Rudert M, Winkler C, Holzapfel BM, Rechl H, Kneschaurek P, Gradinger R, Molls M, Röper B, et al.
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]. Date of publication 2010 Apr 1;volume 186(4):224-8.
1. Strahlenther Onkol. 2010 Apr;186(4):224-8. doi: 10.1007/s00066-010-2046-0. Epub
2010 Mar 26.
A new modification of combining vacuum therapy and brachytherapy in large
subfascial soft -tissue sarcomas of the extremities.
Rudert M(1), Winkler C, Holzapfel BM, Rechl H, Kneschaurek P, Gradinger R, Molls
M, Röper B.
Author information:
(1)Department of Orthopedics, University of Würzburg, Würzburg, Germany.
l-orthopaedie.klh@mail.uni-wuerzburg.de
PURPOSE: To present a modification of a technique combining the advantages of
brachytherapy for local radiation treatment and vacuum therapy for wound
conditioning after resection of subfascial soft-tissue sarcomas (STS) of the
extremities.
PATIENTS AND METHODS: Between January and May 2008, four patients with large (>
10 cm) subfascial STS of the thigh underwent marginal tumor excision followed by
early postoperative HDR (high-dose-rate) brachytherapy (iridium-192) and vacuum
therapy as part of their interdisciplinary treatment. The sponge of the vacuum
system was used to stabilize brachytherapy applicators in parallel positions and
to allow for a maximal wound contraction in the early postoperative phase, thus
preventing seroma and deterioration of local dose distribution as optimized in
computed tomography-(CT-)based three-dimensional conformal treatment planning. In
three patients this was followed by external-beam radiotherapy. Acute wound
complications and late effects according to LENT-SOMA after 4-8 months of
follow-up were recorded.
RESULTS: The combination of vacuum and brachytherapy was applicable in all
patients. CT scans from the 1st postoperative day showed the shrinkage of the
sponge located in the tumor bed with the brachytherapy applicators in the
intended position and easily visible. 15-18 Gy in fractions of 3 Gy bid
prescribed to 5 mm tissue depth were applied over the next days with removal of
the sponge and applicators on days 5-8. No early or late toxicity exceeding grade
2 was observed. The mean Enneking Score for functional outcome was 63% (perfect
function = 100%).
CONCLUSION: The combination of vacuum and brachytherapy is applicable and safe in
the treatment of large subfascial STS.
DOI: 10.1007/s00066-010-2046-0
PMID: 20354665 [Indexed for MEDLINE]
