INTRAOPERATIVE INTERSTITIAL IRIDIUM BRACHYTHERAPY IN THE MANAGEMENT OF SOFT-TISSUE SARCOMAS - PRELIMINARY-RESULTS OF A FEASIBILITY PHASE-IISTUDY

Between May 1986 and June 1999, 48 patients with soft tissue sarcomas underwent 50 intraoperative interstitial implants in conjunction with conservative tumoral resections. Brachytherapy was part of the initial treatment in 27 cases and was done in 21 other previously treated pat ients, For the last ones brachytherapy was, in most of the cases, the only treatment in addition to surgery. The implant dose was 40-65 Gy. When combined with external irradiation the mean prescribed dose was 2 0 Gy (12-25 Gy). With a median follow-up of 33 months, the 3-year actu arial survival rate was 81% and the local disease-free survival 91.7%, Five local failures were observed only in patients with recurrent sar comas: two were inside the treated volume and three outside (local fai lure 5/48 = 10.4%). Acute side-effects occurred in 11 patients (11/48 = 23%), with skin breakdown (two cases) infection and hematoma (one ca se), infection, lymphocele, secondary skin breakdown and vascular rupt ure (one case), infection and limited skin breakdown (two cases) and d elayed healing (five cases). As a consequence, six patients required r eoperation but no amputation was necessary. The functional results wer e good, Only three patients had a moderate limitation of movement. Lat e complications occurred in five patients: bone fracture (one case), l eg oedemas not interfering with normal activity (three cases), periphe ral neuropathy fibrosis related requiring surgery (one case), Therefor e, this preliminary report shows that adjuvant intraoperative brachyth erapy is feasible and is safe in treating soft tissue sarcomas, even i n previously irradiated patients. However, further evaluation is neede d to determine the real place of intraoperative implant in the managem ent of soft tissue sarcomas.