Perioperative hyperfractionated high-dose rate brachytherapy for the treatment of soft tissue sarcomas: multicentric experience.
BACKGROUND
Low-dose rate brachytherapy is a well-established adjuvant treatment for soft tissue sarcomas (STS). The experience with high-dose rate brachytherapy (HDR BT) in this indication is limited. The purpose of our study was to evaluate the viability of perioperative hyperfractionated HDR BT for STS.


METHODS
Forty-five patients with primary (17 cases) or recurrent (28 cases) STS were treated with resection and HDR BT between 1998 and 2007. Eleven patients were treated with HDR BT alone (mean dose 40 Gy; 30-54 Gy) and 34 were treated with a combination of HDR BT (mean dose 24 Gy; 15-30 Gy) and external beam radiotherapy (EBRT) (40-50 Gy). Hyperfractionation, 3 Gy twice daily, was used for HDR BT with plastic tubes. Adjuvant chemotherapy was indicated for patients with high risk of dissemination.


RESULTS
Local control (LC) was achieved in 17 patients (100%) treated for primary tumor and in 18 of 28 patients (64%) treated for recurrence; this difference was statistically significant (p = 0.004). Distant metastases occurred in seven patients (15.6%). The 5-year overall survival was 70%; the 5-year local control was 74%. LC was significantly better for extremities sarcomas in comparison with trunk tumors, for patients treated with EBRT and BT in comparison with BT alone, and for doses >65 Gy.


CONCLUSIONS
Our study suggests that perioperative HDR BT is a promising method for achieving high biological doses with good LC in the postoperative radiotherapy of STS and that combination of BT and EBRT provides better tumor control than BT alone.
Petera
Jirí
J
Department of Oncology and Radiotherapy, University Hospital Hradec Králové, Hradec Králové, Czech Republic. petera@fnhk.cz
Soumarová
Renata
R
Růzicková
Jana
J
Neumanová
Renata
R
Dusek
Ladislav
L
Sirák
Igor
I
Macingová
Zuzana
Z
Paluska
Petr
P
Kasaová
Linda
L
Hodek
Miroslav
M
Vosmik
Milan
M
D000328:Adult; D000368:Aged; D001918:Brachytherapy; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D019990:Perioperative Care; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome