Permanent iodine-125 implant and external beam radiation therapy for the treatment of malignant brain tumors.

Survival data of 114 patients treated for malignant brain tumors with 125I interstitial radiation therapy at Henry Ford Hospital, Detroit, Mich. (1986-1990), are presented. The first 64 patients were treated with temporary 125I implants with a total prescribed dose of 60 Gy at a dose rate of 40 cGy/h. In order to reduce the risk of injury to the surrounding normal tissue associated with high-dose brachytherapy, a new approach was initiated using permanent implants with a lower dose rate; 50 patients were treated after surgical resection with permanent implantation of 125I seeds at a lower dose rate of 4-7 cGy/h, with a total dose of 10,000-12,000 cGy, and concurrent external radiation therapy of 5,000 cGy. The rationale of this protocol was to increase the effectiveness of the low-dose-rate implant by a concurrent 'daily' boost of external radiation, thus inhibiting the proliferation of tumor cells during the protracted low-dose radiation treatment. Survival was compared between groups with permanent and temporary implants in terms of effectiveness in tumor control as well as impact on clinical condition. Low-dose-rate implant with concurrent external radiation therapy seems to offer the best chance for long-term survival without deterioration in the clinical condition.     

Stereotactic interstitial brachytherapy of malignant astrocytomas with remarks on postimplantation computed tomographic appearance

Seventeen patients were treated with stereotactically implanted high activity iodine-125 seeds, 12 patients for recurrent malignant astrocytomas (Protocol I) and 5 patients for newly diagnosed glioblastomas (Protocol II). Total radiation dosage to the recurrent tumors in Protocol I, including prior external beam irradiation, averaged 13,500 cGy. In the follow-up period of 6 to 50 months, the survival rate was 93% at 6 months, 60% at 12 months, 50% at 18 months, and 38% at 24 months after implantation. In Protocol II, brachytherapy was used as an interstitial radiation boost to the conventional treatment of newly diagnosed glioblastomas. External beam therapy and interstitial brachytherapy provided 11,000 cGy to these tumors. In the follow-up period of 15 to 27 months, there was a 100% survival at 12 months, 75% at 18 months, and 25% at 24 months after implantation. Eight of our 17 patients required reoperation for persistent or recurrent mass lesions at 6 to 15 months postimplantation; 7 were found to harbor masses of radionecrosis containing nests of anaplastic astrocytes; 1 had frank tumor recurrence. Median survival in this group of patients requiring reoperation was 18.7 months postimplantation. In a review of postimplantation computed tomographic scans, significant mass effect and crossover of hypodensity or enhancement into the corpus callosum or opposite hemisphere were found to have prognostic significance; persistent areas of contrast enhancement and excessive peritumoral hypodensity did not.     

Permanent Iodine-125 Implants in the Treatment of Low-Grade Gliomas

We report a retrospective study on the use of the permanent iodine-125 (¹²⁵I) implants in the management of low-grade gliomas. From July 1988 to July 1997, 16 patients with low-grade gliomas underwent permanent ¹²⁵I implants in the management of their lesions. There were 7 males and 9 females ranging in age from 4 to 48 years (mean 19). The location was in the cerebral hemisphere in 7 patients, brainstem in 5 patients and thalamus/basal ganglia in 4 patients. Prior to brachytherapy, 9 patients underwent surgical resection and 7 patients underwent stereotactic biopsy procedures. Fourteen patients were treated as part of the initial management and 2 were recurrent. The histological diagnosis was: 9 WHO grade II astrocytomas, 3 oligodendrogliomas, 2 gemistocytic astrocytomas, 1 pilocytic astrocytoma, and 1 ependymoma. The tumor volume ranged from 0.7 to 33.4 cc (mean 8.4). Stereotactic treatment planning was used to encompass the contrast-enhancing rim of the tumor visualized by computerized tomography with an initial dose rate of 0.05 Gy/hour with ¹²⁵I. The total activity ranged from 0.8 to 20.5 mCi. With a median follow-up period of 35 months (range, 4–105 months), the 2- and 5-year survival rates were 93.7% and 87.5%, respectively. Three patients underwent reoperation after implants, two of three had recurrent disease, and one had radiation necrosis. Permanent ¹²⁵I implants appear to be safe and effective as a part of the multimodality management of low-grade gliomas.     

