Techniques to deliver high dose localized irradiation for tissue-sparing management of sarcomas

Soft tissue sarcomas may be effectively treated conservatively with limited surgery combined with high dose tumor-bed irradiation instead of more radical surgery or amputation alone. High dose local irradiation is safely accomplished with intraoperative electron beam therapy (EBT) or perioperative interstitial 192iridium endocurietherapy (ECT), following external beam radiation therapy (EXRT), to deliver a minimum tumor bed dose of 8,000 rad to 10,000 rad. We describe our techniques for EBT and ECT in the management of soft tissue sarcomas. Two case reports of sarcoma of the pterygoid region treated with EXRT, surgery, and perioperative ECT, and sarcoma of the thigh treated with EXRT, surgery, and intraoperative EBT are used to illustrate the techniques.