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A 10-year experience of pediatric brachytherapy
E A Healey1, R C Shamberger, H E Grier
1Joint Center for Radiation Therapy, Children's Hospital, Boston, MA, USA.
Insights
Brachytherapy, a radiation therapy technique, showed effective disease control in pediatric cancer patients with low morbidity. This study highlights its value as an adjunct treatment for selected young patients.
Area of Science:
- Oncology
- Radiation Oncology
- Pediatric Oncology
Background:
- Brachytherapy is a specialized radiation technique used in cancer treatment.
- Its application and outcomes in pediatric oncology require specific evaluation due to unique patient factors.
Purpose of the Study:
- To review the efficacy and morbidity of brachytherapy in pediatric cancer patients treated at the Joint Center for Radiation Therapy (JCRT).
- To assess brachytherapy's role as an adjunct to multimodal cancer management in children.
Main Methods:
- Retrospective review of 18 pediatric patients (6 months to 23 years) who received 19 brachytherapy implants between 1982 and 1992.
- Utilized Iodine-125 (I-125) seed implants (permanent and temporary) and Iridium-192 (Ir-192) implants for various pediatric malignancies, including brain tumors and sarcomas.
- Most patients also received external beam radiotherapy.
Main Results:
- Disease control at the implant site was achieved in 13 of 17 evaluable cases.
- Median follow-up was 55 months for surviving patients.
- Treatment-related morbidity was low, with two cases reported: one severe desquamation and one death from postoperative complications.
Conclusions:
- Brachytherapy demonstrated long-term disease control in a heterogeneous group of pediatric cancer cases.
- The overall morbidity associated with brachytherapy in this cohort was minimal.
- Brachytherapy is an effective adjunctive treatment for properly selected pediatric cancer patients.
Purpose:
The purpose of this project was to review the brachytherapy experience in the pediatric population at the Joint Center for Radiation Therapy (JCRT) with respect to efficacy and morbidity.
Methods And Materials:
Treatment outcome was reviewed for 18 children between the ages of 6 months and 23 years who received 19 implants between 1982 and 1992 at JCRT. Fourteen children received permanent Iodine-125 seed implants placed in the operative tumor bed at the time of resection. Two children received sterotactically 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 implants 3 years 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 underwent 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 controlled 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 patient died of postoperative complications.
Conclusion:
Despite the heterogeneous mix of cases, the use of brachytherapy in this pediatric population resulted in several cases of long-term disease control, and the overall morbidity was very low. Therefore, in properly selected pediatric cases, brachytherapy appears to be an efficacious adjunct to multimodality cancer management.