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Dávila Fajardo R, Scarzello G, Gaze MN, Boterberg T, Cameron A, Fuchs J, Guérin F, Hoskin P, Krasin MJ, Kroon P, Magelssen H, Mercke C, Merks JHM, Paulsen F, Pommier P, Ramos M, Rees H, Rogers T, Schmid M, Seitz G, Slater O, Smeulders N, Stenman J, Terwisscha S, Chargari C, Mandeville HC. Brachytherapy for rhabdomyosarcoma: Survey of international clinical practice and development of guidelines. Radiother Oncol 2024; 195:110273. [PMID: 38588921 DOI: 10.1016/j.radonc.2024.110273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/07/2024] [Accepted: 04/04/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to address the lack of published data on the use of brachytherapy in pediatric rhabdomyosarcoma by describing current practice as starting point to develop consensus guidelines. MATERIALS AND METHODS An international expert panel on the treatment of pediatric rhabdomyosarcoma comprising 24 (pediatric) radiation oncologists, brachytherapists and pediatric surgeons met for a Brachytherapy Workshop hosted by the European paediatric Soft tissue Sarcoma Study Group (EpSSG). The panel's clinical experience, the results of a previously distributed questionnaire, and a review of the literature were presented. RESULTS The survey indicated the most common use of brachytherapy to be in combination with tumor resection, followed by brachytherapy as sole local therapy modality. HDR was increasingly deployed in pediatric practice, especially for genitourinary sites. Brachytherapy planning was mostly by 3D imaging based on CT. Recommendations for patient selection, treatment requirements, implant technique, delineation, dose prescription, dose reporting and clinical management were defined. CONCLUSIONS Consensus guidelines for the use of brachytherapy in pediatric rhabdomyosarcoma have been developed through multicenter collaboration establishing the basis for future work. These have been adopted for the open EpSSG overarching study for children and adults with Frontline and Relapsed RhabdoMyoSarcoma (FaR-RMS).
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Affiliation(s)
- Raquel Dávila Fajardo
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Division Imaging and Oncology, University Medical Center, Utrecht, the Netherlands.
| | | | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
| | - Alison Cameron
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.
| | - Joerg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Childreńs Hospital, Tuebingen, Germany
| | - Florent Guérin
- Department of Paediatric Surgery, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Paris, France
| | - Peter Hoskin
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Matthew J Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, USA
| | - Petra Kroon
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands; Division Imaging and Oncology, University Medical Center, Utrecht, the Netherlands.
| | | | - Claes Mercke
- Department of Oncology-Pathology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
| | - Johannes H M Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Division Imaging and Oncology, University Medical Center, Utrecht, the Netherlands.
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital, Tuebingen, Germany.
| | - Pascal Pommier
- Department of Radiation Oncology, Centre Leon Berard, Lyon, France.
| | - Monica Ramos
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Helen Rees
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.
| | - Tim Rogers
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Maximilian Schmid
- Medical University of Vienna, Department of Radiation Oncology, Comprehensive Cancer Center, Vienna, Austria.
| | - Guido Seitz
- Department of Pediatric Surgery and Urology, University Hospital Giessen-Marburg, Campus Marburg, Marburg, Germany.
| | - Olga Slater
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
| | - Naima Smeulders
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
| | - Jakob Stenman
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
| | - Sheila Terwisscha
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France.
| | - Henry C Mandeville
- The Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
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Woodhouse KD, Devlin PM, Kollmeier M, Lin LL, Orio P, Ouhib Z, Song D, Viswanathan AN, Watanabe Y, Yu Y, Small W, Schechter NR. ACR-ABS-ASTRO Practice Parameter for the Performance of Low-Dose-Rate Brachytherapy. Am J Clin Oncol 2022; 45:243-248. [PMID: 35485607 DOI: 10.1097/coc.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM/OBJECTIVES/BACKGROUND The American College of Radiology (ACR), the American Brachytherapy Society (ABS), and the American Society for Radiation Oncology (ASTRO) have jointly developed the following practice parameter for the performance of low-dose-rate (LDR) brachytherapy. LDR brachytherapy is the application of radioactive sources in or on tumors in a clinical setting with therapeutic intent. The advantages of LDR brachytherapy include improving therapeutic ratios with lower doses to nontarget organs-at-risk and higher doses to a specific target. METHODS This practice parameter was developed according to the process described under the heading. The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters-Radiation Oncology of the Commission on Radiation Oncology, in collaboration with ABS and ASTRO. RESULTS This practice parameter was developed to serve as a tool in the appropriate application of this evolving technology in the care of cancer patients or other patients with conditions where radiation therapy is indicated. It addresses clinical implementation of LDR brachytherapy including personnel qualifications, quality assurance standards, indications, and suggested documentation. This includes a contemporary literature search. CONCLUSIONS This practice parameter is a tool to guide the use of LDR brachytherapy and does not assess relative clinical indication for LDR brachytherapy when compared with other forms of brachytherapy or external beam therapy, but to focus on the best practices required to deliver LDR brachytherapy safely and effectively, when clinically indicated. Comparative costs of versus other modalities therapy may also need to be considered.
