title: Safety and efficacy of radiation dose delivered via iodine-125 brachytherapy mesh implantation for deep cavity sarcomas.
abstract: BACKGROUND
  Radiation delivered as brachytherapy (BRT) via catheters placed during extremity soft tissue sarcoma (STS) resection results in acceptable local control rates; however, there are limitations in deep cavities. (125)I seeds embedded in mesh provide a flexible BRT platform that may be contoured to irregular deep cavities surfaces, but the risks and benefits are unknown.
  
  
  METHODS
  Patients with thoracic, abdominal, pelvic, retroperitoneal, and deep truncal STS undergoing resection and implantation of permanent (125)I mesh BRT at our institution were reviewed. Local recurrence rates within the tumor bed covered by mesh (in field) and postoperative complications were analyzed.
  
  
  RESULTS
  Between 2000 and 2010, a total of 46 patients were treated for primary (n = 8, 17 %) or recurrent (n = 38, 83 %) deep cavity STS (median follow-up 34.8 months); 74 % received external-beam radiotherapy for this or a prior presentation. In-field recurrences were observed in 9 patients (19.5 %). Crude cumulative incidences of in-field, regional, and distant recurrences at 5 years were 26.3, 54.2, and 54.1 %, respectively. 5-year overall survival rate was 47.2 %; median survival was 44.0 months. Twenty-two patients (48 %) experienced complications, half of whom (24 %) developed grade III/IV complications requiring percutaneous intervention (n = 6) or reoperation (n = 5) at a median of 35.5 days. There were no postoperative deaths.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to report safety and efficacy for permanent (125)I mesh BRT implantation after resection of deep cavity STS. Local in-field recurrence rates were relatively low in this high-risk population. However, 24 % developed complications requiring intervention. (125)I mesh BRT appears effective, but it should be used with caution.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA, mfairweather@partners.org.
authors.forename: Mark
authors.initials: M
authors.lastname: Fairweather
authors.forename: Jiping
authors.initials: J
authors.lastname: Wang
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Devlin
authors.forename: Jorgen
authors.initials: J
authors.lastname: Hansen
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Baldini
authors.forename: John E
authors.initials: JE
authors.lastname: Ready
authors.forename: David J
authors.initials: DJ
authors.lastname: Sugarbaker
authors.forename: Monica M
authors.initials: MM
authors.lastname: Bertagnolli
authors.forename: Chandrajit P
authors.initials: CP
authors.lastname: Raut
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000401:mortality*; D003131:Combined Modality Therapy; D005121:Extremities / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012449:Safety; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate
chemical_list: D007457:Iodine Radioisotopes