Long-term results of Perioperative High Dose Rate Brachytherapy (PHDRB) and external beam radiation in adult patients with soft tissue sarcomas of the extremities and the superficial trunk: Final results of a prospective controlled study

Marta Gimeno; Mikel San Julián; Mauricio Cambeiro; Leire Arbea; Paola Jablonska; Marta Moreno-Jiménez; Santiago Amillo; Javier Aristu; Fernando Lecanda; Rafael Martinez-Monge

doi:10.1016/j.radonc.2019.02.011

Long-term results of Perioperative High Dose Rate Brachytherapy (PHDRB) and external beam radiation in adult patients with soft tissue sarcomas of the extremities and the superficial trunk: Final results of a prospective controlled study

Radiother Oncol. 2019 Jun:135:91-99. doi: 10.1016/j.radonc.2019.02.011. Epub 2019 Mar 19.

Affiliations

¹ Department of Oncology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Spain.
² Department of Orthopedic Surgery, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Spain.
³ Department of Solid Tumors and Biomarkers, Center for Applied Medical Research University of Navarra, Pamplona, Spain.
⁴ Department of Oncology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Spain. Electronic address: rmartinezm@unav.es.

PMID: 31015176
DOI: 10.1016/j.radonc.2019.02.011

Abstract

Background: To analyze toxicity, patterns of failure, and survival in 106 adult patients with soft tissue sarcomas of the extremity and the superficial trunk treated in a prospective controlled trial of combined Perioperative High Dose Rate Brachytherapy (PHDRB) and external beam radiotherapy (EBRT).

Methods: Patients were treated with surgical resection and 16 Gy or 24 Gy of PHDRB for negative or close/positive margins, respectively. EBRT (45 Gy) was added postoperatively. Adjuvant chemotherapy was given to selected patients with high-grade tumors.

Results: The median follow-up was 7.1 years (range, 0.6-16.0). Grade ≥3 adverse events were observed in 22 patients (20.8%), and grade ≥4 events in 14 patients (13.2%). No grade 5 events were noted. Multivariate analysis (p = 0.003) found that Grade ≥3 toxic events increased with increasing implant volume (TV₁₀₀). Local control, locoregional control, and distant control rates at 5 and 10 years were 89% and 87%, 82% and 80% and 75% and 69%, respectively. Multivariate analysis (p = 0.024) found that positive margins correlated with decreased local control. Disease-free survival and overall survival rates at 5 and 10 years were 64% and 59% and 73% and 62%, respectively. In multivariate analysis, disease-free survival rates decreased with increasing tumor size (p = 0.0001) and inadequate margins (p = 0.024), and overall survival decreased with increasing tumor size (p = 0.001) and male gender (p = 0.039).

Conclusions: The combination of conservative surgery, high-dose PHDRB, and EBRT produces adequate function and local control in the majority of patients with soft tissue sarcomas of the extremities and the superficial trunk, including a substantial percentage of cases with positive margins. Patients with larger tumors are at a higher risk of complications, treatment failure, and cancer-related death and require an individualized treatment approach.

Keywords: Brachytherapy; External beam radiation therapy; High dose rate; Perioperative; Soft tissue sarcomas.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Brachytherapy / methods*
Disease-Free Survival
Extremities
Female
Humans
Male
Middle Aged
Prospective Studies
Radiotherapy Dosage
Radiotherapy, Adjuvant
Sarcoma / mortality
Sarcoma / radiotherapy*
Torso