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Interstitial irradiation in the management of soft tissue sarcomas
1253
Proceedingsofthe23rdAnnualASTRMetting
patients sustained a late occurring fracture through the biopsy site. Most patients had a soft tissue component of the mass appreciated orior to the cortical bone biopsy which may have provided diaqnostic tissue without Fractures occurred from one to thirty-one disturbing the cortical bone. months following the biopsy procedure. Several factors contribute to the risk of late fractures. High dose irradiation, a defect created by a bone biopsy and the tumor all combine to alter the structural integrity of a bone. Alteration of the biopsy technique can potentially reduce this complication. A sample of the soft tissue component of a suspected Ewing's tumor should be submitted for frozen If a small round cell malignancy can be identified, the procedure section. If no tumor can be identified, then a small oval biopsy may be terminated. of bone can be taken, preferably along the compression portion of the femoral shaft where stress forces are least. Management of fractures should be individualized recognizing that prior high dose irradiation will retard callous formation. Early mobility and ambulation are high priorities in selecting the most appropriate treatment. The use of an internal fixation device illustrates one such approach and the possible satisfactory results that can be obtained.
87
INTERSTITIAL IRRADIATION MANAGEMENT OF SOFT TISSUE Ajmel Puthawala, M.D. A. M. Nisar Syed, M.D., Donald L. Eads, M.D.
IN THE SARCOMAS
F.R.C.S.,
Department of Endocurietherapy Memorial Hospital Medical Center,
D.M.R.T.
(Eng.)
Long Beach
We have treated 24 patients with diagnosis of soft tissue sarcoma of various sites from February 1, 1975, to July 31, 1979, at Los Angeles CountyUniversity of Southern California Medical Center, Southern California Cancer Center, and Memorial Hospital of Long Beach. Eleven of these patients had interstitial irradiation as a part of a planned primary treatment. These patients had conservative surgery (local excision) followed by 4000 rad to 5000 rad megavoltage external irradiation. Two to three weeks after completion of external irradiation, these patients received interstitial 192Ir implant boost to a dose of 2000 to 3000 rad (total tumor dose of 7000 to 8000 rad). The remaining 13 patients had recurrent soft tissue sarcomas after primary surgery. All 11 patients in the primary treatment group achieved local control and 9 of these patients have remained alive for a minimum follow-up period of 2 years. Ten out of thirteen patients with recurrent sarcomas achieved local control, and seven of the thirteen (54%) remain alive to minimum follow-up period of 2 years. Morbidity of the treatment had been minimal except for one patient who developed perineal nerve palsy, and another patient had significant fibrosis. All patients with soft tissue sarcomas of the extremities have good functional results. Our experience indicates that interstitial irradiation appears to provide a better local control in the primary as well as recurrent soft tissue sarcomas.
88
ACONTROLLED STUDYOFNUTRITIONALINTAKEIN PATIBFlTS UI'RI ULI~ANTDISEASEUNDERaOINff RADIATION TREA'HDJT. Dr. Michael Horiarty, F.R.C.g.I., F.R.C.R. * Hs. Wry Moloney, Rip. Diet. ; Saint Luke's Rospital, Rathgar, Dublin 6. Institute of Technology, Kevin Street, Ihblin 8.
It is now becoming reco&sed that many patients even on first presentation with malignant disease are nutritionally and metabolically subuonaal and that this state is often further aggravated by the auticancer treatment these patients receive.
Proceedingsofthe23rdAnnualASTRMetting
patients sustained a late occurring fracture through the biopsy site. Most patients had a soft tissue component of the mass appreciated orior to the cortical bone biopsy which may have provided diaqnostic tissue without Fractures occurred from one to thirty-one disturbing the cortical bone. months following the biopsy procedure. Several factors contribute to the risk of late fractures. High dose irradiation, a defect created by a bone biopsy and the tumor all combine to alter the structural integrity of a bone. Alteration of the biopsy technique can potentially reduce this complication. A sample of the soft tissue component of a suspected Ewing's tumor should be submitted for frozen If a small round cell malignancy can be identified, the procedure section. If no tumor can be identified, then a small oval biopsy may be terminated. of bone can be taken, preferably along the compression portion of the femoral shaft where stress forces are least. Management of fractures should be individualized recognizing that prior high dose irradiation will retard callous formation. Early mobility and ambulation are high priorities in selecting the most appropriate treatment. The use of an internal fixation device illustrates one such approach and the possible satisfactory results that can be obtained.
87
INTERSTITIAL IRRADIATION MANAGEMENT OF SOFT TISSUE Ajmel Puthawala, M.D. A. M. Nisar Syed, M.D., Donald L. Eads, M.D.
IN THE SARCOMAS
F.R.C.S.,
Department of Endocurietherapy Memorial Hospital Medical Center,
D.M.R.T.
(Eng.)
Long Beach
We have treated 24 patients with diagnosis of soft tissue sarcoma of various sites from February 1, 1975, to July 31, 1979, at Los Angeles CountyUniversity of Southern California Medical Center, Southern California Cancer Center, and Memorial Hospital of Long Beach. Eleven of these patients had interstitial irradiation as a part of a planned primary treatment. These patients had conservative surgery (local excision) followed by 4000 rad to 5000 rad megavoltage external irradiation. Two to three weeks after completion of external irradiation, these patients received interstitial 192Ir implant boost to a dose of 2000 to 3000 rad (total tumor dose of 7000 to 8000 rad). The remaining 13 patients had recurrent soft tissue sarcomas after primary surgery. All 11 patients in the primary treatment group achieved local control and 9 of these patients have remained alive for a minimum follow-up period of 2 years. Ten out of thirteen patients with recurrent sarcomas achieved local control, and seven of the thirteen (54%) remain alive to minimum follow-up period of 2 years. Morbidity of the treatment had been minimal except for one patient who developed perineal nerve palsy, and another patient had significant fibrosis. All patients with soft tissue sarcomas of the extremities have good functional results. Our experience indicates that interstitial irradiation appears to provide a better local control in the primary as well as recurrent soft tissue sarcomas.
88
ACONTROLLED STUDYOFNUTRITIONALINTAKEIN PATIBFlTS UI'RI ULI~ANTDISEASEUNDERaOINff RADIATION TREA'HDJT. Dr. Michael Horiarty, F.R.C.g.I., F.R.C.R. * Hs. Wry Moloney, Rip. Diet. ; Saint Luke's Rospital, Rathgar, Dublin 6. Institute of Technology, Kevin Street, Ihblin 8.
It is now becoming reco&sed that many patients even on first presentation with malignant disease are nutritionally and metabolically subuonaal and that this state is often further aggravated by the auticancer treatment these patients receive.