title: Perioperative high-dose-rate brachytherapy in soft tissue sarcomas of the extremity and superficial trunk in adults: initial results of a pilot study.
abstract: OBJECTIVE
  This study was undertaken to determine the feasibility of perioperative high-dose-rate brachytherapy (PHDRB) as an alternative to standard low-dose-rate brachytherapy in adult patients with soft tissue sarcomas.
  
  
  METHODS
  Twenty-five adult patients with soft tissue sarcomas of the extremities or the superficial trunk were treated with surgical resection and PHDRB (16, 24, or 32Gy) for negative, close/microscopically positive, or grossly involved surgical resection margins, respectively. External beam radiation therapy (45Gy) was added postoperatively. Adjuvant chemotherapy with ifosfamide and doxorubicin was given to patients with high-grade tumors.
  
  
  RESULTS
  Resection margins were negative in 6 patients (24.0%), close/microscopically positive in 18 (72.0%), and grossly involved in 1 (4.0%). One patient (4.0%) with wound dehiscence needed reoperation. Three patients failed in the anatomical region treated, but relapse sites were not adjacent to the area treated with PHDRB. After a median followup of 23.2 months (range 2.8-48.0), the 4-year local and regional control rates were 100% and 80.5%, respectively. Four-year overall survival was 78.2%.
  
  
  CONCLUSIONS
  Locoregional control and survival results are encouraging for this high-risk patient population. PHDRB results seem to be similar to those obtained with low-dose-rate brachytherapy.
authors.affiliation: Department of Oncology, University of Navarra Clinic, University of Navarra, Pamplona, Spain. rmartinezm@unav.es
authors.forename: Rafael
authors.initials: R
authors.lastname: Martínez-Monge
authors.forename: Mikel
authors.initials: M
authors.lastname: San Julián
authors.forename: Santiago
authors.initials: S
authors.lastname: Amillo
authors.forename: Mauricio
authors.initials: M
authors.lastname: Cambeiro
authors.forename: Leire
authors.initials: L
authors.lastname: Arbea
authors.forename: Jeanette
authors.initials: J
authors.lastname: Valero
authors.forename: María
authors.initials: M
authors.lastname: González-Cao
authors.forename: Salvador
authors.initials: S
authors.lastname: Martín-Algarra
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D019583:Dose Fractionation, Radiation; D005121:Extremities / Q000473:pathology / Q000528:radiation effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D019990:Perioperative Care; D010865:Pilot Projects; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012509:Sarcoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis; D013997:Time Factors; D017211:Treatment Failure; D047368:Tumor Burden / Q000528:radiation effects