A O Naghavi1, D C Fernandez1, N Mesko2, A Juloori3, A Martinez4, J G Scott3, C Shah5, L B Harrison1. 1. Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL. 2. Department of Orthopedics, Cleveland Clinic, Cleveland, OH. 3. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH. 4. 21st Century Oncology/Michigan Health Care Professionals, Farmington Hills, MI. 5. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH. Electronic address: shahc4@ccf.org.
Abstract
PURPOSE: Radiation therapy represents an essential treatment option in the management of soft tissue sarcomas (STS). Brachytherapy represents an important subset of radiation therapy techniques used for STS, with evolving indications and applications. Therefore, the purpose of this guideline was to update clinicians regarding the data surrounding brachytherapy (BT) and provide recommendations for the utilization of BT in patients with STS. METHODS AND MATERIALS: Members of the American Brachytherapy Society with expertise in STS, and STS BT in particular, created an updated guideline for the use of BT in STS based on a literature review and clinical experience. RESULTS: Guidelines are presented with respect to dose and fractionation and technical features to improve outcomes and potentially reduce the risk of toxicity. Brachytherapy as monotherapy can be considered in low-risk cases or in situations where re-irradiation is being considered. Brachytherapy boost can be considered in cases at higher risk of recurrence or where BT alone cannot adequately cover the target volume. To limit wound complications, the start of BT delivery should be delayed until final wound closure, or if after immediate reconstruction, started after postoperative Day 5. CONCLUSIONS: The current guidelines have been created to provide clinicians with a review of the data supporting BT in the management of STS as well as providing indications and technique guidelines to ensure optimal patient selection and clinical outcomes.
PURPOSE: Radiation therapy represents an essential treatment option in the management of soft tissue sarcomas (STS). Brachytherapy represents an important subset of radiation therapy techniques used for STS, with evolving indications and applications. Therefore, the purpose of this guideline was to update clinicians regarding the data surrounding brachytherapy (BT) and provide recommendations for the utilization of BT in patients with STS. METHODS AND MATERIALS: Members of the American Brachytherapy Society with expertise in STS, and STS BT in particular, created an updated guideline for the use of BT in STS based on a literature review and clinical experience. RESULTS: Guidelines are presented with respect to dose and fractionation and technical features to improve outcomes and potentially reduce the risk of toxicity. Brachytherapy as monotherapy can be considered in low-risk cases or in situations where re-irradiation is being considered. Brachytherapy boost can be considered in cases at higher risk of recurrence or where BT alone cannot adequately cover the target volume. To limit wound complications, the start of BT delivery should be delayed until final wound closure, or if after immediate reconstruction, started after postoperative Day 5. CONCLUSIONS: The current guidelines have been created to provide clinicians with a review of the data supporting BT in the management of STS as well as providing indications and technique guidelines to ensure optimal patient selection and clinical outcomes.
Authors: Serguei A Castaneda; Marian Khalili; Jacqueline Emrich; Veronica M Zoghbi; Michael S Weingarten; Mark J Rivard; Wilbur B Bowne; Jaganmohan Poli Journal: Adv Radiat Oncol Date: 2019-07-26