title: Long-term morbidity in children treated with fractionated high-dose-rate brachytherapy for soft tissue sarcomas.
abstract: BACKGROUND
  The purpose of this study was to determine the long-term local control, disease-free survival, and morbidity of fractionated high-dose-rate brachytherapy (F-HDR) in infants and children with soft tissue sarcomas.
  
  
  METHODS
  Fifteen children (13 girls and 2 boys, ages 5-101 months) with soft tissue sarcomas were treated with chemotherapy, organ-preserving surgery, and F-HDR (36 Gy in 12 fractions) to post-chemotherapy volumes. External beam radiotherapy was not part of the primary treatment, although four patients (27%) subsequently received salvage external beam radiotherapy after treatment failure. Chemotherapy was administered to all patients based on their tumor histology and stage.
  
  
  RESULTS
  After a median follow-up of 10 years (range 32-154 months), 12 patients (80%) were alive without evidence of disease. Ten-year overall survival and local control rates were both 80% (12/15 children). The overall survival was better (91%) for children with microscopic residual versus gross residual disease (75%). With longer follow-up, grade 3 to 4 brachytherapy-related late morbidities increased from 8% (1/12) to 20% (3/15) and included trismus/osteonecrosis, vaginal stenosis, and periurethral fibrosis. There were two late complications associated with puberty that occurred 8 to 10 years after the initial treatments. Acute toxicity occurred in five patients (38%) and consisted primarily of grade 1 to 3 skin and mucosal reactions.
  
  
  CONCLUSIONS
  As the sole radiation modality, F-HDR achieved excellent local control and disease-free survival in properly selected children with soft tissue sarcomas while preserving normal bone and organ development. A significant percentage of patients experience adverse late sequelae as a result of this treatment.
authors.affiliation: Division of Radiation Oncology, The Arthur G. James Cancer Hospital and Solove Research Institute, The Ohio State University Hospitals, Columbus, Ohio 43210, USA. nag.1@osu.edu
authors.forename: Subir
authors.initials: S
authors.lastname: Nag
authors.forename: Douglas
authors.initials: D
authors.lastname: Tippin
authors.forename: Frederick B
authors.initials: FB
authors.lastname: Ruymann
mesh_terms: D001918:Brachytherapy / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009017:Morbidity; D009364:Neoplasm Recurrence, Local; D009926:Organ Preservation; D012208:Rhabdomyosarcoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D012509:Sarcoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D012983:Soft Tissue Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D017211:Treatment Failure