Soft tissue sarcomas treated with L.D.R. brachytherapy

Sarcomas of the extremities occur 2-2.5 times more often in the lower extremities than in the upper and are more likely to recur at the primary site than as distant metastases. It is believed that the chances of recurrence are higher if the patient is older than 53 and the primary tumour is high grade. When considering treatment for these patients it is usually necessary to have a multimodality approach. It seems that these tumours require very high doses because they are thought to be radioresistant. In reviewing the literature it appears that to adequately treat this disease the dose needs to be greater than 60 Gy and less than 90 Gy after which nerve damage occurs. These doses are normally given after healing from surgery has occurred. Local recurrence after original surgery often is thought to herald distant metastases and therefore amputation as a means of control is thought a drastic form of treatment when there is no guarantee of cure. This debate has therefore lead centres to investigate other approaches to treatment of this disease. This article looks at the approach taken by Peter MacCallum Cancer Institute to treatment of this disease. It demonstrated some of the problems associated with tis form of treatment as well as positive outcomes, which include the delivery of the high doses required while still preserving the limb and its function. 2 refs., 5 figs