20-year experience with intraoperative high-dose-rate brachytherapy for pediatric sarcoma: Outcomes, toxicity, and practice recommendations Journal Article
| Authors: | Folkert, M. R.; Tong, W. Y.; LaQuaglia, M. P.; Wexler, L. H.; Chou, A. J.; Magnan, H.; Zelefsky, M. J.; Wolden, S. L. |
| Article Title: | 20-year experience with intraoperative high-dose-rate brachytherapy for pediatric sarcoma: Outcomes, toxicity, and practice recommendations |
| Abstract: | Methods and Materials: Seventy-five pediatric patients underwent HDR-IORT for sarcoma from May 1993 to November 2013. The median age was 9 years old (36 patients were ≤6 years old). HDR-IORT was part of initial therapy in 37 patients (49%) and for recurrent disease in 38 patients (51%). Forty-one patients (55%) received HDR-IORT and postoperative external beam RT (PORT), and 22 patients (29%) were previously treated with external beam radiation therapy to the IORT site. Local control (LC), overall survival (OS) and event-free survival (EFS) were estimated using Kaplan-Meier methods. Results: At a median follow-up of 7.8 years for surviving patients, 5-year projected rates of LC, EFS, and OS were 63% (95% confidence interval [CI] 50%-76%), 33% (95% CI 21%-45%), and 43% (95% CI 30%-55%), with a median survival of 3.1 years. The 5-year LC, EFS, and OS rates for patients with recurrent disease were 46% (95% CI, 28%-64%), 30% (95% CI, 13%-46%), and 36% (95% CI, 18%-54%). Acute toxicity ≥grade 3 occurred in 2 (2.5%) treatments; late toxicity ≥grade 3 occurred in 4 (5.3%) patients 0.3-9.9 years after HDR-IORT. The incidence of toxicity ≥grade 3 was not associated with HDR-IORT applicator size, HDR-IORT dose, prior RT or PORT, or prior or postoperative chemotherapy, but all toxicity ≥grade 3 occurred in patients ;6 years treated with HDR-IORT doses ≥12 Gy. Conclusions: HDR-IORT is a well-tolerated component of multimodality therapy for pediatric sarcoma, allowing additional local treatment while reducing external beam exposure. Taking clinical considerations into account, doses between 8-12 Gy are appropriate for HDR-IORT in patients ≤6 years of age. Purpose: To assess outcomes and toxicity of high-dose-rate intraoperative radiation therapy (HDR-IORT) in the management of pediatric sarcoma. |
| Keywords: | adolescent; adult; cancer chemotherapy; child; event free survival; major clinical study; overall survival; cancer recurrence; conference paper; radiation dose; outcome assessment; follow up; neuropathy; retrospective study; childhood cancer; sarcoma; brachytherapy; dermatitis; external beam radiotherapy; acute toxicity; encephalitis; personal experience; intraoperative radiotherapy; human; male; female; intraoperative high-dose-rate brachytherapy |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 90 |
| Issue: | 2 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2014-10-01 |
| Start Page: | 362 |
| End Page: | 368 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2014.06.016 |
| PROVIDER: | scopus |
| PUBMED: | 25304795 |
| DOI/URL: | |
| Notes: | Export Date: 1 December 2014 -- Source: Scopus |
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