Abstract
Purpose: Locally recurrent extremity soft tissue sarcoma remains a therapeutic challenge; conservative surgery alone results in an inferior local control rate. This study demonstrates a new interstitial (IS) brachytherapy (BT) technique in a patient with recurrent extremity soft tissue sarcoma. Patients and methods: A 53-year-old man with recurrent left thigh malignant fibrous histiocytoma underwent conservative surgery and adjuvant intensity-modulated radiotherapy (IMRT) after two surgical excisions. A magnetic resonance imaging (MRI) of the lower extremity after the conservative surgery and IMRT revealed a left thigh mass measuring 12 cm × 8 cm × 7 cm. An IS BT with 3 fractions of 8 Gy each and guided with three-dimensional (3D) computed tomography (CT) was administered. For this procedure, IS metal needles were inserted at a depth of 1 cm into the tumor as a preliminary implantation, and their direction and depth were adjusted repeatedly until a satisfactory distribution was achieved through multiple CT scans. Results: The course of the IS BT procedure was uneventful. No severe bleeding, infection, or other complications were observed. At 3, 12, and 24 months after the IS BT, lower extremity MRI scans showed a left thigh mass measuring 10 cm × 5 cm × 4, 8 cm × 3 cm × 2 cm, and 6 cm × 2 cm × 2 cm, respectively. Minimal fibrosis, local numbness, and edema in the treatment area were noted. The patient had an excellent quality of life. Conclusion: Favorable oncologic outcomes for locally recurrent extremity soft tissue sarcoma were achieved using 3D CT-guided IS BT. This BT technique may contribute to an excellent local control rate and offer an effective and safe therapeutic option in selected cases.
Patterns of major wound complications following multidisciplinary therapy for lower extremity soft tissue sarcoma
