High-dose-rate brachytherapy for soft tissue sarcoma in children: a single institution experience

Abstract

Purpose: To report our experience treating soft tissue sarcoma (STS) with high dose rate brachytherapy alone (HBRT) or in combination with external beam radiotherapy (EBRT) in pediatric patients. Methods and materials:Eighteen patients, median age 11 years (range 2 -16 years) with grade 2-3 STS were treated with HBRT using Ir-192 in a interstitial (n = 14) or intracavitary implant (n = 4). Eight patients were treated with HBRT alone; the remaining 10 were treated with a combination of HBRT and EBRT.Results: After a median follow-up of 79.5 months (range 12 -159), 14 patients were alive and without evidence of disease (5-year overall survival rate 84.5%). There were no local or regional failures in the group treated with HBRT alone. One patient developed distant metastases at 14 months and expired after 17 months. In the combined HBRT and EBRT group, there was 1 local failure (22 months), and 3 patients developed pulmonary metastatic disease 18, 38 and 48 months after diagnosis and no these patients were alive at the time of this report. The overall local control to HBRT alone and HBRT plus EBRT were 100 and 90%, respectively. The acute affects most common were local erythema and wound dehiscence in 6 (33%) and 4 (22%) patients.Late effects were observed in 3 patients (16.5%). Conclusion:Excellent local control with tolerable side effects have been observed in a small group of paediatric patients with STS treated by HBRT alone or in combination with EBRT.

Risk assessment of radio-chemotherapy in pediatric soft tissue sarcomas

“…The local control rates were effective, but the operational difficulties to care children with BRT sources make this approach restricted to few institutions. However, the theoretical advantages of HBRT make this treatment modality an interesting option to multidisciplinary management of STS (Viani et al, 2008). Moreover, in the present work, one patient only developed urinary complications in the form of artificial bladder and urinary diversion due to radical cystectomy for bladder mass.…”

“…A variety of radio-therapeutic approaches have been used in the adjuvant local management of STS. These include EBRT, BRT, and intraoperative radiation therapy (Viani et al, 2008). Unfortunately, radiation to soft tissues and bones within the treatment field can lead to skeletal deformity and growth retardation.…”

“…Only one patient (0.9%) with nasopharyngeal mass and extensive intracranial component developed convulsions following week 4 and it was attributed to the disease itself. However, EBRT can cause growth retardation or adversely affect organ function in the pediatric population (Viani et al, 2008). On the other hand, Sterzing et al reported acute side effects of RTH were low grade skin erythema (grade I-II), mucositis (grade I-II), local alopecia, mild nausea, mild diarrhea, loss of taste and epistaxis.…”

Sarcomas

“…(Curtis et al 2009 ;Krasin et al 2010 ;Wolden et al 2005 ;Eaton et al 2013 ). Techniques to reduce the integral dose to the body like brachytherapy and particle therapy are of particular value in this age group (Blank et al 2010 ;Combs et al 2012 ;Cotter et al 2011 ;Childs et al 2012 ;Laskar et al 2007 ;Lee et al 2005 ;Timmermann et al 2007 ;Viani et al 2008 ).…”

Educational Corner Brachytherapy in paediatric malignancies – review of indications

“…BRT can reduce the dose of radiation to normal tissues and shortens the overall treatment time while maintaining a comparable high rate of local control. Thus, reductions in normal tissue doses decrease the probability of growth deformity, radiochemotherapy interactions, and theoretically, the risk of second tumour induction [1, 2]. …”