Control of locally advanced extremity soft tissue sarcomas by function-saving resection and brachytherapy

Amputation has often been advised for the treatment of deep-seated or bulky soft tissue sarcomas of the limb because of proneness to local recurrence after conservative resection. The authors evaluated the efficacy of local control by means of function-preserving resection and high-dose brachytherapy of the tumor bed using Iridium-192 implants in 33 patients with locally advanced sarcomas, 17 without prior therapy and 16 with locally recurrent tumors. Local control was achieved in 100% of the previously untreated group, and 62.5% of the previously treated, recurrent group after a median follow-up time of 36 months (range, 19 months-7.5 years). Serious wound complications developed in nine patients, two of whom required amputation. Prehensile or walking function was preserved in 31 of the 33 treated limbs. These results indicate that conservative resection and brachytherapy can successfully control locally advanced limb sarcomas with good preservation of limb function.