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Neoplasma Vol.51, p.59-63, 2004 |
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Title: Perioperative fractionated high-dose rate brachytherapy in the treatment of soft tissue sarcomas | ||
Author: J., PETERA ; R., NEUMANOVA ; K., ODRAZKA ; M., ONDRAK ; R., SOUMAROVA ; P., JANICEK ; E., PROCHAZKA ; T., KOHLOVA ; | ||
Abstract: The purpose of the study was to investigate the viability of
perioperative fractionated high dose rate brachytherapy (HDR BT)
for primary and reccurent soft tissue sarcomas (STS). From
February 1998 through June 2002, 21 adult patients, 11 females and
10 males with either low grade or high grade soft tissue sarcomas
were treated by perioperative HDR BT. Surgical margin was negative
in 10 cases, close in 4 and positive in 4 in cases. In 3 cases it
was not described. BT was used as a part of primary treatment in
10 cases and for the treament of reccurent tumor in 11 cases. The
localisation of the tumor was the extremity in 16 patients and the
trunk in 5 patients. Ten patients were treated with HDR BT alone
(total mean dose 40 Gy) and 11 were treated with combination of
external beam radiotherapy (EBRT) (40--50 Gy) and brachytherapy
(total mean dose 24 Gy). Hyperfractionation 2.4--3 Gy twice daily
at 10 mm from the source was used for BT. Follow-up periods were
between 7--48 months (median: 20 months). Local control in
patients treated pro primary STS was 100%.The pulmonal metastases
were a cause of death in one case, one patient was alive with
dissemination and one patient was disease free after salvage
surgery and chemotherapy for lung metastases. Local control was
achieved only in 3 of 11 patients treated for reccurent tumor
(27%). Six patiens were disease free after salvage surgery, 2
patients died of disease progression, one patient died of toxicity
of chemotherapy without evidence of disease and 2 patients are
alive with distant metastases. Local control was achieved in 5 of
11 (45%) patients with positive, close or not stated surgical
margin and in 5 of 10 (50%) patients with negative margin. Local
control was 100% in patients treated by EBRT + BT, but only 20% in
patients treated by BT alone. No infection or delayed wound
healing has occurred after BT. Soft tissue necrosis was seen in 4
cases, subcutanous fistula in one case and peripheral nerve palsy
in one case. Despite small number of patients and short follow up
our study suggest that perioperative HDR BT is easy and promissing
when used as a part of primary treatment for STS. The treatment
results for recurrence are poor and in a lot of cases radical
surgical approach should have been considered for the salvage.
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Keywords: soft tissue sarcomas, high dose rate brachytherapy, local control, complications | ||
Year: 2004, Volume: 51, Issue: | Page From: 59, Page To: 63 | |
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