Low-dose-rate intraoperative brachytherapy combined with external beam irradiation in the conservative treatment of soft tissue sarcoma
Identifieur interne : 000752 ( France/Analysis ); précédent : 000751; suivant : 000753Low-dose-rate intraoperative brachytherapy combined with external beam irradiation in the conservative treatment of soft tissue sarcoma
Auteurs : M. Delannes [France] ; L. Thomas [France] ; P. Martel [France] ; P. Bonnevialle [France] ; E. Stoeckle [France] ; Ch Chevreau [France] ; B. N Bui [France] ; N. Daly-Schveitzer [France] ; J. Pigneux [France] ; G. Kantor [France]Source :
- International Journal of Radiation Oncology, Biology, Physics [ 0360-3016 ] ; 2000.
Abstract
Purpose: Conservative treatment of soft tissue sarcomas most often implies combination of surgical resection and irradiation. The aim of this study was to evaluate low-dose-rate intraoperative brachytherapy, delivered as a boost, in the local control of primary tumors, with special concern about treatment complications. Methods and Materials: Between 1986 and 1995, 112 patients underwent intraoperative implant. This report focuses on the group of 58 patients with primary sarcomas treated by combination of conservative surgery, intraoperative brachytherapy, and external irradiation. Most of the tumors were located in the lower limbs (46/58—79%). Median size of the tumor was 10 cm, most of the lesions being T2–T3 (51/58—88%), Grade 2 or 3 (48/58—83%). The mean brachytherapy dose was 20 Gy and external beam irradiation dose 45 Gy. In 36/58 cases, iridium wires had to be placed on contact with neurovascular structures. Results: With a median follow-up of 54 months, the 5-year actuarial survival was 64.9%, with a 5-year actuarial local control of 89%. Of the 6 patients with local relapse, 3 were salvaged. Acute side effects, essentially wound healing problems, occurred in 20/58 patients, late side effects in 16/58 patients (7 neuropathies G2 to G4). No amputation was required. The only significant factor correlated with early side effects was the location of the tumor in the lower limb (p = 0.003), and with late side effects the vicinity of the tumor with neurovascular structures (p = 0.009). Conclusion: Brachytherapy allows early delivery of a boost dose in a reduced volume of tissue, precisely mapped by the intraoperative procedure. Combined with external beam irradiation, it is a safe and efficient treatment technique leading to high local control rates and limited functional impairment.
Url:
DOI: 10.1016/S0360-3016(99)00548-9
Affiliations:
- France
- Aquitaine, Midi-Pyrénées, Nouvelle-Aquitaine, Occitanie (région administrative)
- Bordeaux, Toulouse
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Bonnevialle</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Centre Hospitalier Universitaire Purpan, Toulouse</wicri:regionArea><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Midi-Pyrénées</region><settlement type="city">Toulouse</settlement></placeName></affiliation></author><author><name sortKey="Stoeckle, E" sort="Stoeckle, E" uniqKey="Stoeckle E" first="E" last="Stoeckle">E. 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Kantor</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Institut Bergonié, Bordeaux</wicri:regionArea><placeName><region type="region">Nouvelle-Aquitaine</region><region type="old region">Aquitaine</region><settlement type="city">Bordeaux</settlement></placeName></affiliation></author></analytic><monogr></monogr><series><title level="j">International Journal of Radiation Oncology, Biology, Physics</title><title level="j" type="abbrev">ROB</title><idno type="ISSN">0360-3016</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="2000">2000</date><biblScope unit="volume">47</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="165">165</biblScope><biblScope unit="page" to="169">169</biblScope></imprint><idno type="ISSN">0360-3016</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0360-3016</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Purpose: Conservative treatment of soft tissue sarcomas most often implies combination of surgical resection and irradiation. The aim of this study was to evaluate low-dose-rate intraoperative brachytherapy, delivered as a boost, in the local control of primary tumors, with special concern about treatment complications. Methods and Materials: Between 1986 and 1995, 112 patients underwent intraoperative implant. This report focuses on the group of 58 patients with primary sarcomas treated by combination of conservative surgery, intraoperative brachytherapy, and external irradiation. Most of the tumors were located in the lower limbs (46/58—79%). Median size of the tumor was 10 cm, most of the lesions being T2–T3 (51/58—88%), Grade 2 or 3 (48/58—83%). The mean brachytherapy dose was 20 Gy and external beam irradiation dose 45 Gy. In 36/58 cases, iridium wires had to be placed on contact with neurovascular structures. Results: With a median follow-up of 54 months, the 5-year actuarial survival was 64.9%, with a 5-year actuarial local control of 89%. Of the 6 patients with local relapse, 3 were salvaged. Acute side effects, essentially wound healing problems, occurred in 20/58 patients, late side effects in 16/58 patients (7 neuropathies G2 to G4). No amputation was required. The only significant factor correlated with early side effects was the location of the tumor in the lower limb (p = 0.003), and with late side effects the vicinity of the tumor with neurovascular structures (p = 0.009). Conclusion: Brachytherapy allows early delivery of a boost dose in a reduced volume of tissue, precisely mapped by the intraoperative procedure. Combined with external beam irradiation, it is a safe and efficient treatment technique leading to high local control rates and limited functional impairment.</div></front></TEI><affiliations><list><country><li>France</li></country><region><li>Aquitaine</li><li>Midi-Pyrénées</li><li>Nouvelle-Aquitaine</li><li>Occitanie (région administrative)</li></region><settlement><li>Bordeaux</li><li>Toulouse</li></settlement></list><tree><country name="France"><region name="Occitanie (région administrative)"><name sortKey="Delannes, M" sort="Delannes, M" uniqKey="Delannes M" first="M" last="Delannes">M. Delannes</name></region><name sortKey="Bonnevialle, P" sort="Bonnevialle, P" uniqKey="Bonnevialle P" first="P" last="Bonnevialle">P. Bonnevialle</name><name sortKey="Bui, B N" sort="Bui, B N" uniqKey="Bui B" first="B. N" last="Bui">B. N Bui</name><name sortKey="Chevreau, Ch" sort="Chevreau, Ch" uniqKey="Chevreau C" first="Ch" last="Chevreau">Ch Chevreau</name><name sortKey="Daly Schveitzer, N" sort="Daly Schveitzer, N" uniqKey="Daly Schveitzer N" first="N" last="Daly-Schveitzer">N. Daly-Schveitzer</name><name sortKey="Delannes, M" sort="Delannes, M" uniqKey="Delannes M" first="M" last="Delannes">M. Delannes</name><name sortKey="Kantor, G" sort="Kantor, G" uniqKey="Kantor G" first="G" last="Kantor">G. Kantor</name><name sortKey="Martel, P" sort="Martel, P" uniqKey="Martel P" first="P" last="Martel">P. Martel</name><name sortKey="Pigneux, J" sort="Pigneux, J" uniqKey="Pigneux J" first="J" last="Pigneux">J. Pigneux</name><name sortKey="Stoeckle, E" sort="Stoeckle, E" uniqKey="Stoeckle E" first="E" last="Stoeckle">E. Stoeckle</name><name sortKey="Thomas, L" sort="Thomas, L" uniqKey="Thomas L" first="L" last="Thomas">L. Thomas</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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