title: Low-dose intraoperative brachytherapy in soft tissue sarcomas involving neurovascular structure.
abstract: OBJECTIVE
  To evaluate intraoperative brachytherapy in the management of soft tissue sarcomas involving neurovascular structures, its impact on local control and complications.
  
  
  METHODS
  Between 01/1989 and 12/2002, 98 patients received an intraoperative implant in conjunction with conservative surgery. Brachytherapy was part of the initial treatment (79 cases) or performed in recurrent disease (19 cases). We studied primary sarcomas involving neurovascular structures treated with conservative surgery and intraoperative brachytherapy (n = 6) or intraoperative brachytherapy and external irradiation (n = 73). Conservative surgery was performed as first treatment (51 cases), after chemotherapy (21 cases) and after primary external radiation (seven cases). Brachytherapy was performed according to Paris system rules. Patients were loaded with Iridium 192 (64 cases) or connected to a Microselectron PDR (15 cases). Mean dose given by brachytherapy was 20 Gy. Mean dose given of external radiotherapy was 46 Gy.
  
  
  RESULTS
  With a median follow-up of 58 months, 5-year actuarial survival was 69% and local free disease at 5 years was 90%. Acute side-effects occurred in 22/79 requiring surgical repair in 10 patients. Late side-effects occurred in 35/79. No patient required amputation for complications. Prognostic factors were studied for the occurrence of acute and late side-effects and local control.
  
  
  CONCLUSIONS
  Intraoperative brachytherapy is efficient with excellent local control rates in soft tissue sarcomas presenting with neurovascular involvement and offers an acceptable conservative option.
authors.affiliation: Institut Bergonié, Regional Cancer Center, Bordeaux Cedex, France.
authors.forename: Carmen
authors.initials: C
authors.lastname: Llácer
authors.forename: Martine
authors.initials: M
authors.lastname: Delannes
authors.forename: Mathieu
authors.initials: M
authors.lastname: Minsat
authors.forename: Eberhard
authors.initials: E
authors.lastname: Stoeckle
authors.forename: Laurent
authors.initials: L
authors.lastname: Votron
authors.forename: Pierre
authors.initials: P
authors.lastname: Martel
authors.forename: Paul
authors.initials: P
authors.lastname: Bonnevialle
authors.forename: Binh
authors.initials: B
authors.lastname: Nguyen Bui
authors.forename: Christine
authors.initials: C
authors.lastname: Chevreau
authors.forename: Guy
authors.initials: G
authors.lastname: Kantor
authors.forename: Nicolas
authors.initials: N
authors.lastname: Daly-Schveitzer
authors.forename: Laurence
authors.initials: L
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012509:Sarcoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis
chemical_list: D007496:Iridium Radioisotopes