Brachytherapy and Function Preservation in the Localized Management of Soft Tissue Sarcomas of the Extremity

Over the past 20 years, it has become evident that limb preservation is possible in the management of soft tissue sarcomas of the extremities. Amputation has been generally replaced by more conservative operations that preserve limb function, followed by radiation therapy. Although external beam irradiation has been the most commonly applied adjuvant, there has been increasing interest in using brachytherapy instead of external beam therapy. The reasons for this tren include the apparent equivalence of local control for properly selected patients using brachytherapy, improved patient convenience, shorter treatment time, and lower cost. A recently published report of a prospective randomized trail shows statistically significant improvement in local control when brachytherapy is added to surgery for high grade sarcomas. The treatment concepts used when using brachytherapy challenge many of the orginal teachings for external beam irradiation with regard to field size, volume irradiated, and the tissues that require treatment in the postoperative setting. This article addresses thse controversies, as well as reviews the evolving role of brachytherapy in the management of soft tissue sarcomas. Issues such as patient selection, integration with other local therapies, and complications are highlighted, and special situations are discussed.