Stereotactic interstitial radiosurgery with a miniature X-ray device in the minimally invasive treatment of selected tumors in the thalamus and the basal Ganglia

The aim of this study was to evaluate the role of interstitial radiosurgery (IR) using the photon radiosurgery system (PRS) in the treatment of selected tumors within the thalamus and the basal ganglia. The PRS is a miniature X-ray generator that was developed for interstitial irradiation. This series included 14 patients (5 with glioblastomas, 4 with low-grade astrocytomas and 5 with metastases) harboring spheroidal lesions with dimensions ranging from 13 to 42 mm (mean 30 mm). After stereotactic biopsy, a radiation dose ranging from 6 to 15.4 Gy (mean 11.3 Gy) was delivered at the target volume margins. Follow-up varied from 3 to 26 months (mean 10.2 months). In the group of glioblastomas, 3 patients died (3-12 months after the procedure) because of tumor progression, while the remaining had tumor control. Two patients with metastases died from systemic disease (4-9 months after the treatment), and 3 were alive and well at the end of the study. Local control was achieved in all metastases. Patients with low-grade astrocytomas were well and imaging studies showed tumor control PRS IR is a minimally invasive procedure for the treatment of selected glial or secondary brain tumors. Compared to conventional radiosurgery (brachytherapy and external radiosurgery), PRS IR presents dose delivery characteristics useful for the treatment of tumors in the thalamus and basal ganglia, without inconveniences such as handling radioisotopes, the need of expensive facilities and radiation protection measures. Although the clinical value needs further investigations, PRS IR seems to be effective in metastases while it provides less benefit in malignant gliomas. PRS IR could have a major role in the treatment of low-grade astrocytomas.     

Interstitial stereotactic radiosurgery of pilocytic astrocytomas in paediatric patients

Summary Objective. To evaluate the clinical presentation, tumour response, clinical improvement and complications in 12 children and young people with a pilocytic astrocytoma, WHO I grade 1, who were treated with interstitial radiosurgery using Iodine-125 seed implants. Patients and Methods. Retrospective analysis of 12 patients aged under 18 years (mean 8.4 years, ranging from 8 months to 17 years of age) with a pilocytic astrocytoma treated between 1993 and 2006. Iodine-125 seeds were used as temporary implants with low-dose rate (≤10 cGy/h) and a calculated reference dose of 60 and 100 Gy to the outer ring of the tumour. Results. There was no perioperative mortality. Two patients worsened transiently, but thereafter each patient improved clinically. Eleven out of 12 tumours shrank after the treatment. The mean volume of the tumours before implantation was 17.9 cm³. and was reduced to 60% of this volume at 6 months, to 26.5% at 12 months, to 8% at 24 months, and was less than 1% at 30–36 months One patient underwent a reimplantation to treat a recurrence 3 years after the initial treatment. Ten patients were alive 2 years after the first intervention. In the longest surving patient, there was no evidence of progression after 13.4 years of follow up.     

Proliferative potential of malignant glioma cells before and after interstitial brachytherapy.

The viability of tumor cells in radionecrotic tissue after interstitial brachytherapy (BRTX) was evaluated using immunohistochemical markers of proliferative potential in primary and recurrent tumors. Tumor specimens from 30 patients with malignant gliomas (14 anaplastic astrocytomas, 16 glioblastomas) taken before and after BRTX were examined using MIB-1 monoclonal antibody. Histological examination of specimens obtained by craniotomy or stereotactic biopsy after BRTX revealed tumor recurrence in 18 patients and radionecrosis in 12 patients including two with pure radionecrosis and 10 with a mixture of both tumor and radionecrosis. The MIB-1 index of the tumors with radionecrosis was 7.6 +/- 5.5%, and that of the primary tumors was 17.0 +/- 11.2%, showing a significant difference (p < 0.05). There was no significant difference between the MIB-1 index of the primary tumors with local recurrence after BRTX and the primary tumors which underwent radionecrosis. Although morphologically viable tumor cells were found in the radionecrotic tissue, BRTX causes a reduction in the proliferative potential of these tumor cells.     

