Abstract
Background
Low-dose rate brachytherapy is a well-established adjuvant treatment for soft tissue sarcomas (STS). The experience with high-dose rate brachytherapy (HDR BT) in this indication is limited. The purpose of our study was to evaluate the viability of perioperative hyperfractionated HDR BT for STS.
Methods
Forty-five patients with primary (17 cases) or recurrent (28 cases) STS were treated with resection and HDR BT between 1998 and 2007. Eleven patients were treated with HDR BT alone (mean dose 40 Gy; 30–54 Gy) and 34 were treated with a combination of HDR BT (mean dose 24 Gy; 15–30 Gy) and external beam radiotherapy (EBRT) (40–50 Gy). Hyperfractionation, 3 Gy twice daily, was used for HDR BT with plastic tubes. Adjuvant chemotherapy was indicated for patients with high risk of dissemination.
Results
Local control (LC) was achieved in 17 patients (100%) treated for primary tumor and in 18 of 28 patients (64%) treated for recurrence; this difference was statistically significant (p = 0.004). Distant metastases occurred in seven patients (15.6%). The 5-year overall survival was 70%; the 5-year local control was 74%. LC was significantly better for extremities sarcomas in comparison with trunk tumors, for patients treated with EBRT and BT in comparison with BT alone, and for doses >65 Gy.
Conclusions
Our study suggests that perioperative HDR BT is a promising method for achieving high biological doses with good LC in the postoperative radiotherapy of STS and that combination of BT and EBRT provides better tumor control than BT alone.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Cionini L, Marzano S, Olmi P. Soft tissue sarcomas: experience with intraoperative brachytherapy in the conservative management. Ann Oncol. 1992;3(Suppl 2):S63–6.
Pisters PW, Harrison LB, Leung DH, Woodruff JM, Casper ES, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol. 1996;14:859–68.
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.
Enneking WF, Spanier SS, Malawer MM. The effect of the anatomic setting on the results of surgical procedures for soft part sarcoma of the thigh. Cancer. 1981;47:1005–22.
Nori D, Schupak K, Shiu MH, Brennan MF. Role of brachytherapy in recurrent extremity sarcoma in patients treated with prior surgery and irradiation. Int J Radiat Oncol Biol Phys. 1991;20:1229–33.
Alekhteyar KM, Porter AT, Herskovic AM, Ryan J, Orton CG, Forman JD, Ahmad K. Preliminary results of hyperfractionated high dose rate brachytherapy in soft tissue sarcoma. Endocuriether Hypertherm Oncol. 1994;10:179–84.
Yoshida K, Inoue T, Koizumi M. Perioperative high dose rate brachytherapy for bone and soft tissue tumors. Nippon Acta Radiol. 1996;41:1635–41.
Crownover RL, Marks KE, Zehr RJ. Initial results with high dose rate brachytherapy for soft-tissue sarcomas. Sarcoma. 1997;1:196–205.
Koizumi M, Inoue T, Yamazaki H, et al. Perioperative fractionated high-dose rate brachytherapy for malignant bone and soft tissue tumors. Int J Radiat Oncol Biol Phys. 1999;43:989–93.
Chun M, Kang S, Kim BS, Oh YT. High dose rate interstitial brachytherapy in soft tissue sarcoma: technical aspects and results. Jpn J Clin Oncol. 2001;31:279–83.
Martínez-Monge R, San Julián M, Amillo S, et al. Perioperative high-dose-rate brachytherapy in soft tissue sarcomas of the extremity and superficial trunk in adults: initial results of a pilot study. Brachytherapy. 2005;4:264–70.
Laskar S, Bahl G, Puri A, et al. Perioperative interstitial brachytherapy for soft tissue sarcomas: prognostic factors and long-term results of 155 patients. Ann Surg Oncol. 2007;14:560–7.
Pohar S, Haq R, Liu L, et al. Adjuvant high-dose-rate and low-dose-rate brachytherapy with external beam radiation in soft tissue sarcoma: a comparison of outcomes. Brachytherapy. 2007;6:53–7.
Habrand JL, Gerbaulet A, Pejovic MH, et al. Twenty years experience of interstitial iridium brachytherapy in the management of soft tissue sarcomas. Int J Radiat Oncol Biol Phys. 1991; 20:405–11.
Schray MF, Gunderson LL, Sim FH, Pritchard DJ, Shives TC, Yeakel PD. Soft tissue sarcoma. Integration of brachytherapy, resection and external irradiation. Cancer. 1990;66:451–6.
Devlin PM. Brachytherapy: applications and techniques. Philadelphia: Lippincott Williams & Wilkins; 2007.
Pisters PW, Leung DH, Woodruff J, Shi W, Brennan MF. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol. 1996;14:1679–89.
Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16:197–203.
Acknowledgment
The project was supported by Research Project MZO 00179906 of the Ministry of Health, Czech Republic and by project Czech National Cancer Programe On-line supported by Astra Zeneca.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Petera, J., Soumarová, R., Růžičková, J. et al. Perioperative Hyperfractionated High-Dose Rate Brachytherapy for the Treatment of Soft Tissue Sarcomas: Multicentric Experience. Ann Surg Oncol 17, 206–210 (2010). https://doi.org/10.1245/s10434-009-0684-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-009-0684-1