Soft tissue sarcomas: experience with intraoperative brachytherapy in the conservative management

Forty-eight patients with soft tissue sarcomas were treated with Iridium implant after wide local excision between 1980 and 1990 at our institution. External irradiation was also given postoperatively in 33 patients with initially resectable tumours (treatment A) and preoperatively in 3 with initially unresectable tumours (treatment C); brachytherapy was the only treatment in 12 patients presenting small superficial tumours or recurring after previous irradiation (treatment B). Median follow up was 51 months (range 6-148). Fifteen patients (31%) failed; local recurrence was present in 9 (18.8%) and distant metastases in 11 (22.9%). Local failures were 3/33 (9%) after the treatment A, 4/12 after the treatment B, 3/2 after the treatment C. The incidence of local failures was affected by the tumor size, the presence of positive histology at the resection margins, and the total radiation dose. There was no impairment of wound healing and no necrosis; a severe sclerosis was observed only in the 3 patients receiving preoperative irradiation probably because large size fractions were used. We concluded that brachytherapy should be included in the radiation program for soft tissue sarcomas when a satisfactory geometry may be achieved and in particular when the tumor is located in sites where external irradiation only has a higher probability of producing major side effects.