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INTRAOPERATIVE HIGH DOSE RATE BRACHYTHERAPY (IOHDR) USING FLAB TECHNIQUE FOR TREATMENT OF SOFT TISSUE SARCOMAS



Abstract

Background: Adjuvant radiotherapy has shown to improve local control in patients with soft tissue sarcoma. Additional brachytherapy represents a means of enhancing the therapeutic ratio, as biological and dosimetric advantage over single external-beam irradiation (EBRT) can be expected. High-dose-rate intraoperative brachytherapy (IOHDR) as a boost therapy should be able to further diminish the rate of local recurrence even when performing marginal resection.

Patients and Methods: Within a period of 10 years, we prospectively studied 84 adult patients treated by marginal resection, IOHDR using the flab technique and EBRT for soft tissue sarcomas. There were 67 high-grade and 17 low-grade tumors, 70 were > 5 cm. Mean follow-up was 37.2 months (range 1–121 months).

Results: There were two local recurrences, following further resection one patient is without evidence of tumor. No treatment-related loss of limb or life occurred. All patients maintained functioning extremities as evidenced by a mean Musculoskeletal Tumor Society (MSTS) functional score of 89.1 (43–100). Treatment-related wound morbidity occurred in a fifth of all patients, as consequence of revision surgery one patient sustained neurovascular complications. The 5-year actuarial disease-free survival was 81.6%. Meta-static disease developed in eighteen patients, all of them had died at last follow-up. There were four cases of late radiation related complications (two fractures of the femur due to radiation osteonecrosis and two late palsies of ischial nerve).

Conclusions: IOHDR using the flab technique in combination with EBRT and marginal resection is an efficient treatment technique leading to excellent local control rates and limited functional impairment.

Correspondence should be addressed to: EFORT Central Office, Technoparkstrasse 1, CH – 8005 Zürich, Switzerland. Email: office@efort.org