Quality of life in patients with glioblastoma multiforme participating in a randomized study of brachytherapy as a boost treatment

OBJECT: Until recently the assessment of outcome in patients treated for glioma has emphasized length of survival with the evaluation of quality of life (QOL) limited to unidimensional, mostly physical, measures. The authors report the multidimensional assessment of QOL as part of a randomized clinical trial of brachytherapy as a boost in the initial treatment of patients with glioblastoma multiforme. METHODS: A questionnaire previously developed by the senior authors and psychometrically validated was completed by patients on randomized entry into the study and at follow-up review every 3 months thereafter. The questionnaire was presented in a linear-analog self-assessment format. Karnofsky Performance Scale (KPS) scores were also recorded on each occasion. No differences were found between patients in either arm of the study (conventional radiation therapy consisting of 50 Gy in 25 fractions or conventional radiation plus a brachytherapy boost of a minimum peripheral tumor dose of 60 Gy) in KPS and QOL scores during the 1st year of follow-up review. However, there was a statistically significant deterioration in patients' overall KPS scores during the 1st year of follow up compared with baseline scores. Of QOL items evaluated, statistically significant deteriorations were found in self care, speech, and concentration, and on subscale analyses, cognitive functioning and physical experience (symptoms) deteriorated significantly during the 1st year of follow up, compared with baseline values. The correlation between QOL and KPS scores was low. CONCLUSIONS: Future studies in patients harboring malignant gliomas must incorporate measures assessing QOL because traditional measures focusing on physical or neurological functioning give an incomplete assessment of the patient's experience.     

Results of Postoperative Radiotherapy for Resectable Hilar Cholangiocarcinoma

Abstract The aim of this study was to assess the value of radiotherapy, and especially intraluminal brachytherapy, after resection of hilar cholangiocarcinoma by analyzing long-term complications and survival. Between 1983 and 1998, 112 patients underwent resection of a hilar cholangiocarcinoma. Of the 91 patients who survived the postoperative period, 20 patients had no additional radiotherapy, 30 patients had only external radiotherapy (46 ± 11 Gy), and 41 patients had a combination of external (42 ± 5 Gy) and intraluminal brachytherapy (10 ± 2 Gy). Overall, 88% of the patients had late complications, with a significantly higher rate of complications occurring among patients receiving external beam irradiation and brachytherapy. Second to abdominal pain (56%), cholangitis (49%) was the most frequent complication and occurred significantly more often in patients who had received brachytherapy. Retrograde bile leakage after closure of the temporary jejunostomy was a troublesome complication in 24% of patients treated with brachytherapy. Overall median survival after treatment with adjuvant radiotherapy was longer than after resection without additional radiation (24 months versus 8 months, respectively). There was, however, no significant benefit from the use of intraluminal brachytherapy. In conclusion, additional radiotherapy after resection of hilar cholangiocarcinoma significantly improved survival and is recommended by giving external beam irradiation but not intraluminal brachytherapy.     

Radiation therapy in the management of low-grade supratentorial astrocytomas

The records of 167 patients with grade 1 or 2 supratentorial pilocytic astrocytomas (41 patients), ordinary astrocytomas (91 patients), or mixed oligoastrocytomas (35 patients) diagnosed between 1960 and 1982 are retrospectively reviewed. The extent of surgical tumor removal was gross total or radical subtotal in 33 patients (20%) and subtotal or biopsy only in the remaining 134 patients (80%). Postoperative radiation therapy was given to 139 (83%) of the 167 patients, with a median dose of 5000 cGy (range 600 to 6500 cGy). Multivariate analysis revealed that a pilocytic histology was the most significant prognostic variable associated with a good survival. The 5- and 10-year survival rates were, respectively, 85% and 79% for the 41 patients with pilocytic astrocytomas compared to 51% and 23% for the 126 patients with ordinary astrocytomas or mixed oligoastrocytomas. Postoperative irradiation did not appear to be associated with improved survival times in the patients with pilocytic astrocytomas; however, in the 126 patients with ordinary astrocytomas or mixed oligoastrocytomas, those who received "high-dose" radiation (greater than or equal to 5300 cGy) had significantly better survival times than those who received "low-dose" radiation (less than 5300 cGy) or surgery alone. The 5- and 10-year survival rates were, respectively, 68% and 39% for the 35 patients receiving high-dose radiation, 47% and 21% for the 67 receiving low-dose radiation, and 32% and 11% for the 19 treated with surgery alone. The survival rate was poor for the 23 patients with ordinary astrocytomas and oligoastrocytomas who underwent gross total or radical subtotal tumor removal (14 of whom were also irradiated): 52% at 5 years and 21% at 10 years, with 19 of 23 patients developing tumor progression and dying 1 to 12 years postoperatively. In contrast, all 10 patients with pilocytic astrocytomas who had gross total or radical subtotal tumor removal alone were long-term survivors, with follow-up periods of about 4 to 25 years.     

