28 Soft tissue sarcomas of the extremities in adults

570 Soft Tissue Sarcoma

plastic tubes. In the initial experience of MSKCC (19), conducted between 1982 and 1985, moderate and major wound complications for patients undergoing surgery alone were compared with those treated with surgery plus brachytherapy. Forty four percent of brachytherapy patients had wound complications, compared with 14% for surgery alone (p=. 006). Implants loaded within the first five postoperative days were asociated with a significantly higher incidence of wound breakdown compared with later loading. The explanation given was related to fibroblast proliferation. From 1985, loading was delayed until at least post-operative day five. (18,19) With this scheme the moderate and major wound complication rate in the brachytherapy group was 14% vs. 10% in the surgery alone patients.

Fig 27.4: Typical necrosis: groin Fig 27.5: Typical necrosis: foot In conclusion, brachytherapy can play a useful role in the treatment of soft tissue sarcomas of the. Local control is improved and a more conservative approach is possible. Precise knowledge of the target volume is crucial, based on CT scan or MRI. It is also necessary to perform a perioperative implant must be performed with the help of the surgeon and pathologist. As far as brachytherapy dose-rates are concerned, LDR can used alone, or in combination with EBRT; HDR is mostly performed in combination with EBRT. Tumour size, histopathological subtype and grade determine the risk of metastases and remain crucial therapeutic issues. 12 References 1. Alekhteyar KM, Leung DH, Brennan MF, Harrison LB. The effect of combined external beam radiotherapy and brachytherapy on local control and wound complications in patients with high- grade soft tissue sarcomas of the extremity with positive microscopic margin. Int J Radiat Oncol Biol Phys 1996; 36 : 321-4. 2. Brennan MF, Shiu MH, Collin C, et al. Extremity soft tissue sarcomas. Cancer Treatment Symposia 1985; 3 : 71-81. 3. Calais G. Radiation therapy in soft-tissue sarcoma. Cancer Radiother 1997; 1 : 457-61. 4. Chaudhary AJ, Laskar S, Badhwar R. Interstitial brachytherapy in soft tissue sarcomas. The Tata Memorial Hospital experience. Strahlenther Onkol 1998; 174 : 522-8. 5. Chuba R, Ben-Josef EB, Porter AT, et al. Adjuvant brachytherapy for primary and recurrent soft tissue sarcoma at WSU (Abstr.). Radiother Oncol 1996; 39 (suppl 1) : 4. 6. Cionini L, Marzano S, Olmi P. Soft tissue sarcomas: experience with intraoperative brachytherapy in the conservative management. Ann Oncol 1992; 3 (suppl. 2) : 63-6.