Brachytherapy for Soft Tissue Sarcoma: Maintaining Local Control While Minimizing Complications

ABSTRACT Background This study aims to assess the clinical and oncologic outcomes of high‐dose brachytherapy (BRT) versus both preoperative and postoperative external beam radiation therapy (EBRT) in the setting of high‐grade soft tissue sarcoma. Methods This is a retrospective cohort study of 144 patients treated surgically for soft tissue sarcoma at the same institution from 2010 to 2021. Patients treated for a soft tissue sarcoma with surgery and radiation therapy in the form of BRT, Neoadjuvant EBRT (Neo‐EBRT) or adjuvant EBRT (AD‐EBRT) were included. Results 56 patients were treated with BRT, 42 with Neo‐EBRT, and 46 with AD‐EBRT. There was a greater incidence of grouped wound complications in Neo‐EBRT with 50% compared to both BRT with 25% and AD‐EBRT with 28.3% ( p  = 0.02). Univariate and multivariate analysis showed that there was an increased risk of wound complications with Neo‐EBRT when compared to brachytherapy ( p  = 0.03 and p  = 0.007, respectively). Univariate and multivariate analysis showed that there was no difference in risk of LR between treatment groups ( p  = 0.28). Conclusion Brachytherapy is a valuable treatment modality that offers clinical and logistical advantages when compared to the conventional Neo‐EBRT in soft tissue sarcomas. Brachytherapy offers a lower risk of wound complications and a comparable local control. This manuscript presents decision‐making strategies for determining the appropriate radiation modality for specific circumstances.