Integration of limb-sparing surgery, brachytherapy, and external-beam irradiation in the treatment of soft-tissue sarcomas.
Advances in the integration of limb-sparing surgery and adjuvant radiation therapy have nearly eliminated the need for ablative or radical resections in the management of soft-tissue sarcomas. The combination of wide or marginal surgical resections, brachytherapy, and external-beam irradiation resulted in a local recurrence rate of 9% in 68 patients followed for a minimum of two years. All recurrences were in nonsubcutaneous high-grade lesions. Treatment-related morbidity occurred in 22% of patients. Wound-healing complications developed in 17% and resolved with nonoperative treatment in half. These results support the efficacy of limb-sparing surgery and adjuvant radiation therapy in the management of soft-tissue sarcomas. Integration of chemotherapy may be necessary for the higher-grade lesions, although effectiveness is uncertain.
O'Connor
M I
MI
Section of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida.
Pritchard
D J
DJ
Gunderson
L L
LL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D002648:Child; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006770:Hospitals, Group Practice; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D012509:Sarcoma / Q000175:diagnosis / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014945:Wound Healing