Klin Onkol 2005; 18(1): 19-22.
Summary:
Background: Low dose rate brachytherapy alone or in combination with external beam radiotherapy is wellestablished adjuvant treatment after surgical resection in soft tissue sarcomas (STS). The experience with high dose radiotherapy in this indication is limited. The purpose of our retrospective study was an evaluation of the viability of perioperative hyperfractionated high dose brachytherapy for primary and recurrent soft tissue sarcomas.
Patients and methods: From February 1998 through June 2002, 21 adult patients with soft tissue sarcomas were treated by interstitial perioperative high dose rate brachytherapy. Brachytherapy was used as a part of the treatment in 10 cases of primary tumors and in 11 cases of recurrent tumors. Ten patients were treated with brachytherapy alone (total mean dose 40 Gy) and 11 were treated with combination of external beam radiotherapy (40 – 50 Gy) and brachytherapy (total mean dose 24 Gy). Hyperfractionation 2.4– 3 Gy twice daily at 10 mm from the plane of sources was used for brachytherapy. Follow-up periods were between 14 and 65 months (median: 35 months). Results: Local control in patients treated for primary soft tissue sarcomas was 100%. Local control was achieved only in 2 of 11 patients treated for recurrent tumor (5-year local control probability 12%). Four patients were disease free after salvage surgery. Soft tissue necrosis was seen in 4 cases, subcutaneous fistula in one case, and peripheral nerve palsy in one case.
Conclusion: Our study – despite small number of patients – suggests, that perioperative high dose brachytherapy is easy and promising when used as a part of primary treatment for STS. The treatment results for repeated recurrences are poor and in a lot of cases brachytherapy should be used earlier or radical surgical approach should be considered for the salvage.
