Nerve tolerance to high-dose-rate brachytherapy in patients with soft tissue sarcoma: a retrospective study

Abstract

Background: Brachytherapy, interstitial tumor bed irradiation, following conservative surgery has been shown to provide excellent local control and limb preservation in patients with soft tissue sarcomas (STS), whereas little is known about the tolerance of peripheral nerves to brachytherapy. In particular, nerve tolerance to high-dose-rate (HDR) brachytherapy has never been properly evaluated. In this study, we examined the efficacy and radiation neurotoxicity of HDR brachytherapy in patients with STS in contact with neurovascular structures.

Early Complications of High-dose-rate Brachytherapy in Soft Tissue Sarcoma: A Comparison With Traditional External-beam Radiotherapy

“…Complications in our brachytherapy cohort primarily consisted of infection and required surgical intervention more often than the EBRT group; for this reason, brachytherapy may ostensibly be less appealing for resections in which vascular or skeletal reconstruction is required. The EBRT cohort demonstrated comparable rates of wound complications, fibrosis, and edema, as documented in other reports [6,7,11,12,24,26,29,32,33,36,37]. Our study highlights the differences in subtypes of complications, with edema and radiation dermatitis more common in the EBRT cohort and infection more common in the HDR-BT cohort.…”

“…With no difference in overall survival or local recurrence between preoperative and postoperative EBRT [7,20,32,36,38], the timing of treatment is based on many factors, such as tumor size, surgeon preference, and previous unplanned excision. Although preoperative EBRT has advantages over postoperative EBRT, such as lower radiation dose and smaller field size, postoperative radiotherapy was most frequently used at our institution when EBRT was utilized due to previous reports of higher wound complication rates [6,24,29,32,36]. Complications associated with HDR-BT are also documented, but small sample sizes and lack of direct comparison between cohorts limit interpretation of this information [1,8,9,18,22,23,29].…”

Evidence and clinical outcomes of adult soft tissue sarcomas of the extremities treated with adjuvant high-dose-rate brachytherapy – a literature review

“…In contrast to this, Kubo et al . [ 23 ] published the results of 7 patients treated between 1995 and 2000 for ESTS involving the neurovascular bundle. They were treated with LSS followed by fractionated HDR.…”