Selected cases with favorable lesions (small [<5 cm] superficial tumors or small deep

tumors) that can be excised with clear margins (>1 cm) may be treated with surgery alone. Radiation OSI-744 research buy therapy should be offered to patients with STS who are at risk of local recurrence. It can be administered as EBRT or BT or in combination. The advantages of BT are the localized nature of the radiation and relative dose sparing of the surrounding tissue. EBRT has the benefit of being able to encompass large volumes of tissue at risk of recurrence, and it is not limited by anatomic constraints. The additional risks of BT are surgical as both BT and EBRT can produce acute or chronic radiation-induced side effects. There are BTK inhibitor cell line no randomized data or consensus

on whether it is preferable to use EBRT alone, BT monotherapy, or BT as a boost in the various clinical settings described in this article. The clinician must use the modality or combination of modalities that are most familiar to the treatment team and suitable to the patient. In the MSKCC randomized trial, BT monotherapy was described as useful for high-grade lesions with favorable surgical findings. This single-institution study did not demonstrate a reduction in local recurrence for low-grade STS, some of which were large and locally recurrent; this finding has not been reported by other investigators. We believe, patients with larger (>5 cm), high grade, or incompletely resected disease (microscopic or gross positive margins) must be treated with sufficient margins and doses high enough to achieve local tumor control. In this setting, depending on morbidity and logistic Cediranib (AZD2171) considerations, BT boost may be preferable to BT alone. In cases

of recurrent cancer, but without previous radiation therapy, it is recommended that BT be used in conjunction with EBRT. In a noteworthy publication MSKCC used their prospective BT database to compare BT monotherapy to EBRT alone in the form of intensity-modulated radiation therapy (IMRT). Despite having more adverse features including positive margins in the IMRT cohort, the LC was better (91% IMRT vs. 81% BT, p = 0.04) (84). This LC rate in the IMRT cohort is similar to some studies using a combination of EBRT and BT [28], [38], [40], [41] and [51]. The authors believe that these results merit further investigations that compare or combine the BT and IMRT. BT is a useful component of the treatment of STS. The radiation oncologist and surgeon must work closely together to determine the extent of disease and to correctly place and stabilize the BT catheters for optimal results. Three-dimensional simulation and treatment planning are required for defining the clinical treatment volume and to identify dose constraints to OAR. Depending on the type and extent of surgery, it is usually advisable to wait several days to allow wound healing before starting treatment.