INTRAOPERATIVE IMPLANT BRACHYTHERAPY IN THE MANAGEMENT OF SOFT-TISSUESARCOMAS

Background: The management of localized soft-tissue sarcomas remains c omplex. This is a retrospective review of a single institution experie nce with manual afterloaded brachytherapy following intra-operative im plantation of the tumour bed during surgery. Methods: Twelve patients over a 3-year period had resection for localized soft-tissue sarcomas and desmoids with insertion of intra-operative brachytherapy implants combined with resection for localized soft-tissue sarcomas. Manual aft erloading of the implant with iridium wires was performed postoperativ ely in all patients. The low dose rate brachytherapy dose varied from 13 to 20 Gy. Supplementary external beam radiation was administered pr e-operatively or postoperatively to bring the total dose of adjuvant i rradiation to 60-65 Gy. Results: After a median follow-up period of 29 months, the 3-year local disease-free survival rare was 63%. The 3-ye ar actuarial survival rate was 83%. There were no failures within the high-dose region of the implant, although two patients had locoregiona l failures adjacent to the tumour bed at the edge of the radiation fie ld. Three patients developed distant metastases. Side effects were not ed in five patients. Wound breakdown and delayed wound healing occurre d in two patients. One patient required an amputation as a result of c hronic non-healing and wound pain. Pathological fractures occurred in two patients. Those patients who did not develop wound breakdown had g ood cosmetic and functional outcomes. Conclusion: Intra-operative impl antation of the tumour bed in combination with tumour resection for so ft-tissue sarcomas results in a high degree of local control with acce ptable complications. This modality offers the patient a high chance o f avoiding a more radical surgical procedure such as limb amputation.