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.