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Affiliation(s)
| | | | | | | | - Peter Orio
- Boca Raton Regional Hospital, Lynn Cancer Institute, Boca Raton, FL
| | - Zoubir Ouhib
- Boca Raton Regional Hospital, Lynn Cancer Institute, Boca Raton, FL
| | | | | | | | - Yan Yu
- Thomas Jefferson University, Woodbury, NJ
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - Naomi R Schechter
- Keck Medical Center of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
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3
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Adjuvant high-dose-rate interstitial brachytherapy for malignant peripheral nerve sheath tumor of the foot: a case report. J Contemp Brachytherapy 2021; 13:338-346. [PMID: 34122575 PMCID: PMC8170520 DOI: 10.5114/jcb.2021.106204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 03/20/2021] [Indexed: 11/17/2022] Open
Abstract
Soft tissue sarcomas of the foot are extremely rare and can therefore be misdiagnosed as benign diseases, and be prematurely removed with an unplanned excision. The standard treatment is a wide local excision with an addition of radiotherapy as an alternative to a radical resection (e.g., below-knee or foot amputation). We report on a patient with primary malignant peripheral nerve sheath tumor in the foot plantar soft tissue, who had no evidence of the disease and no severe late toxicity higher than grade 2, 40 months after receiving amputation of toes and adjuvant interstitial high-dose-rate brachytherapy (HDR-BT). To the best of our knowledge, only a few cases were treated with HDR-BT with this scenario. From our findings, HDR-BT could be a safe and quick treatment option for these types of lesions.
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Cammelli S, Cortesi A, Buwenge M, Zamagni A, Ferioli M, Ghigi G, Romeo A, Morganti AG. The role of radiotherapy in adult soft tissues sarcoma of the extremities. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1583-1596. [PMID: 33954820 PMCID: PMC8702420 DOI: 10.1007/s00590-021-02990-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/18/2021] [Indexed: 01/19/2023]
Abstract
Local management of adult soft tissue sarcoma of the extremities has evolved over the past decades. Until the 1970s, radical surgery (amputations) was the standard therapeutic procedure resulting in significant physical and psychological morbidity for the patients. In the present era, limb sparing surgery combined with radiotherapy represents the current standard of care for high grade and > 5 cm STSs. This approach guarantees high local control rate and function preservation. The aim of this paper is to summarize the current evidence for RT in STSs of the extremities. Outcomes, technical details (techniques, timing, dose, volumes of treatment) and the emerging role of RT in the management of oligometastatic disease will be analysed. Finally, results of the recent clinical trials testing new scenarios in RT of STSs will be described.
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Affiliation(s)
- Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. .,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Annalisa Cortesi
- Radiotherapy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Milly Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alice Zamagni
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Martina Ferioli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulia Ghigi
- Radiotherapy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Antonino Romeo
- Radiotherapy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Alessio G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Surgical resection, intraoperative radiotherapy and immediate plastic reconstruction: A good option for the treatment of distal extremity soft tissue sarcomas. Rep Pract Oncol Radiother 2020; 25:919-926. [PMID: 33088227 DOI: 10.1016/j.rpor.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/06/2020] [Accepted: 09/10/2020] [Indexed: 12/24/2022] Open
Abstract
Aim To show three patients with soft tissue sarcomas of distal extremities conservatively treated after tumor-board discussion, involving margin-free surgery, exclusive intraoperative radiotherapy, and immediate reconstruction. Background Current guidelines show clear and robust recommendations regarding the composition of the treatment of sarcomas of extremities. However, little evidence exists regarding the application of these treatments depending on the location of the primary neoplasia. Tumors that affect the distal extremities present different challenges and make multidisciplinary discussions desirable. Methods/Results We reported 3 patients who were approached with a conservative intention, after tumor board recomendation. The goals from the treatment performed were aesthetic and functional preservation, while enruring locoregional control. We had wound healing complications in 2 of the cases, requiring additional reconstruction measures. Patients are followed up for 24, 20 and 10 months; local control is 100%, and functional preservation is 100%. Conclusions Despite being a small series, it was sufficient to illustrate successful multidisciplinary planning, generating a therapeutic result with improved quality of life for patients who had an initial indication for extremity amputation.
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Sütterlin AL, Demmert M, Kovács G, Claviez A, Schulz C, Lauten M. Interventional radiotherapy (brachytherapy) achieves very good long-term quality of life in children and adolescents with soft-tissue sarcoma. Pediatr Blood Cancer 2020; 67:e28464. [PMID: 32706504 DOI: 10.1002/pbc.28464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/16/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Effective local therapy (surgery, radiation) and systemic multidrug chemotherapy are mandatory for curing childhood sarcoma. The standard radiation therapy for pediatric patients with soft-tissue sarcoma (STS) is external beam radiotherapy (EBRT). Because EBRT may cause long-term side effects with adverse effects on the patients' health and quality of life (QoL), alternative strategies are required. Interventional radiotherapy (IRT; brachytherapy) is established as a standard treatment for several tumors in adulthood. Single-center series have reported low levels of late effects and improved QoL in survivors treated with IRT in childhood. However, IRT is still applied infrequently in pediatric patients. METHODS Thirty patients with STS were treated with IRT between 1992 and 2012 at the University Hospital Schleswig Holstein, Germany. Five patients were lost to follow-up, and 25 patients (mean age at time of data collection 24.8 years [range, 10.7-36.1]) could be analyzed focusing on overall survival and QoL (EORTC-C30 questionnaire). For more detailed information regarding general and health-specific questions, a separate questionnaire was developed. RESULTS Nineteen of 25 patients were alive 13.4 [1.6-25.2] years after first cancer disease, and the three-year overall survival was 76% (SE, 0.09). The score of QoL/global health status (76.2 [16.6-100]) in our patients outvalues the European (66.1) and equals the German (75.9) reference value. CONCLUSION IRT is an effective treatment option for pediatric patients with localized STS. Its role among other radiation dose-sparing techniques such as proton beam therapy has to be defined in prospective studies.
