Adjuvant Brachytherapy for Primary and Recurrent Soft-Tissue Sarcoma at WSU

The direct application of radiation to the tumor bed following conservative surgery in the treatment of soft-tissue sarcoma may offer excellent local control for patients with primary and recurrent disease. Prognostic factors and outcome parameters were evaluated for fifty-four patients with adjuvant interstitial implants performed since 1983. Thirty-nine patients were treated at initial presentation and 15 for local recurrence. Histology included MFH (n = 19), liposarcoma (n = 17), MPNST (n 4), synovial sarcoma (n = 5), and others (n = 9). There were thirty-nine high grade and 15 low grade tumors. Margins were negative, microscopically positive, and grossly positive in 15, 34, and 7 patients respectively. Thirty-two patients were treated with high dose-rate radiation (HDR) to a median dose of 17.52 Gy. The HDR fraction size ranged from 1.88 to 3.5 Gy (median 2.19 Gy). Nineteen of the HDR patients received additional external-beam radiotherapy (EBRT; 10 to 50 Gy with a median of 39.6 Gy). Twenty-two patients were treated with low dose-rate (LDR) implants (median dose 25 Gy). Eighteen of the LDR patients received EBRT (median dose 30Gy). With a median follow-up time of 50 months, actuarial 4-year local control, overall survival, and disease-free survival were 82%, 59%, and 58%, respectively. Mild to moderate skin and wound complications (48%) were treated conservatively. In three cases further surgery was required to manage wound toxicity. One patient death was attributed to adriamycin cardiotoxicity. All local failures occurred within 32 months. Histologic grade and implant type were not predictive of local control. In addition, the local control and survival of patients treated for primary versus recurrent disease was not different