• Brachytherapy for soft tissue sarcoma
  • Aida Karami,1,* Mohammad Hossein Jamshidi,2
    1. Department of Radiologic Technology, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
    2. Department of Radiologic Technology, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.


  • Introduction: Introduction: Compared to external beam radiation therapy (EBRT), brachy radiaton therapy (BRT) minimizes the radiation dose to surrounding normal tissues, maximizes the radiation dose delivered to the tumor, and shortens treatment times. In the usual dosage schedule, treatment is completed within 6 days and requires only one hospitalization. After loading catheters are placed in a target area of the tumor operative bed, defined by the surgeon, and spaced at 1-cm intervals to cover the entire area of risk. BRT can also be used for delivery of a boost to the tumor bed in conjunction with EBRT.
  • Methods: Methods: The databases of PubMed and Google Scholar were explored by different combinations of terms: brachytherapy, cancer, soft tissue sarcoma. The obtained results were selected for the title and abstracts. Finally, 15 relevant papers were selected and review full text.
  • Results: Results: A phase III trial of post-operative BRT versus no BRT was conducted in 126 patients who had complete resection of either extremity or superfacial trunk STS. The BRT dose was 45 Gy as low-dose rate BRT. Five-year local control rates were 82% and 67% for the BRT and surgery alone groups, respectively. The advantage of BRT was seen only in the high-grade sarcomas It was limited to local control, as there was no difference between the groups in distant metastasis or disease-specific survival. Although it is unclear if BRT is associated with a higher risk of wound complications (see section ‘Wound healing after surgery and radiation’), the rate of wound re-operation may be higher. BRT has been combined with free flap construction as a means of enhancing primary healing in difficult anatomical situations without an increase in the incidence of wound breakdown. There have been no randomized comparisons of the relative efficacy or morbidity of EBRT compared with BRT. In a retrospective comparison of patients treated by intensity-modulated radiotherapy (IMRT) or BRT, the IMRT group appeared to have somewhat worse prognostic features, but the 5-year local control rate was significantly higher than in the BRT group (92% versus 82%). BRT for sarcomas has traditionally been given by low dose rate radiation. There are increasing data available on the use of fractionated high-dose rate schedules.High dose rate BRT has used in conjunction with external beam radiotherapy for the tumor bed boost in doses of 15–24 Gy, often hyper fractionated at 2.3–4 Gy bid.One report using high dose rate BRT alone in doses of 40 Gy at 2.3–3 Gy bid unfortunately reported poor local control of only 20%, in contrast with 100% when BRT was combined with external beam radiation.
  • Conclusion: Conclusion: In contrast, a more recent report showed local control of 93% with surgery and high dose rate BRT in patients with negative margins, whereas local control was only 48% in patients with positive margins, suggesting that for the latter group, if BRT is used, then it should be done in conjunction with external beam radiation.
  • Keywords: Keywords: Brachytherapy, Cancer, soft tissue sarcoma.