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Affiliation(s)
- Anna Lotte Sütterlin
- Department of Pediatric and Adolescent Medicine, Pediatric Hematology and Oncology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Martin Demmert
- Department of Pediatric and Adolescent Medicine, Pediatric Hematology and Oncology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - György Kovács
- Department of Radiotherapy, Interdisciplinary Brachytherapy Unit, University Hospital Schleswig Holstein, Lübeck, Germany.,Gemelli INTERACTS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alexander Claviez
- Department of Pediatric and Adolescent Medicine, Pediatric Hematology and Oncology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Christian Schulz
- Department of Radiotherapy, University Hospital Schleswig Holstein, Kiel, Germany
| | - Melchior Lauten
- Department of Pediatric and Adolescent Medicine, Pediatric Hematology and Oncology, University Hospital Schleswig Holstein, Lübeck, Germany
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Report of the First Patient Treated for Pelvic Sarcoma With a Directional 103Pd Brachytherapy Device. Adv Radiat Oncol 2019; 5:127-133. [PMID: 32051899 PMCID: PMC7004947 DOI: 10.1016/j.adro.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/16/2019] [Accepted: 06/24/2019] [Indexed: 11/24/2022] Open
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Novel Treatment of a Malignant Peripheral Nerve Sheath Tumor of the Median Nerve. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 6:e2011. [PMID: 30656108 PMCID: PMC6326595 DOI: 10.1097/gox.0000000000002011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/18/2018] [Indexed: 11/26/2022]
Abstract
Malignant peripheral nerve sheath tumors are rare, associated with a poor prognosis and uncertainty regarding the appropriate management. We report a novel oncologic and reconstructive treatment of a young patient with a malignant peripheral nerve sheath tumor of the median nerve of the left hand. The patient underwent a wide local excision, an opponensplasty, a nerve reconstruction by nerve allografts followed by brachytherapy treatment. Two years later, the patient remains disease free with preserved function of her hand.
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9
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Sari SY, Yazici G, Gultekin M, Hurmuz P, Gurkaynak M, Ozyigit G. Sarcoma. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-97145-2_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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10
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Experimental study of pelvic perioperative brachytherapy with iodine 125 seeds (I-125) in an animal model. J Contemp Brachytherapy 2018; 10:463-469. [PMID: 30479624 PMCID: PMC6251451 DOI: 10.5114/jcb.2018.79470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/02/2018] [Indexed: 12/18/2022] Open
Abstract
Purpose The aim of this study is to investigate the feasibility of perioperative I-125 low-dose-rate brachytherapy mesh implantation in pelvic locations in an animal model, before applying it clinically. Material and methods The animal model was the Romanov adult ewe. Non-radioactive dummy I-125 seeds were implanted by laparotomy in the pelvic area. Forty-five dummy seeds were placed on a 10 cm² polyglactin mesh to obtain a dose of 160 Gy at 5 mm from the center of each seed. Three CT scans were performed at day 15, day 70, and day 180 after surgery to check the positioning of the mesh for eventual seed migration according to bony landmarks and to perform a 3D theoretical dosimetric study. The experimental study design was based on Simon’s minimax plan with a preliminary analysis of 10 ewes to validate the protocol and a second series of 7 ewes. Results After the first step, 9 of 10 ewes were investigated. For 8 of 9 animals, the 160 Gy isodose line volume was within 10%, showing feasibility of the procedure and allowing 7 more to be added. At the end of the study, 16 of 17 animals were examined. No seeds loss was observed. The volume difference of the 160 Gy isodose line was within 10% in 13 of 16 ewes between the three CT scans. Twelve out of 16 had a coordinate deviation less than or equal to 10 mm on the three axes between the first and the third scans. Conclusions These results show the technical feasibility of the pelvic mesh implantation in ewes. A phase I study for patients with locally advanced or recurrent pelvic tumors amenable to surgery, in combination with surgical resection should be possible.
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Paik EK, Kim MS, Cho CK, Yoo HJ, Jang WI, Seo YS, Jin SH, Jeon DG, Lee DH. Feasibility of using stereotactic body radiation therapy for unresectable soft tissue tumors of the trunk. Oncotarget 2018; 9:27851-27857. [PMID: 29963242 PMCID: PMC6021255 DOI: 10.18632/oncotarget.25539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 05/17/2018] [Indexed: 12/03/2022] Open
Abstract
Purpose To evaluate the feasibility of stereotactic body radiation therapy (SBRT) for unresectable soft tissue tumors of the trunk. Materials and Methods Between January 2002 and December 2008, 23 patients with 36 lesions of soft tissue tumors, which were located in the trunk and not suitable for resection, underwent SBRT. Among the 36 lesions, 31 were malignant and 5 were benign. The median tumor volume was 24 cm3 (range, 2.6–213 cm3). SBRT doses ranged from 20 to 48 Gy in 1–5 fractions. Results With a median follow-up of 73 months, the overall survival (OS) and local control (LC) rates at 5 years were 39% and 52%, respectively. For malignant tumors, the OS and LC rates at 5 years were 28% and 47%, respectively. For benign tumors, the OS and LC rates at 5 years were 80% and 100%, respectively. There was no acute toxicity of grade ≥3. One case of grade 3 late skin toxicity was reported 10 months after SBRT. Conclusion SBRT may be an effective and safe treatment modality for the local control of unresectable soft tissue tumors of the trunk including tumors of a benign nature.