Hypofractionated Stereotactic Radiotherapy for Recurrent Malignant Gliomas

Objective: The results of hypofractionated stereotactic radiotherapy (SRT) for the treatment of unselected patients with malignant glioma recurrent after conventional therapy were analyzed. Materials and Methods: Between January 1997 and March 1999, 21 patients with recurrent malignant glioma received SRT at UCLA. All patients received prior conventional radiotherapy (median 6000 cGy). The interval from initial diagnosis to SRT varied from 3 to 99 months (median 11). Tumor volume ranged from 4.5 to 33.7 cc (median 12). Fifteen patients had glioblastoma multiforme and 3 had anaplastic astrocytoma with an oligodendroglial component. Two patients with prior low-grade astrocytoma and one with an unbiopsied brainstem tumor did not have pathological confirmation of tumor grade at time of relapse. Five patients had multifocal recurrences and 11 had imaging evidence of indistinct tumor. Twelve patients had progressive disease after receiving salvage chemotherapy. Patients received 4–6 daily fractions of 400 to 600 cGy. Median total SRT dose was 2500 cGy. Follow-up ranged from 1 to 20 months and no patients were lost. Results: The actuarial median and one-year survival were 6.7 months and 15%, respectively. Fifteen patients died of progressive glioma and one of a pulmonary embolus. Sixteen patients relapsed after SRT: 11 local, 4 local plus distant, one marginal. All patients with distant relapse also had local failure at some time. The median time to local relapse for the 14 patients with an initial component of local failure was 5 months. There were trends to superior survival for those with an initial diagnosis of nonglioblastoma and those with frontal/occipital lobe recurrences. No patient developed documented radionecrosis. Two patients underwent operation following SRT. Histopathological analysis of the operative specimen revealed malignant glioma. Conclusions: The authors conclude that hypofractionated SRT is a feasible, safe alternative for patients with recurrent malignant glioma. Local failure represents the overwhelming pattern of relapse after SRT, regardless of the clinical or imaging characteristics of patients with recurrent tumor. Improving the outcome for this group of patients may require a multimodality approach of SRT plus concurrent chemotherapy.     

Long-Term Follow-Up of Brachytherapy in Untreated Malignant Glioma

Objective: Long-term follow-up of patients with malignant glioma randomized to treatment with and without brachytherapy. Methods: Twenty-six patients were randomized to brachytherapy and external radiation, and 23 to external radiation alone. There were 19 and 17 glioblastomas, and 3 and 8 anaplastic astrocytomas, in the nonimplant and implant groups, respectively, and 1 malignant oligodendroglioma in each group. For brachytherapy, iodine- 125 seeds were implanted to deliver a homogeneous dose of 40 cGy/hr for a maximum of 6000 cGy to the enhancing tumor margin. All patients received external radiation for a total of 6020 cGy delivered to the tumor plus 3 cm margin over 7 weeks, followed by BCNU chemotherapy. Conclusions: The median survival was 78 and 66 weeks in the implant and nonimplant groups respectively, and their survival curves were not different (log rank, p=0.394). A significant multivariate relationship did exist between survival and age (p=0.0092), tumor grade (p=0.0001), and Karnofsky (p=0.021). Treatment with brachytherapy is subject to selection bias, which does exclude a large proportion of patients.     

An inflatable balloon catheter and liquid 125I radiation source (GliaSite Radiation Therapy System) for treatment of recurrent malignant glioma: multicenter safety and feasibility trial

