Adjuvant high-dose-rate and low-dose-rate brachytherapy with external beam radiation in soft tissue sarcoma: A comparison of outcomes

Pohar, Surjeet; Haq, Rashid; Liu, Lizhong; Koniarczyk, Michael; Hahn, Seung; Damron, Timothy; Aronowitz, Jesse N.

doi:10.1016/j.brachy.2006.11.004

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Volume 6, Issue 1 , Pages 53-57, January 2007

Adjuvant high-dose-rate and low-dose-rate brachytherapy with external beam radiation in soft tissue sarcoma: A comparison of outcomes

Surjeet Pohar
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY
- Department of Radiation Oncology, Eastern Virginia Medical School, Norfolk, VA
- Corresponding author. Department of Radiation Oncology, Eastern Virginia Medical School, 600 Gresham Drive, Norfolk, VA 23507. Tel.: +1-757-388-2075; fax: +1-757-627-0334.
Rashid Haq
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY
Lizhong Liu
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY
Michael Koniarczyk
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY
Seung Hahn
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY
Timothy Damron
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY
Jesse N. Aronowitz
- Department of Radiation Oncology, University of Massachusetts, Worcester, MA

Received 25 September 2006; received in revised form 1 November 2006; accepted 3 November 2006.

Abstract

Purpose

To compare outcomes of patients treated with low-dose-rate (LDR) adjuvant brachytherapy (BT)+external beam radiation therapy (EBRT) vs. high-dose-rate (HDR) adjuvant BT+EBRT.

Methods and materials

Thirty-seven patients with soft tissue sarcoma (STS) were treated with pre- or postoperative external beam irradiation and postoperative LDR or HDR BT.

Results

There was no significant difference in the 2-year local control rates (90% with LDR boost vs. 94% for HDR). The rate of National Cancer Institute (NCI) grades 2–4 wound-healing complications was 40% in the LDR group vs. 18% in the HDR group (p=0.14). On univariate analysis, only suboptimal geometry of the implant predicted for increasing complication rate in the LDR group. In the HDR group, BT dose per fraction, total BT dose, and total biologically equivalent dose (BED₃) radiation dose were significant.

Conclusions

HDR and LDR boost BT results in acceptable local control for STS. There is a suggestion that HDR may have lower incidence of severe (grade ≥3) acute toxicity than LDR.

Keywords: HDR, Brachytherapy, Sarcoma, Radiotherapy