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Affiliation(s)
- Eun Kyung Paik
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Mi-Sook Kim
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Chul-Koo Cho
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Hyung Jun Yoo
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Won Il Jang
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Young-Seok Seo
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Sung-Ho Jin
- Department of Surgery, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Dae Geun Jeon
- Department of Orthopedic Surgery, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Dong Han Lee
- CyberKnife Center, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
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Does an Algorithmic Approach to Using Brachytherapy and External Beam Radiation Result in Good Function, Local Control Rates, and Low Morbidity in Patients With Extremity Soft Tissue Sarcoma? Clin Orthop Relat Res 2018; 476:634-644. [PMID: 29443850 PMCID: PMC6260030 DOI: 10.1007/s11999.0000000000000079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND High-dose-rate brachytherapy (HDR-BT) and external-beam radiation therapy (EBRT) are two modalities used in the treatment of soft tissue sarcoma. Previous work at our institution showed early complications and outcomes for patients treated with HDR-BT, EBRT, or a combination of both radiation therapy modalities. As the general indications for each of these approaches to radiation therapy differ, it is important to evaluate the use of each in an algorithmic way, reflecting how they are used in contemporary practice at sites that use these treatments. QUESTION/PURPOSES: (1) To determine the proportions of intermediate- and long-term complications associated with the use of brachytherapy in the treatment of primary high-grade extremity soft tissue sarcomas; (2), to characterize the long-term morbidity of the three radiation treatment groups using the Radiation Therapy Oncology Group/ European Organization for Research and Treatment of Cancer (RTOG/EORTC) Late Radiation Morbidity Scoring Scheme; (3) to determine whether treatment with HDR-BT, EBRT, and HDR-BT+EBRT therapy, in combination with limb-salvage surgery, results in acceptable local control in this high-risk group of sarcomas. METHODS We retrospectively studied data from 171 patients with a diagnosis of high-grade extremity soft tissue sarcoma treated with limb-sparing surgery and radiation therapy between 1990 and 2012 at our institution, with a mean followup of 72 months. Of the 171 patients, 33 (20%) were treated with HDR-BT, 128 (75%) with EBRT, and 10 (6%) with HDR-BT+EBRT. We excluded 265 patients with soft tissue sarcomas owing to axial tumor location, previous radiation to the affected extremity, incomplete patient records, patients receiving primary amputation, recurrent tumors, pediatric patients, low- and intermediate-grade tumors, and rhabdoid histology. Fifteen patients (9%) were lost to followup for any reason including died of disease or other causes during the first 12 months postoperatively. This included four patients who received HDR-BT (12%), 11 who received EBRT (9%), and none who received HDR-BT+EBRT (0%) with less than 12 months followup. Determination of radiation therapy technique for each patient was individualized in a multidisciplinary forum of sarcoma specialists. Anticipated close or positive surgical margins and a low likelihood of complex soft tissue procedures were factors that encouraged use of brachytherapy, whereas the anticipated need for secondary procedures and/or soft tissue coverage encouraged use of EBRT alone. Combination therapy was used when the treatment volume exceeded the treatment field of the brachytherapy catheters or when the catheters were used to boost a close or positive surgical margin. Local recurrence, complications, and morbidity outcomes scores (RTOG) were calculated based on chart review. Between-group comparisons pertaining to the proportion of patients experiencing complications, morbidity outcomes scores, and local recurrence rates were not performed because of dissimilarities among the patients in each group at baseline. RESULTS The HDR-BT treatment group showed a high incidence of intermediate-term complications, with the three most common being: deep infection (33%, 11 of 33); dehiscence and delayed wound healing (24%, eight of 33); and seroma and hematoma (21%, seven of 33). The EBRT group showed a high incidence of intermediate- and long-term complications with the three most common being: chronic radiation dermatitis (35%, 45 of 128); fibrosis (27%, 35 of 128); and chronic pain and neuritis (13%, 16 of 128). The RTOG scores for each treatment group were: HDR-BT 0.8 ± SD 1.2; EBRT 1.9 ± 2.0; and HDR-BT+EBRT 1.7 ± 1.7. Overall, 142 of 169 (84%) patients were free from local recurrence: 27 (82%) in the HDR-BT group, 108 (86%) in the EBRT group, and seven (70%) in the combination therapy group. CONCLUSIONS In this single-institution study, an algorithmic approach to using HDR-BT and EBRT in the treatment of patients with high-grade soft tissue sarcomas can yield acceptable complication rates, good morbidity outcome scores, and a high degree of local control. Based on these results, we believe HDR-BT is best for patients with an anticipated close margin, a positive surgical margin, and for patients who are unlikely to receive a complex soft tissue procedure. Conversely, if a secondary procedure and/or soft tissue coverage are likely to be used, EBRT alone may be reasonable. Finally, combination therapy might be considered when the treatment volume exceeded the treatment field capacity for HDR-BT or when the catheters were used to boost a close or positive surgical margin. LEVEL OF EVIDENCE Level IV, therapeutic study.
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13
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Radiotherapy in soft-tissue sarcoma of the extremities. Clin Transl Oncol 2018; 20:1127-1135. [PMID: 29476322 DOI: 10.1007/s12094-018-1848-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 02/15/2018] [Indexed: 10/18/2022]
Abstract
Sarcomas are an infrequent and heterogeneous group of neoplasia. Surgery with or without associated radiotherapy (RT) is the basic treatment for this type of tumour. To increase the therapeutic ratio (the index between cytotoxic effects in tumours and normal tissue complications with a certain dose of radiation), new advances are being investigated to increase local and distant control and to decrease the morbidity of the treatment. The aim of this review was to analyse the different strategies, based on technology and biology, which are being investigated to increase the therapeutic ratio of this disease.
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Abstract
This article discusses the epidemiology, diagnosis, and management of primary soft-tissue sarcomas (STS). These musculoskeletal tumors are a rare and heterogeneous group of malignancies, which are best managed by multidisciplinary teams in specialist sarcoma referral centers. Historically, the standard for local control of these tumors has been amputation. Evolutions in multimodality treatment have seen a shift toward preservation of the limb. Advances in limb-sparing surgery have seen the quality of life in sarcoma patients to improve drastically; however, unplanned surgical excision of STS remains a major treatment dilemma in the control of local disease.
