HIGH-DOSE-RATE BRACHYTHERAPY IN CHILDHOOD SARCOMAS - A LOCAL-CONTROL STRATEGY PRESERVING BONE-GROWTH AND FUNCTION

The administration of external beam radiation therapy (EBRT) has been an integral part of the successful treatment of childhood sarcomas. Ho wever, EBRT has severe late morbidity in the developing child. In an a ttempt to deliver adequate tumoricidal radiation while preserving bone growth and organ function, 13 children with diverse sarcomas were tre ated with high dose rate brachytherapy (HDR). Seven patients had rhabd omyosarcoma and six patients had other soft tissue sarcoma variants. A ll patients were treated with disease-appropriate chemotherapy, usuall y according to the Intergroup Rhabdomyosarcoma Study. Eleven patients received fractionated 36 Gy HDR alone at a mean of 3.5 months from dia gnosis. Two patients received 10-12.5 Gy intraoperative HDR brachyther apy and additional 27 Gy EBRT. Nine of 11 patients in first remission have had no recurrences. One died of recurrent pulmonary metastases. T he other patient that did recur is disease-free 21 months post-recurre nce. Two additional patients were treated with HDR after tumor recurre nce. One patient with recurrent Ewing's sarcoma, relapsed and died. Th e second is disease free 3 months after autologous bone marrow transpl ant. Grade 1 morbidity occurred in 46%, Grade 2 in 15%, and Grade 3 in 8% of the children, while relatively good bone and organ growth was m aintained. The combination of conservative surgery, chemotherapy, and HDR offers the potential for disease control in young children while p reserving bone growth and organ function. (C) 1995 Wiley-Liss, Inc.