Peri-Operative Brachytherapy In Soft-Tissue Sarcomas. Hospital USM Experience

Overview: Radiotherapy is an important adjuvant modality in the management of extremity soft-tissue tumors. Interstitial brachytherapy implantation is a precise technique of delivering radiation that conforms to the tumor bed. Materials and Method:Selected extremity soft-tissue sarcomas were managed with wide-excision followed by preoperative implantation of brachytherapy catheters. The implant was irradiated 3-5 th day post-surgery to a dose of 3Gy BID for 3-5 days using high dose rate (HDR) system. Further additional external radiotherapy dose of 40- 50Gy in conventional fractionation was delivered to the tumor bed. Observations: 17 patients with soft tissue sarcoma were treated from 2001 to 2007.The median age of patient was 26 years (4-74 years) with male to female ratio of 12:5. Three out of 17 patients develop local recurrence and 7-patient relapse as lung metastases. At the time of reporting, 2-year local control rate was 88% and 24 month overall survival rate was 50%. The complication was minimal and manifested as subcutaneous fibrosis, pigmentation and wound dehiscence. Conclusions: Perioperative interstitial brachytherapy is an option of radiotherapy for better local control in high grade large volume and recurrent soft-tissue tumor. Proper case selection and optimal multidisciplinary management could improve survival in future.