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Affiliation(s)
- Domagoj Ante Vodanovich
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia,Department of Surgery, St. Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia
| | - Peter F M Choong
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia,Department of Surgery, St. Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia,Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, Victoria, Australia,Address for correspondence: Prof. Peter F M Choong, Level 2, Clinical Sciences Building, 29 Regent Street, Fitzroy 3065, Victoria, Australia. E-mail:
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15
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Adjuvant radiotherapy with brachytherapy boost in soft tissue sarcomas. J Contemp Brachytherapy 2017; 9:256-262. [PMID: 28725250 PMCID: PMC5509983 DOI: 10.5114/jcb.2017.68215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/25/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose The standard primary treatment for soft tissue sarcoma (STS) is a wide surgical resection, preceded or followed by radiotherapy. Purpose of this retrospective study was to assess the efficacy of perioperative brachytherapy (BRT) plus postoperative external beam radiation therapy (EBRT) in patients with intermediate-high risk STS. Material and methods BRT delivered dose was 20 Gy. External beam radiation therapy was delivered with 3D-technique using multiple beams. The prescribed dose was 46 Gy to the PTV. Neoadjuvant and adjuvant chemotherapy (CHT) was used in patients with potentially chemosensitive histological subtypes. The primary aim of the study was to analyze overall survival (OS) and local control (LC) in a large patient population treated with surgery, perioperative BRT, and adjuvant EBRT ± CHT. Secondary objective was to identify prognostic factors for patients outcome in terms of LC, disease-free survival (DFS), and OS. Results From 2000 to 2011, 107 patients presenting 2-3 grade (FNLCC) primary or recurrent STS were treated with surgery, perioperative BRT, and adjuvant EBRT ± CHT. Five-year LC and OS were 80.9% and 87.4%, respectively. At univariate analysis, a higher LC was recorded in primary vs. recurrent tumors (p = 0.015), and in lower limb tumors vs. other sites (p = 0.027). An improved DFS was recorded in patients with lower limb tumors vs. other sites (p = 0.034). Conclusions The combination of BRT and EBRT was able to achieve satisfactory results even in a patients population with intermediate-high risk STS. Patients with recurrent or other than lower limb sited tumors show a worse LC.
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American Brachytherapy Society consensus statement for soft tissue sarcoma brachytherapy. Brachytherapy 2017; 16:466-489. [DOI: 10.1016/j.brachy.2017.02.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/04/2017] [Accepted: 02/06/2017] [Indexed: 12/31/2022]
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17
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Iridium-Knife: Another knife in radiation oncology. Brachytherapy 2017; 16:884-892. [PMID: 28392144 DOI: 10.1016/j.brachy.2017.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 02/19/2017] [Accepted: 03/07/2017] [Indexed: 01/30/2023]
Abstract
PURPOSE Intratarget dose escalation with superior conformity is a defining feature of three-dimensional (3D) iridium-192 (192Ir) high-dose-rate (HDR) brachytherapy (BRT). In this study, we analyzed the dosimetric characteristics of interstitial 192Ir HDR BRT for intrathoracic and cerebral malignancies. We examined the dose gradient sharpness of HDR BRT compared with that of linear accelerator-based stereotactic radiosurgery and stereotactic body radiation therapy, usually called X-Knife, to demonstrate that it may as well be called a Knife. METHODS AND MATERIALS Treatment plans for 10 patients with recurrent glioblastoma multiforme or intrathoracic malignancies, five of each entity, treated with X-Knife (stereotactic radiosurgery for glioblastoma multiforme and stereotactic body radiation therapy for intrathoracic malignancies) were replanned for simulated HDR BRT. For 3D BRT planning, we used identical structure sets and dose prescription as for the X-Knife planning. The indices for qualitative treatment plan analysis encompassed planning target volume coverage, conformity, dose falloff gradient, and the maximum dose-volume limits to different organs at risk. RESULTS Volume coverage in HDR plans was comparable to that calculated for X-Knife plans with no statistically significant difference in terms of conformity. The dose falloff gradient-sharpness-of the HDR plans was considerably steeper compared with the X-Knife plans. CONCLUSIONS Both 3D 192Ir HDR BRT and X-Knife are effective means for intratarget dose escalation with HDR BRT achieving at least equal conformity and a steeper dose falloff at the target volume margin. In this sense, it can reasonably be argued that 3D 192Ir HDR BRT deserves also to be called a Knife, namely Iridium-Knife.
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18
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Viswanathan AN, Erickson BA, Ibbott GS, Small W, Eifel PJ. The American College of Radiology and the American Brachytherapy Society practice parameter for the performance of low-dose-rate brachytherapy. Brachytherapy 2017; 16:68-74. [DOI: 10.1016/j.brachy.2016.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 06/15/2016] [Indexed: 12/01/2022]
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20
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Yang B, Guo WH, Lan T, Yuan F, Liu GJ, Zan RY, You X, Tan QY, Liao ZY. CT-guided 125I seed implantation for inoperable retroperitoneal sarcoma: A technique for delivery of local tumor brachytherapy. Exp Ther Med 2016; 12:3843-3850. [PMID: 28101168 PMCID: PMC5228165 DOI: 10.3892/etm.2016.3897] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/19/2016] [Indexed: 02/05/2023] Open
Abstract
Radical surgery is currently the first treatment of choice for retroperitoneal soft tissue sarcoma (RSTS). However, the prognosis of RSTS remains poor due to ineffective local control and a high incidence of metastasis after surgical resection. Brachytherapy has been shown to safely provide local radiotherapy for numerous types of cancer when used alone or in combination with surgical resection, but has not been well characterized in the management of RSTS. The aim of this study was to evaluate CT-guided 125I seed implantation for local control and pain relief in the treatment of inoperable RSTS. A total of 23 patients with RSTS were treated with 125I implantation. Pain was assessed using a visual analog scale. Other endpoints were evaluated via computed tomography scan or phone call/e-mail records. The occurrence of complications was assessed preoperatively (baseline) and during postoperatively follow-up or until patient succumbed. All patients were successfully treated with 125I implantation. A mean number of 70.87 radioactive seeds were applied in each patient. During the follow-up, two patients were unaccounted for, local recurrence occurred in three patients, five succumbed and complications were observed in sixteen. The patient's VAS score changed from 7.4 preoperatively to 7.6, 2.3, 2.0, 1.2, 1.5, 1.4 and 2.5 at 24 h, 1, 3, 6, 12, 24 and 36 months after the procedure, respectively. Good local control and significant pain relief after 125I seed implantation was observed in patients with inoperable RSTS. Thus, the present results suggest that this method could be an effective treatment option for patients with inoperable RSTS.
