The role of brachitherapy and external beam radiationtherapy for high grade soft tissue sarcomas of extremities

The prognostic factors in 112 patients with localized high-grade soft tissue sarcomas of the limbs, associated with local failure, distant relapse and overall survival, were determined. The patients were treated from July 1990 to june 2005 by limb-sparing surgery, brachytherapy, and conventional postoperative radiation therapy. This was followed by chemotherapy in one fourth of the cases. At an median follow-up of 75.0 months (11.4-161.5), overall survival rate was 77.5% and 71.1% at 5 and 7 years, disease free survival rate was 63.3% and 58.4% at 5 and 10 years and local control was achieved in 91.5% and 87.0% at 5 and 10 years. Wide surgical margins were associated with a significantly better local control rate compared to margninal or intralesional margins. Tumor size did correlate with systemic but not local recurrence. Tumor site and histiotype did not appear to have an impact on outcome. Chemotherapy did not show to have an impact on local or systemic control. 14 patients (12.5%) had local complications attributed to radiotherapy. 11 patients developed wound healing problems, which needed further surgery. Using our treatment algorithm for high-grade soft tissue sarcoma of the extremities, good local and systemic control can be achieved with a low complication rate. Further studies need should focus on refining treatment modalities, thereby improving overall survival.