Early Complications of High-dose-rate Brachytherapy in Soft Tissue Sarcoma: A Comparison With Traditional External-beam Radiotherapy

Abstract

Background Radiotherapy and surgery are routinely utilized to treat extremity soft tissue sarcoma. Multiple radiation modalities have been described, each with advantages and disadvantages, without one modality demonstrating clear superiority over the others.Questions/purposes We determined the overall initial complication rate in patients receiving surgery and radiotherapy, which specific complications were found when comparing different modalities, and whether combination therapy increased the overall rate of complications compared with surgery and single-modality radiotherapy. Patients and MethodsWe retrospectively reviewed the records of 190 patients who received external-beam radiotherapy (141 patients), high-dose-rate brachytherapy (37 patients), or both (12 patients). We evaluated 100 men and 90 women (mean age, 57 years; range, 18-94 years) for tumor size and subtype, comorbidities, stage, grade, margin of resection, type of adjuvant treatment, and complications. Minimum followup was 3 months (mean, 40 months; range, 3-155 months). Results The most frequent early complications in the high-dose-rate brachytherapy cohort were infection, cellulitis, and seroma and/or hematoma. In the external-beam radiotherapy cohort, chronic edema, fibrosis, and chronic radiation dermatitis were more frequently encountered. The total number of early complications and overall incidence of major complications requiring further surgery were similar among the three cohorts, but a larger number of patients in the high-dose-rate brachytherapy group required subsequent surgery for infection compared with the external-beam radiotherapy group. Conclusions High-dose-rate brachytherapy decreases radiation exposure and allows shorter duration of treatment compared with traditional external-beam radiotherapy but has a higher perioperative wound complication rate. Level of Evidence Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This work was performed at

Identification of infectious species after resection of soft‐tissue sarcomas

“…The 16.5% incidence of postoperative infections found, herein, is within the range of 10%‐35%, reported elsewhere in the literature . However, the time course of such infections is quite different from what has been previously reported.…”

“…In particular, external beam radiation therapy (EBRT) is a mainstay of treatment of STSs at most centers. Postoperative infections are common after resection of STSs, with various series reporting postoperative infection rates from 10% to 35% . Although operative deep tissue infections have not been shown to affect oncological outcomes, they are a source of substantial morbidity and cost …”

Therapeutic options and postoperative wound complications after extremity soft tissue sarcoma resection and postoperative external beam radiotherapy

“…Additionally, different types of complications are reported. These include persistent pain, oedema, fibrosis, pathological fracture, joint stiffness, osteoradionecrosis, osteomyelitis, chronic radiation dermatitis and wound‐related complications . The timing of radiation therapy mostly influences wound‐related complications, such as wound healing disorders, infection, seroma or haematoma.…”

The Pedicled Myocutaneous Flap as a Choice Reconstructive Technique for Immediate Adjuvant Brachytherapy in Sarcoma Treatment

“…Wound dehiscence, infection, seroma, and hematoma are radiation-induced complications that can threaten the viability of the reconstruction and can delay adjuvant radiation treatment and chemotherapy [18][19][20] . Moreover, compared with ebrt, brachytherapy has been shown to increase the rate of perioperative wound complications despite its minimization of long-term damage to the surrounding viable tissues.…”