Intra-operative brachytherapy for sarcomas – pro
Intraoperative radiotherapy (IORT) is a treatment modality in which resectable lesions are removed surgically and the remaining cancer nests are sterilized by irradiation during the surgical procedure. IORT is usually performed with an electron beam (IOERT), since specific beam energy can be chosen to produce the desired depth of tissue penetration with a sharp fall-off of radiation dose, thereby avoiding the problems caused by exposure of normal tissue beneath the tumors.
The members of the American Brachytherapy Society (ABS) with expertise in soft tissue sarcoma formulated brachytherapy guidelines based upon their clinical experience and a review of the literature. It should be noted that unlike the usual case, there are no randomized or even many comparative studies and these guidleines represent summary experience rather than randomized evidence.
Brachytherapy used alone or in combination with EBRT is an established means of safely providing adjuvant local treatment after resection for soft tissue sarcomas. Brachytherapy options include LDR techniques with Ir-192 or I-125, fractionated HDR brachytherapy or intraoperative HDR therapy. Recommendations are made for patient selection, techniques, dose rates and dosages. Complications and possible interventions to minimize their occurrence and severity are reviewed.
Brachytherapy represents an effective means of enhancing the therapeutic ratio, offering both biological and dosimetric advantage. The treatment approach used depends upon the institution, physician expertise and the clinical situation. Guidelines are established for the use of brachytherapy in the treatment of soft tissue sarcomas. Practitioners and cooperative groups are encouraged to use these guidelines to formulate their treatment and dose-reporting policies. These guidelines will be modified as further clinical results become available.
Toshihiko Inoue, Perioperative High Dose Rate Brachytherapy for Soft Tissue Sarcoma Journal of Clinical Oncology 31:237-239 (2001)
Nag S, Shasha D, Janjan N, Petersen I, Zaider M. The American Brachytherapy Society recommendations for soft tissue sarcomas. Int J Radiat Oncol Biol Phys 2001;49:1033–43
Janjan N, Crane C, Delclos M, Ballo M. Brachytherapy for locally recurrent soft-tissue sarcoma.Am J Clin Oncol. 2002 Feb;25(1):9-15.