title: Surgical resection with adjuvant brachytherapy in soft tissue sarcoma of the extremity - a case report.
abstract: OBJECTIVE
  Surgery is the major therapeutic method in soft tissue sarcomas of the extremity (E-STS). Treatment of large high-grade tumours, which resection cannot be performed with a wide safe margin, should include complementary radiation and/or chemo-therapy. Hopefully, the use of adjuvant brachytherapy will improve the prognosis of E-STS.
  
  
  METHODS
  After a long process of diagnosing a tumour in the medial compartment of the thigh, a 65-year-old woman with diagnosed synovial sarcoma underwent a surgery. Compartment resection was performed and the tumour was removed with a 10 mm safety margin of healthy tissue. Adjuvant brachytherapy was delivered with (192)Ir (MicroSelectron, Nucletron Electa Group, Stockholm, Sweden(®)) with 10 Ci of nominal activity to a dose of 55 Gy in 16 days because of large tumour size (99 × 78 × 73 mm) and its proximity to the neurovascular bundle. No complications were reported. The patient was discharged from the hospital on the 28(th) day after the surgery. The wound healed without any complications and the outpatient follow-up is being continued.
  
  
  CONCLUSIONS
  Adjuvant brachytherapy is rarely used after surgical treatment due to its limited accessibility in hospitals with surgical and orthopaedic departments. There are numerous publications proving positive influence of brachytherapy on local control and decreased number of recurrences. The recurrence-free survival time also increased significantly, however no direct impact on the number of distant metastases was found. Treatment is well tolerated and short. The complication rate varies between centres from 5 to 30%. The most common adverse effects include: peripheral neuropathy, skin necrosis and osteonecrosis of the long bones.
  
  
  CONCLUSIONS
  Treatment of large soft tissue sarcomas of the extremity (E-STS) should include combination of surgical intervention and external beam radiotherapy or brachytherapy. Adjuvant brachytherapy improves local control rate up to 78%, is well tolerated and rarely causes complications. We couldn't determine which type of adjuvant radiation therapy is more effective.
authors: Oncologic Orthopaedics Department.
authors: Grzegorz
authors: G
authors: Guzik
authors: Jarosław
authors: J
authors: Lyczek
authors: Lukasz
authors: L
authors: Kowalik
keywords: brachytherapy; compartment surgery; soft tissue sarcoma
references: Curr Opin Oncol. 2008 Jul;20(4):400-6
references: 18525335
references: Ann Oncol. 2009 May;20 Suppl 4:132-6
references: 19454434
references: Acta Orthop Scand Suppl. 1999 Jun;285:50-7
references: 10429623
references: Ann Surg Oncol. 2002 Jan-Feb;9(1):48-56
references: 11829430
references: Brachytherapy. 2005;4(4):264-70
references: 16344256
references: Ann Surg Oncol. 2006 Feb;13(2):245-52
references: 16411144
references: J Clin Oncol. 1996 Mar;14(3):859-68
references: 8622034
references: Lancet. 2002 Jun 29;359(9325):2235-41
references: 12103287
references: Am J Surg. 2006 Feb;191(2):230-4
references: 16442951
references: CA Cancer J Clin. 2006 Sep-Oct;56(5):282-91; quiz 314-5
references: 17005597
references: Surg Oncol Clin N Am. 2002 Jan;11(1):11-22
references: 11928795