title: Intraoperative high-dose-rate brachytherapy for pediatric solid tumors: a 10-year experience.
abstract: OBJECTIVE
  To evaluate the efficacy and toxicity of intraoperative high-dose-rate brachytherapy (IOHDR) in the management of pediatric solid tumors.
  
  
  METHODS
  The records of 66 pediatric patients who underwent IOHDR for a solid tumor from February 1993 through December 2002 were retrospectively reviewed. The median age was 7 years (range 9 months to 24 years). Thirty-five patients (53%) were treated for recurrent disease and 24 (36%) had documented metastatic disease. Twenty-nine patients (44%) received both EBRT and IOHDR. The IOHDR dose was prescribed to a depth of 0.5 cm from the surface of a multichannel tissue-equivalent applicator. The median prescription dose was 12 Gy (range, 4-15 Gy).
  
  
  RESULTS
  After a median follow-up of 12 months, the 2-year actuarial rates of local control and overall survival were 56% and 54%, respectively, with a median survival of 29 months. Post-operative EBRT significantly improved (p=0.002) 2-year local control (83% v. 29%). Perioperative complications occurred in 8 of 66 patients while late complications occurred in only 3. The actuarial 2-year late complication rate was 12%. Late events that occurred in or near the IOHDR treatment site included small bowel obstruction, broncho-esophageal fistula, and bone growth retardation.
  
  
  CONCLUSIONS
  IOHDR is emerging as an integral part of multimodality therapy for pediatric solid tumors as an adjunct to EBRT for local control. IOHDR alone may not be appropriate in the majority of patients. Subacute toxicities occurred rarely and may be related to the combination of extensive surgery, EBRT, and multi-agent chemotherapy in this population.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: Karyn A
authors.initials: KA
authors.lastname: Goodman
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Wolden
authors.forename: Michael P
authors.initials: MP
authors.lastname: LaQuaglia
authors.forename: Kaled
authors.initials: K
authors.lastname: Alektiar
authors.forename: David
authors.initials: D
authors.lastname: D'Souza
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zelefsky
mesh_terms: D000293:Adolescent; D000328:Adult; D001918:Brachytherapy / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D008297:Male; D009017:Morbidity; D009369:Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome