Radiation has an important therapeutic role in the management of soft tissue sarcomas. It is used preoperatively, post- operatively, or intraoperatively using interstitial implants or intraoperative electrons, depending on institutional practices.
This procedure should be undertaken as a team effort involving the surgeon, radiation oncologist, medical oncologist, pathologist, radiologist, and the other support staff including physical therapy and rehabilitation.
The patient selection for this procedure includes patients with sarcomas of the extremity or superficial trunk of more than 5 cm with an intermediate- to high-grade histology in whom the surgical margins are negative. Brachytherapy may be considered as a boost following a course of external beam irradiation in intermediate- to high- grade sarcomas if the intraoperative findings indicate a need for additional therapy postoperatively.
In tumors less than 5 cm, certain situations may warrant a boost to the tumor bed using brachytherapy. These include positive margins, uncertain margins, surgical field contamination, or deep lesions.
Experience with HDR brachytherapy shows control rates of 50%–100%.