Implant brachytherapy: a novel treatment for recurrent orbital rhabdomyosarcoma.

BACKGROUND: Orbital rhabdomyosarcoma is the most common primary malignancy of the orbit in childhood. Tumor resection and exenteration were the preferred treatment modalities for rhabdomyosarcoma. In the past 20 years, however, combined local radiation and systemic chemotherapy have shown excellent survival results. Tumor recurrence after any of the aforementioned therapies is almost always fatal. We have developed a novel treatment for recurrent disease that has resulted in long-term survival for three patients. METHODS: Three patients with recurrent orbital rhabdomyosarcoma were previously treated with primary radiation and chemotherapy. At the time of recurrence, exenteration and localized brachytherapy were performed. An individually molded poly(methylmethacrylate) (Lucite; E. I. du Pont de Nemours & Co., Wilmington, Del.) device loaded with radioactive iodine seeds delivered localized high-dose radiation, 6000 cGy over 6 days, to the orbit without irradiating the brain. RESULTS: All patients are alive and free of disease with follow-up ranging from 4 years and 4 months to 8 years and 4 months. CONCLUSION: A novel technique of delivering localized radiation to the orbit of three children with recurrent orbital rhabdomyosarcoma appears curative.

Scapulectomy for soft tissue sarcoma.

Between 1961 and 1978, 19 patients with primary soft tissue sarcomas were treated by resection of part or all of the scapula and musculoaponeurotic attachments. Recurrence-free survival was from 2 to 18 years (mean 10.7 years) in all six patients with a histologically low-grade fibrosarcoma and from 2.5 to 9 years (mean 4.9 years) in three of six patients with high-grade tumours. In all 12 patients the margin of resection was satisfactory. In contrast, only two of seven patients with high-grade sarcomas and gross or microscopically involved resection margins were alive 1 year after operation. Long-term salvage or cure of soft tissue sarcomas at this or other sites depends upon the histologic grade of the tumour and the feasibility of an adequately wide monobloc excision. Adjunctive measures to diminish the likelihood of local recurrence and to avoid amputation in marginal situations include intraoperative brachytherapy (with iodine-125 or iridium-192) and supplemental external radiotherapy. Recent experience with intensive multiple-agent chemotherapy indicates an appreciable reduction in the occurrence of systemic metastases from tumours with this potential.