This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Alektiar, K. M. Articles by Brennan, M. F. Search for Related Content PubMed PubMed Citation Articles by Alektiar, K. M. Articles by Brennan, M. F. Related Collections Radiation Therapy

Adjuvant Brachytherapy for Primary High-Grade Soft Tissue Sarcoma of the Extremity

From the Department of Radiation Oncology (KMA, MJZ), the Department of Biostatistics (DL), and the Department of Surgery (JHH, DMB), Memorial Sloan-Kettering Cancer Center, New York, New York.

Correspondence: Address correspondence and reprint requests to: Kaled M. Alektiar, MD, Memorial Sloan-Kettering Cancer Center, Department of Radiation Oncology, 1275 York Ave., New York, NY 10021; Fax: 212-639-2417; E-mail:alektiak{at}mskcc.org

Background: We reviewed single-institution experience using brachytherapy alone for primary high-grade soft tissue sarcoma of the extremity.

Methods: Between July 1982 and September 1997, 202 adult patients with primary high-grade soft tissue sarcoma of the extremity were treated with limb-sparing surgery and adjuvant brachytherapy. All patients underwent complete gross resection, but the margin of resection was microscopically positive in 18% of patients. The median dose of brachytherapy was 45 Gy delivered over 5 days. Tumors located in the shoulder or groin were defined as central location. Complications were assessed in terms of wound complications, bone fracture, and peripheral nerve damage.

Results: With a median follow-up of 61 months, the 5-year local control, distant relapse–free survival, and overall survival rates were 84%, 63%, and 70%, respectively. On multivariate analysis, poor local control correlated with shoulder location, positive microscopic margins of resection, and nonshoulder upper extremity site. The 5-year actuarial rates of wound complications requiring reoperation, bone fracture, and grade 3 nerve damage were 12%, 3%, and 5%, respectively.

Conclusions: Adjuvant brachytherapy provides adequate local control and acceptable morbidity that compares favorably with data reported for external beam radiation. Shoulder tumor location was identified as an independent prognostic factor for poor local control, mandating further improvement in the local management of these tumors.

Key Words: Brachytherapy • Soft tissue sarcoma • Extremity • High grade