A 10-year experience of pediatric brachytherapy.
OBJECTIVE
The purpose of this project was to review the brachytherapy experience in the pediatric population at the Joint Center for Radiation Therapy (JCRT) with respect to efficacy and morbidity.


METHODS
Treatment outcome was reviewed for 18 children between the ages of 6 months and 23 years who received 19 implants between 1982 and 1992 at JCRT. Fourteen children received permanent Iodine-125 seed implants placed in the operative tumor bed at the time of resection. Two children received sterotactically placed afterloaded high-activity I-125 seed brain implants, and one child received a high-activity I-125 brain implant followed by a permanent I-125 seed brain implants 3 years later. One girl received a temporary Iridium-192 volume implant for a vulvar rhabdomyosarcoma. Among the 15 permanent I-125 implants, the cases included five primary brain tumors, one metastatic brain tumor, six sarcomas, and one each of the following: suprarenal neuroblastoma, hepatoblastoma, and adenocarcinoma of the pancreas. All patients underwent surgery and most patients (15 out of 18) received external beam radiotherapy to a field that included the implant.


RESULTS
The median follow-up from the time of diagnosis for patients who remain alive is 55 months (range 24 to 119 months), and the median follow-up from the time of implant is 46 months (15 to 60 months). Disease was controlled in the area of the implant in 13 of 17 evaluable cases. Two patients experienced treatment-related morbidity; one patient developed severe desquamation related to an "adriamycin recall reaction," and one patient died of postoperative complications.


CONCLUSIONS
Despite the heterogeneous mix of cases, the use of brachytherapy in this pediatric population resulted in several cases of long-term disease control, and the overall morbidity was very low. Therefore, in properly selected pediatric cases, brachytherapy appears to be an efficacious adjunct to multimodality cancer management.
Healey
E A
EA
Joint Center for Radiation Therapy, Children's Hospital, Boston, MA, USA.
Shamberger
R C
RC
Grier
H E
HE
Loeffler
J S
JS
Tarbell
N J
NJ
D000293:Adolescent; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D001932:Brain Neoplasms / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D018237:Germinoma / Q000532:radiotherapy; D006801:Humans; D007223:Infant; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000532:radiotherapy; D009369:Neoplasms / Q000532:radiotherapy*; D010190:Pancreatic Neoplasms / Q000532:radiotherapy; D012208:Rhabdomyosarcoma / Q000532:radiotherapy; D012509:Sarcoma / Q000532:radiotherapy; D012512:Sarcoma, Ewing / Q000532:radiotherapy
D007457:Iodine Radioisotopes