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Affiliation(s)
- Biao Yang
- Department of Abdominal Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Wen-Hao Guo
- Department of Abdominal Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Ting Lan
- Department of Pathology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Fang Yuan
- Department of Radiology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Guan-Jian Liu
- Chinese Evidence-Based Medicine Center, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Rui-Yu Zan
- Department of Abdominal Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xin You
- Department of Abdominal Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Qiao-Yue Tan
- Department of Radiology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Zheng-Yin Liao
- Department of Abdominal Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Ducassou A, Haie-Méder C, Delannes M. [Brachytherapy for sarcomas]. Cancer Radiother 2016; 20:685-9. [PMID: 27614500 DOI: 10.1016/j.canrad.2016.07.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
The standard of care for local treatment for extremities soft tissue sarcomas relies on conservative surgery combined with external beam radiotherapy. Brachytherapy can be realized instead of external beam radiotherapy in selected cases, or more often used as a boost dose on a limited volume on the area at major risk of relapse, especially if a microscopic positive resection is expected. Close interaction and communication between radiation oncologists and surgeons are mandatory at the time of implantation to limit the risk of side effects. Long-term results are available for low-dose rate brachytherapy. Nowadays, pulsed dose rate or high-dose-rate brachytherapy are more often used. Brachytherapy for paediatric sarcomas is rare, and has to be managed in reference centres.
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Affiliation(s)
- A Ducassou
- Département de radiothérapie et de curiethérapie, institut Claudius-Regaud, IUCT-Oncopôle, 1, avenue Joliot-Curie, 31059 Toulouse cedex, France.
| | - C Haie-Méder
- Département de radiothérapie et de curiethérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - M Delannes
- Département de radiothérapie et de curiethérapie, institut Claudius-Regaud, IUCT-Oncopôle, 1, avenue Joliot-Curie, 31059 Toulouse cedex, France
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22
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King MT, Voros L, Cohen GN, Lanning RM, Ganly I, O'Suoji CC, Wolden SL. High-dose-rate brachytherapy of rhabdomyosarcoma limited to the external auditory canal. Brachytherapy 2016; 16:181-185. [PMID: 27528589 DOI: 10.1016/j.brachy.2016.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/10/2016] [Accepted: 07/11/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To report on the single-catheter high-dose-rate brachytherapy treatment of a 21-month-old girl child with an embryonal, botryoid-type, rhabdomyosarcoma limited to the external auditory canal (EAC). METHODS AND MATERIALS A 2.4-mm diameter catheter was inserted into the right EAC and placed against the tympanic membrane. A computed tomography simulation scan was acquired. A brachytherapy treatment plan, in which 21 Gy in seven fractions was prescribed to a 1-mm depth along the distal 2 cm of the catheter, was generated. Treatments were delivered under anesthesia without complication. A dosimetric comparison between this plan and an intensity-modulated radiation therapy (IMRT) plan was then conducted. A clinical target volume (CTV), which encompassed a 1-mm margin along the distal 2 cm of the catheter, was delineated for both plans. Given positioning uncertainty under image guidance, a planning target volume (PTV = CTV + 3-mm margin) was defined for the IMRT plan. The IMRT plan was optimized for maximal CTV coverage but subsequently normalized to the same CTV volume receiving 100% of the prescription dose (V100) of the brachytherapy plan. RESULTS The IMRT plan was normalized to the brachytherapy CTV V100 of 82.0%. The PTV V100 of this plan was 34.1%. The PTV exhibited dosimetric undercoverage within the middle ear and toward the external ear. Mean cochlea doses for the IMRT and brachytherapy plans were 26.7% and 10.5% of prescription, respectively. CONCLUSIONS For rhabdomyosarcomas limited to the EAC, a standard brachytherapy catheter can deliver a highly conformal radiation plan that can spare the nearby cochlea from excess radiation.
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Affiliation(s)
- Martin T King
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Laszlo Voros
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Gil'ad N Cohen
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Ryan M Lanning
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Ian Ganly
- Department of Otolaryngology-Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Chibuzo C O'Suoji
- Department of Pediatrics, West Virginia University School of Medicine, Charleston, WV
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY.
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23
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Mejia Oneto JM, Khan I, Seebald L, Royzen M. In Vivo Bioorthogonal Chemistry Enables Local Hydrogel and Systemic Pro-Drug To Treat Soft Tissue Sarcoma. ACS CENTRAL SCIENCE 2016; 2:476-82. [PMID: 27504494 PMCID: PMC4965853 DOI: 10.1021/acscentsci.6b00150] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Indexed: 05/18/2023]
Abstract
The ability to activate drugs only at desired locations avoiding systemic immunosuppression and other dose limiting toxicities is highly desirable. Here we present a new approach, named local drug activation, that uses bioorthogonal chemistry to concentrate and activate systemic small molecules at a location of choice. This method is independent of endogenous cellular or environmental markers and only depends on the presence of a preimplanted biomaterial near a desired site (e.g., tumor). We demonstrate the clear therapeutic benefit with minimal side effects of this approach in mice over systemic therapy using a doxorubicin pro-drug against xenograft tumors of a type of soft tissue sarcoma (HT1080).
