Tumor bed brachytherapy with a mesh template: an accessible alternative to intraoperative radiotherapy.
OBJECTIVE
Locally advanced and recurrent malignancies often require adjuvant radiotherapy to achieve tumor control. We report our experience with a technique that uses an intraoperatively placed mesh template for the delivery of radiotherapy.


METHODS
from 1988 to 1996, 14 patients were treated with tumor bed brachytherapy using this mesh technique. Sites of involvement included the head and neck region (n = 6), abdomen/pelvis (n = 4), retroperitoneum (n = 3), and the lower extremity (n = 1). During surgery, plastic catheters were evenly placed within a mesh template (Vicryl or Marlex), which was positioned in the tumor bed. The catheters were afterloaded with radioactive sources once the final pathology had been determined and the patient required limited nursing care. Radiation dose was titrated to the surgico-pathologic findings (e.g., margin status).


RESULTS
All of the patients tolerated the procedure without experiencing acute or chronic sequelae. The median survival time was 13 months. Local control was achieved in 11 of 13 evaluable patients, with an actuarial local control of 82% at 6 months.


CONCLUSIONS
Tumor bed brachytherapy with a mesh implant is a practical technique to improve tumor control and warrants further investigation.
DiBiase
S J
SJ
Department of Radiation Oncology, Jefferson Medical College, Philadelphia, Pennsylvania, USA.
Rosenstock
J G
JG
Shabason
L
L
Corn
B W
BW
D000008:Abdominal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D000368:Aged; D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D012186:Retroperitoneal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D012509:Sarcoma / Q000532:radiotherapy / Q000601:surgery; D013526:Surgical Mesh
D007496:Iridium Radioisotopes