title: Perioperative high-dose-rate interstitial brachytherapy combined with external beam radiation therapy for soft tissue sarcoma.
abstract: OBJECTIVE
  The aim of our study was to evaluate the role of perioperative high-dose-rate interstitial brachytherapy (PHDRIBT) in combination with external beam radiation therapy (EBRT) in patients with localized soft tissue sarcoma (STS).
  
  
  METHODS
  From year 2004 to 2010, 52 patients with localized STS were treated with wide local excision plus PHDRIBT followed by EBRT. Median size of the tumor was 8 cm (range, 4-19 cm). A single-plane interstitial brachytherapy implant with an average of nine catheters was performed during the surgical resection. The PHDRIBT was started on third postoperative day to deliver a high-dose-rate dose of 16 Gy in four fractions over 2 days using twice-a-day fractionation schedule. After 4 weeks, EBRT was started for a prescription dose of 50 Gy by conventional fractionation. Subsequently, chemotherapy was administered, if indicated as per our institutional policy. Patients were followed up regularly to study local control, survival, and toxicity.
  
  
  RESULTS
  At a median followup of 46 months, no patient developed local recurrence, but 12 patients developed distant metastases. The 5-year overall survival and disease-free survival were 67% and 63%, respectively. Main acute toxicity was delayed wound healing observed in 3 patients (5.7%). Commonest late toxicity was chronic skin/subcutaneous fibrosis noticed in 5 patients (9.6%).
  
  
  CONCLUSIONS
  The PHDRIBT combined with EBRT provides excellent local control and survival rates with acceptable acute and late toxicity in patients with localized STS.
authors: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: sharmadn@hotmail.com.
authors: Daya Nand
authors: DN
authors: Sharma
authors: Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India.
authors: S V Suryanarayana
authors: SV
authors: Deo
authors: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
authors: Goura Kisor
authors: GK
authors: Rath
authors: Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India.
authors: Nootan Kumar
authors: NK
authors: Shukla
authors: Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India.
authors: Sameer
authors: S
authors: Bakhshi
authors: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
authors: Ajeet Kumar
authors: AK
authors: Gandhi
authors: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
authors: Pramod Kumar
authors: PK
authors: Julka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology*; D018714:Radiotherapy, Adjuvant; D012509:Sarcoma / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D012867:Skin / Q000473:pathology / Q000528:radiation effects*; D012983:Soft Tissue Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate; D014945:Wound Healing / Q000528:radiation effects; D055815:Young Adult
keywords: High-dose rate; Interstitial brachytherapy; Perioperative; Soft tissue sarcoma