Role of brachytherapy in adult soft tissue sarcomas

The use of brachytherapy in the management of adult soft tissue sarcomas of the extremities has been applied in combination with conservative surgery in an attempt to avoid amputation. Retrospective studies and a single prospective trial currently underway suggest that this combination is highly effective in improving local control for high-grade tumors, independent of size, location in the extremity, and depth. However, no effect has been shown in preventing distant metastases, or in prolonging survival in high-grade tumors. Likewise, no effect has been documented on low-grade tumors. Whether adjuvant chemotherapy can improve overall and disease-free survival remains debatable. New innovative brachytherapy approaches are being investigated to eliminate radiation exposure associated with the use of low-dose-rate Iridium-192 (Ir-192), and to further improve the treatment results in all tumor grades.