Brachytherapy 3 (2004) 196–200 Feasibility report of conservative surgery, perioperative high-dose-rate brachytherapy (PHDRB), and low-to-moderate dose external beam radiation therapy (EBRT) in pediatric sarcomas Rafael Martı ´nez-Monge 1, * , Cristina Garra ´n 1 , Mauricio Cambeiro 1 , Mikel San Julia ´n 2 , Juan Alcalde 3 , Luis Sierrasesu ´maga 4 1 Department of Oncology, University of Navarra Clinic, University of Navarra, Pamplona, Spain 2 Department of Orthopedic Surgery, University of Navarra Clinic, University of Navarra, Pamplona, Spain 3 Department of Head and Neck Surgery, University of Navarra Clinic, University of Navarra, Pamplona, Spain 4 Department of Pediatrics, University of Navarra Clinic, University of Navarra, Pamplona, Spain ABSTRACT PURPOSE: This study was undertaken to determine the feasibility of perioperative high-dose-rate brachytherapy (PHDRB) as an accelerated boost in patients with pediatric sarcomas. METHODS AND MATERIALS: Five pediatric patients (ages 7–16) with soft tissue sarcomas (STS) or soft tissue recurrences of previously treated osteosarcomas were treated with surgical resection and PHDRB (16–24 Gy) for R0-R1 resections. Patients with STS and osteosarcomas received 27 Gy and 45 Gy of EBRT postoperatively. RESULTS: After a median follow-up of 27 months (range, 12–50) all the patients remain locally controlled. Only 1 patient developed regrowth of pulmonary metastases and died of distant disease at 16 months. CONCLUSIONS: The use of PHDRB is safe in the short-term in this pediatric population. Only 1 patient suffered a partial wound dehiscence that may not be entirely related to PHDRB. Patients with recurrent osteosarcomas can be treated in a fashion similar to their adult soft tissue counterparts and avoid limb amputation. Younger patients with STS may achieve local control and prevent growth retardation with a combination of PHDRB and moderate doses of EBRT.  2004 American Brachytherapy Society. All rights reserved. Keywords: Pediatric; Soft tissue sarcomas; Osteosarcoma; Perioperative; High dose rate; Brachytherapy Introduction Conventional EBRT is an integral part of the treatment of most children and adolescents with soft tissue sarcomas (STS). However, in the growing child, potential growth retar- dation and deformity associated with the use of EBRT are a serious concern that can limit its use (1). Radiation techniques that improve the therapeutic ratio are especially important for these growing individuals. Intra- operative radiation boosting techniques have the advantage of direct tumor bed localization and displacement of radiosen- sitive structures, where possible, away from the area irrad- Received 4 May 2004; received in revised form 3 September 2004; accepted 10 September 2004. * Corresponding author. Department of Oncology, University of Navarra Clinic, University of Navarra, Avda Pı ´o XII s/n, Pamplona, Navarra, Spain E-31080. Tel.: +34-948-255400; fax: +34-948-255500. E-mail address: rmartinezm@unav.es (R. Martı ´nez-Monge). 1538-4721/04/$ – see front matter  2004 American Brachytherapy Society. All rights reserved. doi:10.1016/j.brachy.2004.09.001 iated. The majority of worldwide experience has been with LDR manual brachytherapy, and this modality has produced acceptable local control and complication rates (2–4). The major disadvantages with this modality have been the issue of radiation protection, the need to immobilize and sedate the younger children during treatment, and the psychological trauma associated with separation from the parents. The advent of remote-controlled LDR, PDR, and HDR machines as well as the development of intraoperative high-dose-rate brachytherapy (IOHDR) and intraoperative electron beam radiotherapy (IOERT) has eliminated radiation exposure hazards to the patient’s family and medical personnel. IOHDR and IOERT have been used in pediatric patients (5–7). However, high-dose (15 Gy) IOERT has been asso- ciated with clinically significant toxicity in late-reacting tis- sues such as vessels and nerves present in the surgical bed (8). As a consequence, these normal tissues at risk of harbor- ing metastatic deposits may remain undertreated for fear of