OBJECT: In this study the authors evaluated the safety and performance of the GliaSite Radiation Therapy System (RTS) in patients with recurrent malignant brain tumors who were undergoing tumor resection. METHODS: The GliaSite is an inflatable balloon catheter that is placed in the resection cavity at the time of tumor debulking. Low-dose-rate radiation is delivered with an aqueous solution of organically bound iodine-125 (lotrex [sodium 3-(125I)-iodo-4-hydroxybenzenesulfonate]), which are temporarily introduced into the balloon portion of the device via a subcutaneous port. Adults with recurrent malignant glioma underwent resection and GliaSite implantation. One to 2 weeks later, the device was filled with Iotrex for 3 to 6 days, following which the device was explanted. Twenty-one patients with recurrent high-grade astrocytomas were enrolled in the study and received radiation therapy. There were two end points: 1) successful implantation and delivery of brachytherapy; and 2) safety of the device. Implantation of the device, delivery of radiation, and the explantation procedure were well tolerated. At least 40 to 60 Gy was delivered to all tissues within the target volume. There were no serious adverse device-related events during brachytherapy. One patient had a pseudomeningocele, one patient had a wound infection, and three patients had meningitis (one bacterial, one chemical, and one aseptic). No symptomatic radiation necrosis was identified during 21.8 patient-years of follow up. The median survival of previously treated patients was 12.7 months (95% confidence interval 6.9-15.3 months). CONCLUSIONS: The GliaSite RTS performs safely and efficiently. It delivers a readily quantifiable dose of radiation to tissue at the highest risk for tumor recurrence.     

Treatment of high-grade low-stage prostate cancer by high-dose-rate brachytherapy

BACKGROUND AND PURPOSE: The best management of patients with low-stage, high-grade prostate cancer remains unclear. In an attempt to improve the outcomes of this high-risk group, we have offered those with Gleason > or =7 cancers removable-source high-dose-rate (HDR) brachytherapy in combination with external-beam radiation. PATIENTS AND METHODS: We reviewed the clinical histories of 61 consecutive patients with high-grade clinical stage T1-T2 lesions who received the combination radiation therapy between March 1997 and November 1998. The average Gleason score was 7.5. The HDR brachytherapy was given in three sessions with removable-source afterloaded (192)Ir to a minimum peripheral dose of 6 Gy. Conformal external-beam radiation in 25 fractions to a dose of 50 Gy was given beginning 1 week later. Patients with prostate volumes >40 cc received a luteinizing hormone-releasing hormone analog before brachytherapy. RESULTS: Among the 52 patients available for follow-up (average duration 11.8 months), there has been one death from prostate cancer. After treatment, only one patient had an initial rise in serum prostate specific antigen (PSA) concentration. In addition to the patient who died, there have been three confirmed treatment failures. Toxicity was mild, with only two patients having RTOG grade 3 or 4 effects. Neither of them required surgery. CONCLUSION: Although long-term results are not available, available data suggest that HDR brachytherapy plus external-beam radiation is at least as effective as any single therapy for high-risk, low-stage prostate cancer. The toxicity is acceptable.     

Late urinary morbidity with high dose prostate brachytherapy as a boost to conventional external beam radiation therapy for local and locally advanced prostate cancer

PURPOSE: Late urinary retention (UR) is a known complication that may occur when using high dose rate brachytherapy (HDR-B) to boost external beam radiation therapy (EBRT) when treating prostate cancer. However, the dosimetric, treatment and clinical factors associated with this complication are not well-known. MATERIALS AND METHODS: From March 1997 to March 2000 a total of 108 patients with local or locally advanced prostate adenocarcinoma were treated with EBRT (45 Gy) and HDR-B as a boost, when 16 to 20 Gy was given in 4 fractions twice daily. Median patient age was 68 years and median followup was 44 months (range 36 to 72). Each implant was performed using 8 to 18 needles with a median active length of 3 cm. Planning ultrasound target volume ranged from 23 to 65 cc. RESULTS: Biological effective doses for the urethral region ranged from 107 to 138 Gy3 (median 113). Crude and 5-year actuarial UR-free survival were 95.4% and 86.2%, respectively. Predictive factors for UR on univariate analysis were age more than 65 years (p = 0.0416), planning ultrasound target volume greater than 35 cc and active length of needles more than 3.5 cm (p = 0.0158). On multivariate analysis by Cox regression age was the only predictive factor (p = 0.027). CONCLUSIONS: HDR-B appears to offer a safe, reproducible and effective method of boosting conventional EBRT in patients with locally advanced prostate cancer. Results with this technology reveal late urinary morbidity rates paralleling those achieved with other forms of treatment, but further long-term followup is still needed to warrant a definitive conclusion.     

