Wound complications after resection and immediate postoperative brachytherapy in the management of soft-tissue sarcomas

When used as the sole source of postoperative radiotherapy, brachyradiation therapy (BRT) (4,500-6,000 cGy) should be delayed beyond the fourth postoperative day to minimize wound complications. However, when 1,000-2,000 cGy BRT are given as a "boost" to the tumor bed, it is unclear if a similar treatment delay is necessary. The purpose of this review was to determine the incidence of wound complications when BRT (1,000-2,000 cGy) is administered < or = 48 h after soft-tissue resection. The results of treatment in 21 patients with soft-tissue sarcomas of the extremity and superficial trunk treated with resection, immediate postoperative brachytherapy, and external beam radiation were reviewed. All patients were followed through the completion of radiation (median follow-up 30 months). A median of seven (range 3-24) after-loading catheters were placed at the time of resection and were loaded with iridium-192 a median of 2 days postoperative to deliver 1,000-2,000 cGy radiation. Eight patients (38%) experienced minor wound complications (seromas, wound separation, and flap edge necrosis) within 30 days of operation. There were no early complications that required reoperation or delayed further therapy. Brachytherapy (1,000-2,000 cGy) can be administered < or = 48 h postoperatively with a low risk of major wound complications. Minor wound complications are common but do not delay further treatment.