7 research outputs found
Free vascularised tissue transfer and brachytherapy for soft-tissue sarcomas of the extremities
We reviewed the medical files of nine patients with localised
soft-tissue sarcomas of the extremities treated with surgical resection,
free vascularised tissue transfer, and computerised after-loading
iridium-192 high dose rate brachytherapy over a period of 8 years. All
patients had external beam radiation therapy in fractions with a total
dose of 48-52 Gy, followed by surgery at approximately 4-5 weeks
postirradiation. Surgical treatment included wide resection of the
primary tumour in six patients, and marginal resection in three
patients. Microsurgical reconstruction of the soft-tissue defect used a
free vascularised musculocutaneous flap that included the gracilis flap
in five patients, the latissimus dorsi flap in four patients, and the
radiovolar flap in one patient. Postoperative brachytherapy dose ranged
from 12 to 24 Gy. Adjuvant chemotherapy was administered in five
patients with large tumours and marginal resection. At a mean follow-up
of 36 months, eight patients were still alive with no evidence of local
recurrence or distant metastases; all these patients had good cosmetic
and functional outcomes. Two patients died with lung metastases; one of
these patients had local tumour recurrence. Wound heating problems and
seroma formations were observed in two patients. Intramedullary nailing
was required in one patient for a pathological fracture. Tumour
resection for soft-tissue sarcomas combined with microsurgical
reconstruction of the soft-tissue defect, preoperative external beam
radiation and high dose rate brachytherapy results in a high degree of
local control with acceptable complications. (C) 2008 Published by
Elsevier Ltd