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Affiliation(s)
- Jose M. Mejia Oneto
- Shasqi Inc., 665 Third Street, Suite 250, San Francisco, California 94107, United States
- E-mail:
| | - Irfan Khan
- University
at Albany, Department of Chemistry, 1400 Washington Avenue, Albany, New York 12222, United States
| | - Leah Seebald
- University
at Albany, Department of Chemistry, 1400 Washington Avenue, Albany, New York 12222, United States
| | - Maksim Royzen
- University
at Albany, Department of Chemistry, 1400 Washington Avenue, Albany, New York 12222, United States
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Jumeau R, Renard-Oldrini S, Courrech F, Buchheit I, Oldrini G, Vogin G, Peiffert D. High dose rate brachytherapy with customized applicators for malignant facial skin lesions. Cancer Radiother 2016; 20:341-6. [PMID: 27321412 DOI: 10.1016/j.canrad.2016.03.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 03/20/2016] [Accepted: 03/23/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE Brachytherapy is a well-known treatment in the management of skin tumors. For facial or scalp lesions, applicators have been developed to deliver non-invasive treatment. We present cases treated with customized applicators with high dose rate system. MATERIAL AND METHODS Patients with poor performance status treated for malignant skin lesions of the scalp or the facial skin between 2011 and 2014 were studied. Afterloading devices were chosen between Freiburg(®) Flap, silicone-mold or wax applicators. The clinical target volume (CTV) was created by adding margins to lesions (10mm to 20mm). The dose schedules were 25Gy in five fractions for postoperative lesions, 30Gy in six fractions for exclusive treatments and a single session of 8Gy could be considered for palliative treatments. RESULTS In 30 months, 11 patients received a treatment for a total of 12 lesions. The median age was 80 years. The median follow-up was 17 months and the 2-year local control rate was 91%. The mean CTV surface was 41.1cm(2) with a mean thickness of 6.1mm. We conceived three wax applicators, used our silicone-mold eight times and the Freiburg(®) Flap one time. We observed only low-grade radiodermitis (grade I: 50%, grade II: 33%), and no high-grade skin toxicity. CONCLUSION High dose rate brachytherapy with customized applicators for facial skin and scalp lesions is efficient and safe. It is a good modality to treat complex lesions in patients unfit for invasive treatment.
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Affiliation(s)
- R Jumeau
- Department of radiotherapy, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France.
| | - S Renard-Oldrini
- Department of radiotherapy, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France
| | - F Courrech
- Department of radiation physics, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France
| | - I Buchheit
- Department of radiation physics, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France
| | - G Oldrini
- Department of radiology, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France
| | - G Vogin
- Department of radiotherapy, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France
| | - D Peiffert
- Department of radiotherapy, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France
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Naghavi AO, Gonzalez RJ, Scott JG, Mullinax JE, Abuodeh YA, Kim Y, Binitie O, Ahmed KA, Bui MM, Saini AS, Zager JS, Biagioli MC, Letson D, Harrison LB, Fernandez DC. Implications of staged reconstruction and adjuvant brachytherapy in the treatment of recurrent soft tissue sarcoma. Brachytherapy 2016; 15:495-503. [PMID: 27180128 DOI: 10.1016/j.brachy.2016.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 03/31/2016] [Accepted: 03/31/2016] [Indexed: 01/18/2023]
Abstract
PURPOSE Prior studies illustrated a reduction in wound complications with the use of staged reconstruction (SR) and negative pressure wound therapy when treating soft tissue sarcoma (STS) with surgical resection followed by high-dose-rate adjuvant brachytherapy. The purpose of this study is to compare the outcomes of SR and immediate reconstruction (IR) brachytherapy in recurrent STS. METHODS AND MATERIALS A retrospective review of 40 patients with recurrent STS of the local extremity and trunk treated with resection followed by adjuvant brachytherapy alone. Margin status was defined as positive (SM(+)) if there was microscopic involvement (R1) or ≤1 mm margin and negative (SM(-)) if >1 mm margin was obtained. SR and IR were compared regarding toxicity, local control, and limb preservation. RESULTS Median followup was 27 months. When comparing the SR (n = 22) and IR (n = 18) cohorts, there was a significantly lower final SM(+) rate in SR (32% vs. 83%, p < 0.01). A 2-year local control benefit seen with SR (80% vs. 34%; p = 0.012) and a final SM(-) (81% vs. 39%; p = 0.023). SR was associated with less toxicity on multivariate analysis, including a 90% decrease in persistent edema, an 80% decrease in wound dehiscence, and a 94% decrease in nonhealing wounds, when compared to IR. Ten of 31 (32%) extremity cases required eventual amputation from either chronic wound complications (n = 4) or local recurrence (n = 6). SR predicted for a benefit in 2-year limb preservation (88% vs. 50%; p = 0.008). CONCLUSION In our series, the treatment with SR brachytherapy resulted in less morbidity and an improved final SM(-) rate. This technique translated to an improvement in both local control and limb preservation of recurrent STS.
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Affiliation(s)
- Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Ricardo J Gonzalez
- Sarcoma Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Jacob G Scott
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - John E Mullinax
- Sarcoma Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Yazan A Abuodeh
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Odion Binitie
- Sarcoma Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Marilyn M Bui
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Amarjit S Saini
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Jonathan S Zager
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Matthew C Biagioli
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Douglas Letson
- Sarcoma Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Louis B Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Daniel C Fernandez
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
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Haas RLM, Miah AB, LePechoux C, DeLaney TF, Baldini EH, Alektiar K, O'Sullivan B. Preoperative radiotherapy for extremity soft tissue sarcoma; past, present and future perspectives on dose fractionation regimens and combined modality strategies. Radiother Oncol 2015; 119:14-21. [PMID: 26718153 DOI: 10.1016/j.radonc.2015.12.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/07/2015] [Accepted: 12/13/2015] [Indexed: 01/12/2023]
Abstract
INTRODUCTION This critical review aims to summarize published data on limb sparing surgery for extremity soft tissue sarcoma in combination with pre-operative radiotherapy (RT). METHODS This review is based on peer-reviewed publications using a PubMed search on the MeSH headings "soft tissue sarcoma" AND "preoperative radiotherapy". Titles and abstracts screened for data including "fraction size AND/OR total dose AND/OR overall treatment time", "chemotherapy", "targeted agents AND/OR tyrosine kinase inhibitors", are collated. Reference lists from some articles have been studied to obtain other pertinent articles. Additional abstracts presented at international sarcoma meetings have been included as well as information on relevant clinical trials available at the ClinicalTrials.gov website. RESULTS Data are presented for the conventional regimen of 50-50.4Gy in 25-28 fractions in 5-6 of weeks preoperative external beam RT with respect to the regimen's local control probability compared to surgery alone, as well as acute and late toxicities. The rationale and outcome data for hypofractionated and/or reduced dose regimens are discussed. Finally, combination schedules with conventional chemotherapy and/or targeted agents are summarized. CONCLUSION Outside the setting of well-designed prospective clinical trials, the conventional 50Gy in 5-6week schedule should be considered as standard. However, current and future studies addressing alternative fraction size, total dose, overall treatment time and/or combination with chemotherapy or targeted agents may reveal regimens of equal or increased efficacy with reduced late morbidities.
