20-year experience with intraoperative high-dose-rate brachytherapy for pediatric sarcoma: Outcomes, toxicity, and practice recommendations

Michael R. Folkert, William Y. Tong, Michael P. Laquaglia, Leonard H. Wexler, Alexander Ja-Ho Chou, Heather Magnan, Michael J. Zelefsky, Suzanne L. Wolden

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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.

Original languageEnglish (US)
Pages (from-to)362-368
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume90
Issue number2
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Brachytherapy
recommendations
toxicity
Sarcoma
Radiotherapy
cancer
radiation therapy
Pediatrics
dosage
confidence
Confidence Intervals
intervals
grade
Disease-Free Survival
Survival
therapy
Therapeutics
chemotherapy
Survival Rate
incidence

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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20-year experience with intraoperative high-dose-rate brachytherapy for pediatric sarcoma : Outcomes, toxicity, and practice recommendations. / Folkert, Michael R.; Tong, William Y.; Laquaglia, Michael P.; Wexler, Leonard H.; Chou, Alexander Ja-Ho; Magnan, Heather; Zelefsky, Michael J.; Wolden, Suzanne L.

In: International Journal of Radiation Oncology Biology Physics, Vol. 90, No. 2, 01.01.2014, p. 362-368.

Research output: Contribution to journalArticle

Folkert, Michael R. ; Tong, William Y. ; Laquaglia, Michael P. ; Wexler, Leonard H. ; Chou, Alexander Ja-Ho ; Magnan, Heather ; Zelefsky, Michael J. ; Wolden, Suzanne L. / 20-year experience with intraoperative high-dose-rate brachytherapy for pediatric sarcoma : Outcomes, toxicity, and practice recommendations. In: International Journal of Radiation Oncology Biology Physics. 2014 ; Vol. 90, No. 2. pp. 362-368.
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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.",
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T1 - 20-year experience with intraoperative high-dose-rate brachytherapy for pediatric sarcoma

T2 - Outcomes, toxicity, and practice recommendations

AU - Folkert, Michael R.

AU - Tong, William Y.

AU - Laquaglia, Michael P.

AU - Wexler, Leonard H.

AU - Chou, Alexander Ja-Ho

AU - Magnan, Heather

AU - Zelefsky, Michael J.

AU - Wolden, Suzanne L.

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N2 - 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.

AB - 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.

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