Integration of limb-sparing surgery, brachytherapy, and external-beam irradiation in the treatment of soft-tissue sarcomas.

Advances in the integration of limb-sparing surgery and adjuvant radiation therapy have nearly eliminated the need for ablative or radical resections in the management of soft-tissue sarcomas. The combination of wide or marginal surgical resections, brachytherapy, and external-beam irradiation resulted in a local recurrence rate of 9% in 68 patients followed for a minimum of two years. All recurrences were in nonsubcutaneous high-grade lesions. Treatment-related morbidity occurred in 22% of patients. Wound-healing complications developed in 17% and resolved with nonoperative treatment in half. These results support the efficacy of limb-sparing surgery and adjuvant radiation therapy in the management of soft-tissue sarcomas. Integration of chemotherapy may be necessary for the higher-grade lesions, although effectiveness is uncertain.