A 10-YEAR EXPERIENCE OF PEDIATRIC BRACHYTHERAPY

Purpose: The purpose of this project was to review the brachytherapy e xperience in the pediatric population at the Joint Center for Radiatio n Therapy (JCRT) with respect to efficacy and morbidity. Methods and M aterials: Treatment outcome was reviewed for 18 children between the a ges of 6 months and 23 years who received 19 implants between 1982 and 1992 at JCRT. Fourteen children received permanent Iodine-125 seed im plants placed in the operative tumor bed at the time of resection. Two children received stereotactically placed afterloaded high-activity I -125 seed brain implants, and one child received a high-activity I-125 brain implant followed by a permanent I-125 seed brain implant 3 year s later. One girl received a temporary Iridium-192 volume implant for a vulvar rhabdomyosarcoma. Among the 15 permanent I-125 implants, the cases included five primary brain tumors, one metastatic brain tumor, six sarcomas, and one each of the following: suprarenal neuroblastoma, hepatoblastoma, and adenocarcinoma of the pancreas. All patients unde rwent surgery and most patients (15 out of 18) received external beam radiotherapy to a field that included the implant. Results: The median follow-up from the time of diagnosis for patients who remain alive is 55 months (range 24 to 119 months), and the median follow-up from the time of implant is 46 months (15 to 60 months). Disease was controlle d in the area of the implant in 13 of 17 evaluable cases. Two patients experienced treatment-related morbidity; one patient developed severe desquamation related to an ''adriamycin recall reaction,'' and one pa tient died of postoperative complications. Conclusion: Despite the het erogeneous mix of cases, the use of brachytherapy in this pediatric po pulation resulted in several cases of long-term disease control, and t he overall morbidity was very low. Therefore, in properly selected ped iatric cases, brachytherapy appears to be an efficacious adjunct to mu ltimodality cancer management.