Reirradiation using brachytherapy for locally recurrent soft tissue sarcoma: A systematic review

Managing locally recurrent soft tissue sarcomas (STS) following prior radiation therapy remains challenging due to the lack of retreatment options and heightened risk of treatment-associated toxicity. Brachytherapy enables delivery of highly localized radiation with rapid dose fall-off and may serve to address these types of tumors. This systematic review evaluates the efficacy and safety of brachytherapy in the management of locally recurrent STS.

A systematic review was conducted, and its findings are reported in accordance with the PRISMA guidelines. PubMed was searched through July 9, 2026, using Medical Subject Heading (MeSH) terms related to recurrent sarcoma, brachytherapy, and reirradiation. Studies were included if they reported local control and/or toxicity outcomes following brachytherapy-based treatment for locally recurrent STS. Case reports, case series with fewer than 5 patients, studies with significant institutional overlap, and studies evaluating retroperitoneal disease were excluded. Two reviewers independently screened studies and extracted data on local control, survival outcomes, and treatment-related toxicity.

Seven retrospective studies met inclusion criteria. Five-year local control rates ranged from 18% to 87%, with better outcomes generally associated with multimodality therapy, smaller tumor burden, and fewer prior recurrences. Overall survival varied across cohorts and was influenced by factors such as tumor grade, recurrence burden, surgical margins, and prior radiation exposure. Grade 3-4 complication rates ranged from 0% to 49%, with higher rates observed in reirradiation settings and cumulative radiation doses approaching or exceeding 100-110 Gy. Emerging approaches, including stereotactic ablative brachytherapy and template-guided placement, demonstrated favorable early safety profiles.

Brachytherapy represents a viable salvage strategy for selected patients with locally recurrent STS; however, outcomes remain heterogeneous. Prospective, multi-institutional studies with standardized reporting are needed to better define its role in the re-irradiation setting.