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

Purpose: A previously reported randomized trial from our institution d emonstrated a local control advantage to adjuvant brachytherapy (BRT) for completely resected high grade soft tissue sarcoma (STS). In recen t years, BRT boost has been combined with wide field external beam rad iotherapy (EBRT) for selected patients in whom the margin(s) of resect ion was positive. This study evaluates the impact of BRT boost plus EB RT on local control in this subset of patients and on wound complicati on rates. Methods and Materials: Between January, 1987 and December, 1 992, 105 adult patients with primary or locally recurrent high grade S TS of the extremity were treated with wide local excision and BRT alon e (87 patients; dose: 45 Gy) or BRT plus EBRT (18 patients; dose: 15-2 0 Gy BRT + 45-50 Gy EBRT). The margin(s) of resection was positive in 10 out of 18 patients in the BRT+EBRT group vs. 17 out of 87 patients in the BRT alone group. Wound complications were classified as major i f they required further operative intervention; moderate if there was purulent discharge, hematoma > 25 ml, wound separation > 2 cm, and per sistent seroma requiring drainage; or minor if less than moderate. Med ian follow-up was 22 months. Results: The overall 2-year actuarial loc al control rate was 86%. There was no difference in the 2-year actuari al local control rate between the BRT+EBRT group (90%) and the BRT alo ne group (82%) (p = 0.32). However, for patients with positive resecti on margins the use of BRT+EBRT produced better local control than BRT alone [9 out of 10 (90%) vs. 10 out of 17 (59%)]. This difference appr oached but did not reach statistical significance (p = 0.08). No diffe rence was seen in patients with negative margins. There was no signifi cant difference in the overall wound complication rate (26% BRT vs. 38 % BRT+EBRT, p = 0.31) nor in the combined major and moderate wound com plication rate (16% BRT vs. 27% BRT+EBRT, p = 0.39). Conclusion: Our p reliminary data suggest a trend in favor of BRT boost + EBRT as the op timal adjuvant local strategy for STS with positive resection margins. There is no significant difference in the wound complication rate wit h either technique. Copyright (C) 1996 Elsevier Science Inc.