Feasibility report of conservative surgery, perioperative high-dose-rate brachytherapy (PHDRB), and low-to-moderate dose external beam radiation therapy (EBRT) in pediatric sarcomas
Rafael Martínez-Monge (1), Cristina Garrán (1), Mauricio Cambeiro (1), Mikel San Julián (2), Juan Alcalde (3), Luis Sierrasesúmaga (4)
(1) Department of Oncology, University of Navarra Clinic, University of Navarra, Pamplona, Spain
(2) Department of Orthopedic Surgery, University of Navarra Clinic, University of Navarra, Pamplona, Spain
(3) Department of Head and Neck Surgery, University of Navarra Clinic, University of Navarra, Pamplona, Spain
(4) Department of Pediatrics, University of Navarra Clinic, University of Navarra, Pamplona, Spain
This study was undertaken to determine the feasibility of perioperative high-dose-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.
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.
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 with recurrent osteosarcomas can be treated in a fashion similar to their adult soft tissue counterparts and 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.
CITATION Brachytherapy. 2004;3(4):196-200