Adjuvant brachytherapy for treatment of chest wall sarcomas

Current results of brachytherapy for soft tissue sarcoma

Perioperative brachytherapy results in a better local control rate than surgery alone for extremity soft tissue sarcoma. Brachytherapy enables the delivery of a high radiation dose to a limited volume of tissue, allows the reduction of radiation treatment time, enables direct visualization of the tumor bed and surrounding critical structures, and costs less than external beam radiotherapy. The literature seems to regard the effectiveness of brachytherapy as comparable to that of external beam radiotherapy, and the side effect profile is acceptable. Traditional low-dose-rate brachytherapy methods require extended periods of patient isolation, but recent technologic advances may obviate this necessity. Newer high-dose-rate (HDR) brachytherapy delivery methods allow for the fractionation of radiation delivery and outpatient treatment in some cases. Furthermore, with HDR brachytherapy, the radiation dose distribution can be tailored around critical anatomic structures. Although the application of HDR brachytherapy to soft tissue sarcoma is relatively new, it seems to result in a satisfactory local control rate and may replace traditional low-dose-rate techniques.

Brachytherapy for locally recurrent soft-tissue sarcoma

Radiation is used to reduce potential risk of local recurrence from microscopic residual disease after surgical resection. Brachytherapy is a clinically established means of providing radiation for soft-tissue sarcomas that recur after surgical resection alone or surgical resection and radiation. Although the total dose of radiation that is prescribed is approximately the same for patients undergoing external beam radiation or brachytherapy, the radiobiologic characteristics of brachytherapy, based on the inverse-square law, provide higher doses of radiation to the surgical bed. This provides a theoretical advantage for the use of brachytherapy as compared with external beam radiation among patients with recurrence after surgical resection. When soft-tissue sarcomas recur in a previously irradiated area, further external beam radiation generally is not possible; therefore, brachytherapy allows a radiotherapeutic alternative in an attempt to reduce the risk of further local recurrence. Recommendations for patient selection, the total dose of radiation, and the radiation dose-rate are outlined. Standard grading systems for response, symptoms, and severity of complications should be used.