Brachytherapy in the Treatment of Soft-Tissue Sarcomas of the Extremities—A Current Concept and Systematic Review of the Literature

Abstract

Introduction: Evidence on the use of brachytherapy in soft-tissue sarcoma (STS) is sparse. Therapy regimens are determined more by local interdisciplinary tumor conferences than by standardized protocols. Patient-specific factors complicate the standardized application of therapy protocols. The individuality of the treatment makes it difficult to compare results. Materials and Methods: A comprehensive literature search was conducted, whereby the literature from a period of almost 44 years (1977–2021) was graded and included in this systematic review. For this purpose, PubMed was used as the primary database. Search string included “soft-tissue sarcoma”, “brachytherapy”, and “extremity.” Four independent researchers reviewed the literature. Only full-text articles written in English or German were included. Results: Of the 175 identified studies, 70 were eligible for analysis based on the inclusion and exclusion criteria. The key points to compare were local complications, recurrence rate and correlation with margins of resection, and the use of brachytherapy regarding tumor grading. Conclusion: Brachytherapy represents an important subset of radiotherapy techniques used in STSs, whose indications and applications are constantly evolving, and for which a local control rate of 50% to 96% has been reported as monotherapy, depending on risk factors. However, the best benefit is seen in the combination of further resection and brachytherapy, and most authors at many other centers agree with this treatment strategy.

A New Sarcoma Shortly after Treatment for High-Grade Glioma with Adjuvant Chemoradiation: A Case Report

“…Behjati et al [ 12 ] demonstrated identifying two signatures of ionizing radiation [ 12 ], but their used method is not accessible to our institution. Treatment for RIS depends on the size and grade of the tumor; however, the main modality of treatment consists of surgical resection, and in some reports, less than 1 third of patients received chemotherapy or radiotherapy [ 13 ].…”

Midterm Results of High-Dose-Rate Intraoperative Brachytherapy in the Treatment of Soft Tissue Sarcomas

“…Despite the positive data supporting IORT, brachytherapy is not a standard method used for the complementary treatment of soft-tissue sarcomas [10,51]. The biggest problem seems to be its limited accessibility and technical limitations resulting from the fact that brachytherapy facilities are rarely located near surgical or oncologic orthopaedic departments offering the possibility of a shared surgical path [10,51,52]. The recent introduction of portable linear accelerators, delivering low-energy (50 kV) photons, could be an option for solving this limitation [10,53,54].…”

“…According to the time scale needed to deliver the radiation dose (dose rate), BRT is nowadays available as an HDR (high-dose rate), an LDR (low-dose rate), and, recently, an ultra-low-dose rate. HDR can be administered twice a day for seven days as fractionated HDR, to overcome patients' confinement and prolonged shielding [10,11]. Technically, administration is possible through flaps or seeds in the surgical bed or into the tumour mass (Figure 1) [10,11].…”

“…HDR can be administered twice a day for seven days as fractionated HDR, to overcome patients' confinement and prolonged shielding [10,11]. Technically, administration is possible through flaps or seeds in the surgical bed or into the tumour mass (Figure 1) [10,11].…”

The Impact of Nanomedicine on Soft Tissue Sarcoma Treated by Radiotherapy and/or Hyperthermia: A Review

“…As mentioned earlier, external beam radiation therapy (EBRT) presents challenges in avoiding the irradiation of healthy tissues. Therefore, brachytherapy is employed as a highly precise treatment technique, positioning applicators precisely at the desired location [ 83 ]. The tumor is irradiated directly by an internal source, with the radiation being attenuated before reaching the healthy surrounding tissues.…”