Brachytherapy and Limb-Sparing Resection in the Management of Soft Tissue Sarcoma

Abstract

In the earlier part of the century, surgical efforts focused mainly on the feasibility and safety of the various surgical operations necessary for wide extirpation of soft tissue sarcoma. Major advances were made in the design and safe execution of these complex surgical procedures, such as forequarter amputation and hemipelvectomy. Functional preservation was at that time a secondary goal. In 1953, Bowden and Booher (1) proposed that carefully selected tumors could be treated by en bloc muscle group resection as an alternative to amputation with equally good local tumor control. Local recurrenceswere nevertheless very common with limb-sparing resections in the 1950’s and 1960’s. Fine et al. (2) reviewed the results of surgical treatment of soft tissue sarcomas up to the late 1960’s and noted local recurrence rates of over 50% in various reports, and in some instances up to 90%. Such local failure rates were obviously unacceptable. Surgeons soon recognized the limitations of surgery as an ablative technique in this setting, and sought the additional use of other methods based on entirely different therapeutic principles.