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

  • Symposium: 2010 Musculoskeletal Tumor Society
  • Published:
Clinical Orthopaedics and Related Research®

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 Methods

We 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.

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Acknowledgments

The authors thank Dr. H. Thomas Temple for his assistance with performing many of the surgeries, project development and data analysis. The authors thank Dr. J. David Pitcher for sharing his cases for which he was the primary surgeon. The authors also thank Dr. Jonathan Hilal and Dr. Jonathan Tresley for their assistance with data collection.

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Authors and Affiliations

  1. Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA

    Cynthia L. Emory MD

  2. University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Corey O. Montgomery MD

  3. Walter Reed National Military Medical Center, Bethesda, MD, USA

    Benjamin K. Potter MD

  4. Cancer HealthCare Associates, University of Miami Hospital, Miami, FL, USA

    Martin E. Keisch MD

  5. University of Miami Miller School of Medicine, Miami, FL, 33136, USA

    Sheila A. Conway MD

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  1. Cynthia L. Emory MD
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  2. Corey O. Montgomery MD
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  3. Benjamin K. Potter MD
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  4. Martin E. Keisch MD
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  5. Sheila A. Conway MD
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Correspondence to Cynthia L. Emory MD.

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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 the University of Miami Miller School of Medicine.

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Emory, C.L., Montgomery, C.O., Potter, B.K. et al. Early Complications of High-dose-rate Brachytherapy in Soft Tissue Sarcoma: A Comparison With Traditional External-beam Radiotherapy. Clin Orthop Relat Res 470, 751–758 (2012). https://doi.org/10.1007/s11999-011-2106-5

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  • DOI: https://doi.org/10.1007/s11999-011-2106-5

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