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Affiliation(s)
- Rick L M Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Aisha B Miah
- Department of Radiotherapy and Physics, Sarcoma Unit, The Royal Marsden Hospital, London, UK
| | | | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA
| | - Elizabeth H Baldini
- Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, USA
| | - Kaled Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, USA
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Canada
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Perioperative high-dose-rate interstitial brachytherapy combined with external beam radiation therapy for soft tissue sarcoma. Brachytherapy 2015; 14:571-7. [DOI: 10.1016/j.brachy.2015.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 11/16/2022]
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Evidence and clinical outcomes of adult soft tissue sarcomas of the extremities treated with adjuvant high-dose-rate brachytherapy - a literature review. J Contemp Brachytherapy 2014; 6:318-22. [PMID: 25337137 PMCID: PMC4200188 DOI: 10.5114/jcb.2014.45758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/11/2014] [Accepted: 09/30/2014] [Indexed: 11/17/2022] Open
Abstract
The treatment strategies for adult soft tissue sarcomas of the extremities place an emphasis on local control, maintenance of limb function, and quality of life. Surgery is the mainstay of treatment for soft tissue sarcomas. Radiotherapy and chemotherapy are also both important treatments used in these patients to optimize the outcomes of limb sparing surgery. Compared to external beam radiation therapy, brachytherapy has the advantage of delivering a concentrated dose to the tumor, whilst sparing the normal tissues. Consequently, early and late complications such as bone fractures and subcutaneous fibrosis are potentially avoided by using brachytherapy. The evidence and clinical outcomes of HDR brachytherapy in soft tissue sarcomas of the extremities are described in this paper by means of a literature review.
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Angiosarcoma of the scalp: a case report. J Contemp Brachytherapy 2014; 6:208-12. [PMID: 25097563 PMCID: PMC4105641 DOI: 10.5114/jcb.2014.43183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/13/2014] [Accepted: 06/26/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of this paper is to report the treatment of angiosarcoma of the scalp. High-dose-rate (HDR) brachytherapy with an individual mold applicator is presented. Case description A case of a 75-year-old male will be presented with multicentric lesions over the scalp in the temple and crown region. Biopsy diagnosis was angiosarcoma of the scalp, nonoperable. The patient was qualified for chemotherapy combined with radiotherapy. Discussion Angiosarcoma of the scalp is a very aggressive tumor. The main aim of the treatment of angiosarcoma is local control of the tumor. Most cases are treated with wide excision surgery. The use of surgery with adjuvant radiotherapy or chemotherapy is recommended in some cases. Chemotherapy and radiotherapy are suggested in the recurrent or extensive lesions with regional or distant metastasis. Radiation therapy can be realized with external beam therapy or brachytherapy. High-dose-rate brachytherapy is an effective, adequate, well tolerated by patients treatment method. In every case, an individual approach is needed. Conclusions The HDR brachytherapy technique is useful and practicable. The advantages of brachytherapy are: targeted dose distribution, low integral dose, and short time of treatment. The mold HDR brachytherapy treatment using an individual applicator was an appropriate tool for the presented patient.
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Thomadsen BR, Erickson BA, Eifel PJ, Hsu IC, Patel RR, Petereit DG, Fraass BA, Rivard MJ. A review of safety, quality management, and practice guidelines for high-dose-rate brachytherapy: executive summary. Pract Radiat Oncol 2014; 4:65-70. [PMID: 24890345 DOI: 10.1016/j.prro.2013.12.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 12/23/2013] [Indexed: 12/26/2022]
Abstract
This white paper was commissioned by the American Society for Radiation Oncology (ASTRO) Board of Directors to evaluate the status of safety and practice guidance for high-dose-rate (HDR) brachytherapy. Given the maturity of HDR brachytherapy technology, this white paper considers, from a safety point of view, the adequacy of general physics and quality assurance guidance, as well as clinical guidance documents available for the most common treatment sites. The rate of medical events in HDR brachytherapy procedures in the United States in 2009 and 2010 was 0.02%, corresponding to 5-sigma performance. The events were not due to lack of guidance documents but failures to follow those recommendations or human failures in the performance of tasks. The white paper summarized by this Executive Summary reviews current guidance documents and offers recommendations regarding their application to delivery of HDR brachytherapy. It also suggests topics where additional research and guidance is needed.
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Affiliation(s)
- Bruce R Thomadsen
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin.
| | - Beth A Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Patricia J Eifel
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - I-Chow Hsu
- Department of Radiation Oncology, University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | | | - Daniel G Petereit
- Department of Radiation Oncology, John T. Vucurevich Cancer Care Institute, Rapid City Regional Hospital, Rapid City, South Dakota
| | - Benedick A Fraass
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mark J Rivard
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts
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Buyyounouski MK, Viswanathan AN, Prestidge BR. Examining the evidence in pursuit of the highest possible brachytherapy standards. Brachytherapy 2014; 13:15-6. [DOI: 10.1016/j.brachy.2013.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 07/13/2013] [Indexed: 10/26/2022]
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