ISPUB.COM The Internet Journal of Oncology Volume 7 Number 2 1 of 6 Peri-Operative Brachytherapy In Soft-Tissue Sarcomas. Hospital USM Experience B Biswal, N Idris, Z Wan, W Ismail, A Halim Citation B Biswal, N Idris, Z Wan, W Ismail, A Halim. Peri-Operative Brachytherapy In Soft-Tissue Sarcomas. Hospital USM Experience. The Internet Journal of Oncology. 2009 Volume 7 Number 2. Abstract Overview: Radiotherapy is an important adjuvant modality in the management of extremity soft-tissue tumors. Interstitial brachytherapy implantation is a precise technique of delivering radiation that conforms to the tumor bed. Materials and Method:Selected extremity soft-tissue sarcomas were managed with wide-excision followed by preoperative implantation of brachytherapy catheters. The implant was irradiated 3-5 th day post-surgery to a dose of 3Gy BID for 3-5 days using high dose rate (HDR) system. Further additional external radiotherapy dose of 40- 50Gy in conventional fractionation was delivered to the tumor bed. Observations: 17 patients with soft tissue sarcoma were treated from 2001 to 2007.The median age of patient was 26 years (4-74 years) with male to female ratio of 12:5. Three out of 17 patients develop local recurrence and 7-patient relapse as lung metastases. At the time of reporting, 2-year local control rate was 88% and 24 month overall survival rate was 50%. The complication was minimal and manifested as subcutaneous fibrosis, pigmentation and wound dehiscence. Conclusions: Peri- operative interstitial brachytherapy is an option of radiotherapy for better local control in high grade large volume and recurrent soft-tissue tumor. Proper case selection and optimal multidisciplinary management could improve survival in future. INTRODUCTION The primary treatment of soft tissue sarcoma is surgery. In the past, the treatment of choice was amputation, however with the development of surgical technique more conservative surgical excision is considered as the gold standard of management. However local recurrence following surgery is an important shortcoming of primary surgical management. The local relapse rate following amputation range from 20-30% whereas wide-excision result in local recurrence rate of 65% 1 . Postoperative radiotherapy reduces local recurrence following limb salvage surgery. For extremity soft tissue sarcoma addition of adjuvant radiotherapy result in 95% local control rate and <10% amputation rate 2-3 . Currently combination chemotherapy is being employed in most soft tissue sarcoma management protocols 4 . Radiotherapy consisted of classical external beam radiotherapy delivering homogenous radiation dose to the tumor volume (surgical bed) to a dose of 40-50Gy in 4 to 5 weeks in conventional fractionation. With external radiotherapy, the dose conformity is not optimal and often results in complications and growth abnormality among young patients. Interstitial brachytherapy is a conformal form of radiation delivery to the tumor bed that can be delivered peroparative or perioperative period. Brachytherapy is known to improve local control in soft tissue sarcomas with high risk factors 5 . MATERIAL AND METHODS Patients with extremity sarcomas were evaluated by the muscoskeletal oncology team. The clinical and radiological records of all the patients were reviewed The evaluations consist of biopsy, magnetic resonance imaging (MRI) of primary, computer axial tomography (CT) thorax, whole body bone scintigraphy, Liver and Kidney chemistry, serum LDH level and complete blood count. The tumor volume was evaluated in 3 dimensions from clinical examination and radiological findings. Tissue diagnoses were obtained in all cases with either open or tru-cut biopsy. Patients were evaluated by musculoskeletal oncology surgeon and prior consent was obtained before the brachytherapy procedure. The selection for perioperative brachytherapy include anticipated narrow surgical margin – near to neurovascular bundle, small and closed compartment – foot/ hand or subcutaneous or skin sarcoma with high recurrence rate, high grade sarcomas and recurrent fibromatosis. SURGICAL TECHNIQUE Wide resection of the primary tumor with adequate margin