Low-dose-rate intraoperative brachytherapy combined with external beam irradiation in the conservative treatment of soft tissue sarcoma

Purpose: Conservative treatment of soft tissue sarcomas most often implies combination of surgical resection and irradiation. The aim of this study wa s to evaluate low-dose-rate intraoperative brachytherapy, delivered as a bo ost, in the local control of primary tumors, with special concern about tre atment complications. Methods and Materials: Between 1986 and 1995, 112 patients underwent intrao perative implant. This report focuses on the group of 58 patients with prim ary sarcomas treated by combination of conservative surgery, intraoperative brachytherapy, and external irradiation. Most of the tumors were located i n the lower limbs (46/58-79%). Median size of the tumor was 10 cm, most of the lesions being T2-T3 (51/58-88%), Grade 2 or 3 (48/58-83%). The mean bra chytherapy dose was 20 Gy and external beam irradiation dose 45 Gy. In 36/5 8 cases, iridium wires had to be placed on contact with neurovascular struc tures. Results: With a median follow-up of 54 months, the 5-year actuarial surviva l was 64.9%, with a 5-year actuarial local control of 89%. Of the 6 patient s with local relapse, 3 were salvaged. Acute side effects, essentially woun d healing problems, occurred in 20/58 patients, late side effects in 16/58 patients (7 neuropathies G2 to G4), No amputation was required. The only si gnificant factor correlated with early side effects was the location of the tumor in the lower limb (p = 0.003), and with late side effects the vicini ty of the tumor with neurovascular structures (p = 0.009), Conclusion: Brachytherapy allows early delivery of a boost dose in a reduce d volume of tissue, precisely mapped by the intraoperative procedure. Combi ned with external beam irradiation, it is a safe and efficient treatment te chnique leading to high local control rates and limited functional impairme nt. (C) 2000 Elsevier Science Inc.