm to the superior and inferior dimensions of the tumour bed, with 1.5-2.0 cm added in the medial and lateral directions, achieving local control rates of 91% (95% CI 86-96%) with lower extremity high grade lesions.…”

Section: Discussionmentioning

confidence: 99%

Post‐Operative Radiotherapy for Soft Tissue Sarcoma of the Anterior Compartment of the Thigh: Should the Sartorius Muscle be Included?

Barnett

Hoole

Twyman

et al. 2005

Sarcoma

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Purpose: The clinical target volume (CTV) of post-operative radiotherapy for soft tissue sarcoma of the limbs conventionally includes the whole of the transverse cross-section of the affected anatomical compartment. In the anterior thigh sartorius appears to lie within its own fascial compartment and can be safely excluded. We investigated the potential impact of omitting sartorius from the anterior muscle compartment on patients with soft tissue sarcoma of the thigh. Patients and methods: We used the planning CT data from six patients who had previously received post-operative radiotherapy for soft tissue sarcoma of the thigh. The anterior compartments were outlined twice, initially including and then excluding the sartorius muscle. The volumes of the anterior compartment (i.e., the CTVs), both with and without sartorius, and the corresponding planning target volumes (PTVs) were calculated. Treatment plans were prepared for each PTV. For both volumes the unirradiated normal tissue corridor was outlined on each CT slice. The volume and circumference of the unirradiated corridor were then calculated. Results: For all six patients there was an important improvement in normal tissue sparing by excluding sartorius. The mean reduction in volume of the anterior compartment when sartorius was excluded was 10% (95% Confidence Interval 8-12%), whilst the mean decrease in PTV was 11% (95% CI 7-14%). There was a substantial increase in the volume of the unirradiated normal tissue corridor, with a mean value of 77% (95% CI 41-114%) when sartorius was excluded. In addition, the percentage increase in the size of the unirradiated normal tissue corridor, expressed as a percentage of the whole leg circumference, was 10% (95% CI 8-13%). When sartorius was included in the anterior compartment, the circumference of the unirradiated corridor was less than one-third of the whole leg circumference in four of the six patients. When sartorius was excluded, the circumference of the unirradiated corridor was greater than one-third of the leg circumference over the entire length of the target volume in all patients. Discussion: It is essential to know the anatomy of the sartorius muscle to be able to exclude it from the anterior compartment. The increase in the size of the normal tissue corridor when sartorius is excluded should deliver clinical advantage by decreasing the normal tissue adverse effects.

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Section: Discussionmentioning

confidence: 99%

Post‐Operative Radiotherapy for Soft Tissue Sarcoma of the Anterior Compartment of the Thigh: Should the Sartorius Muscle be Included?

Barnett

Hoole

Twyman

et al. 2005

Sarcoma

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“…However, the marginal failure rate, i.e. adjacent to the area implanted initially, was high (31%) in the Institut Gustave Roussy series treated with brachytherapy (Habrand et al 1991 ). Only 4% of patients failed centrally.…”

Section: Brachytherapymentioning

confidence: 94%

“…Experimental animal studies demonstrated that local failure was associated with significant increase in distant metastasis. A number of studies (Collin et al 1988, Emrich et al 1989, Habrand et al 1991 concluded that distant metastasis was significantly more likely in patients with local recurrence. Stotler et a!.…”

Section: Local Recurrence and Survivalmentioning

confidence: 99%

Radiotherapy in soft tissue sacoma of the extremities

Ngan

1997

Acta Orthopaedica Scandinavica

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“…Brachytherapy (BT) and intraoperative RT show several advantages over external RT: more precise delimitation of the clinical target during operative performance, a reduction of the total time of treatment and better protection of soft tissues. BT, as a mono-therapy, is employed in patients with medium-grade STS, or in highgrade sarcomas that have been completely removed and show negative margins (R0) [25][26][27][28]. There is no indication for the treatment of low-grade sarcomas with BT as a mono-therapy, as no amelioration has been reported in the local control of the condition when compared with surgery alone [29,30].…”

Section: Critical Factors In the Treatment Of Localised Stsmentioning

confidence: 96%

Centralised treatment of soft tissue sarcomas in adults

et al. 2008

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The clinical research developed in specialised centres and oncologic cooperative groups has permitted various scientific societies to collect recommendations used in the treatment of soft tissue sarcomas (STS) and incorporate them into clinical practice guidelines (CPG). Some studies have been conducted in diverse healthcare ambits to assess the influence of CPG. This revision of the medical literature analyses the impact that healthcare management -centralised or otherwise- and clinical practice in conformity with CPG have on the clinical outcome variables of STS. Eight CPG have been identified, as well as 12 conformity studies or audits. These conformity studies and audits demonstrate that the grade of adaptation of medical interventions with CPG, medical healthcare in reference centres and procedures of referrals to these centres, as well as the process of organising healthcare teams into Sarcoma Committees, have a significant influence on clinical outcome. We can conclude that excellent healthcare of STS implies the adaptation of healthcare practice to CPG, the existence of Reference Centres guided by Sarcoma Committees, and the observance of strict referral procedures within the Healthcare Area.

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Twenty years experience of interstitial iridium brachytherapy in the management of soft tissue sarcomas

Cited by 89 publications

References 24 publications

Post‐Operative Radiotherapy for Soft Tissue Sarcoma of the Anterior Compartment of the Thigh: Should the Sartorius Muscle be Included?

Post‐Operative Radiotherapy for Soft Tissue Sarcoma of the Anterior Compartment of the Thigh: Should the Sartorius Muscle be Included?

Radiotherapy in soft tissue sacoma of the extremities

Centralised treatment of soft tissue sarcomas in adults

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