Management OF Soft Tissue Sarcoma OF Lower Limb - 2 Case Reports AND Review OF THE Literature

Abstract

Two cases of lower limb soft tissue sarcoma, one malignant fibrous histiocytoma and one liposarcoma, were treated by surgery and a postoperative high dose rate of interstitial brachytherapy with and without external beam irradiation in Taichung Veteran General Hospital. Both cases were advanced stage and high grade in histology at presentation and had a high concern for leg preservation. Conservative surgical treatments were performed by wide excision and marginal excision, respectively. The interstitial catheters were implanted with 1-cm spacing in a parallel array intra-operatively. High dose rate brachytherapy was planned by Plato Brachytherapy Planning System and was started 4 days after the operation by the application of the micro selection after loader using iridum-192 as the irradiation source. The total doses were 2880cGy and 2800 cGy respectively and were applied in 8 and 7 fractions was given to one case but was withheld in the second case due to delayed wound healing after brachytherapy. There were on significant wound complications in the first case. There was also no bone fracture or peripheral nerve damage in either case except muscle fibrosis occurred after the irradiation. Both of the patients were satisfied with the function of the preserved limbs during a follow up one year later. No local recurrence or distant metastasis was seen at present. For advanced lower limbs soft tissue sarcoma, wide excision plus interstitial brachytherapy may be an alternative management for the preservation of the limbs. Though we had a good initial local control of these two cases but it does not indicate there will be a good prognosis later on. However it did improve the patient’s quality of life and their self-con-fidence in facing the disease. Further long-term follow-up is necessary and hopefully there will be good long-term survival in the future.