后路减压内固定术结合术中~(125)I粒子永久性植入治疗脊柱转移瘤脊髓压迫症

目的观察后路减压内固定术结合术中~(125)I粒子永久性植入治疗脊柱转移瘤脊髓压迫症(MESCC)的疗效。方法回顾性分析2012年1月—2014年12月在本院行后路减压内固定术结合术中~(125)I粒子植入(研究组,n=20)或术后常规放疗(对照组,n=40)的MESCC病例,观察并比较两组患者术后疼痛视觉模拟量表(VAS)评分、卡氏功能状态量表(KPS)评分、神经功能预后、生存期和并发症发生率。结果两组患者术后VAS评分均低于术前(P0.05),KPS评分均高于术前(P0.05)。研究组术后1周、1个月和3个月VAS评分明显低于对照组(P0.05),术后6个月两组VAS评分相近。研究组术后1周和1个月KPS评分明显高于对照组(P0.05),术后3个月、6个月两组KPS评分相近。研究组和对照组术后分别有90.0%(18/20)和75.0%(30/40)的患者具备行走能力,中位生存期分别为7.0个月(95%可信区间:4.3~13.7个月)和6.6个月(95%可信区间:3.8~9.0个月),并发症发生率分别为10.0%(2/20)和15.0%(6/40),两组差异均无统计学意义(P0.05)。结论后路减压内固定术结合术中125I粒子植入治疗MESCC在短期疼痛缓解和一般体力状态改善方面,疗效优于后路减压内固定术联合术后常规放疗。     

Relationship of response to transurethral hyperthermia and prostate volume in BPH patients.

A response to transurethral microwave hyperthermia (TUHT) at 915 MHz and its relationship to prostate volume was examined in 63 poor surgical risk benign prostatic hyperplasia (BPH) patients. All patients had moderate-to-severe obstructive signs and symptoms, and received > or = 5 TUHT one-hour sessions. Treatment temperature was controlled on the urethral surface at 45 degrees C +/- 1 degree C. Follow-up ranged from twelve to forty-four months (mean 18 months). The mean prostate volume was 57 cc (range 10-301 cc). There were 40 patients (63%) with prostate volume < or = 50 cc and 23 (37%) with a volume > 50 cc. Treatment failure was seen in 6 patients (10%). It was 10 percent in 40 patients with smaller glands and 9 percent for those 23 with larger prostates, N.S. at p = 0.49. Subjective treatment response was seen in 58 patients (92%). It was 90 percent for the 40 patients with < or = 50 cc prostates vs. 96 percent for the 23 with > 50 cc prostates, N.S. at p = 0.75. This study suggests that the initial prostate volume is not an important parameter predicting response to TUHT.     

Brachytherapy: a viable alternative in the management of basal meningiomas

Thirteen patients with intracranial meningiomas of the skull base were treated with one or more high-activity iodine-125 seeds. In 11 patients, the seeds were implanted stereotactically under local anesthesia. A minimum dose of 100 to 500 Gy was delivered to the tumor at a dose rate of 5 to 25 cGy/h. Indications for this procedure included recurrence after initial surgery or as the primary modality of treatment in patients who were not candidates for surgery. All 13 patients are alive at a median follow-up of 15 months. Nine of 11 patients (82%) without calcification in their meningiomas achieved complete response. The remaining 4 patients-2 with calcification and 2 without--achieved partial response. No early or late complications were observed. We conclude from our experience that both recurrent and primary meningiomas of the skull base can be treated effectively with permanent iodine-125 brachytherapy.     

INTRA-OPERATIVE IMPLANT BRACHYTHERAPY IN THE MANAGEMENT OF SOFT-TISSUE SARCOMAS

Background : The management of localized soft-tissue sarcomas remains complex. This is a retrospective review of a single institution experience with manual afterloaded brachytherapy following intra-operative implantation of the tumour bed during surgery. Methods : Twelve patients over a 3-year period had resection for localized soft-tissue sarcomas and desmoids with insertion of intra-operative brachytherapy implants combined with resection for localized soft-tissue sarcomas. Manual afterloading of the implant with iridium wires was performed postoperatively in all patients. The low dose rate brachytherapy dose varied from 13 to 20 Gy. Supplementary external beam radiation was administered pre-operatively or postoperatively to bring the total dose of adjuvant irradiation to 60–65 Gy. Results : After a median follow-up period of 29 months, the 3-year local disease-free survival rate was 63%. The 3-year actuarial survival rate was 83%. There were no failures within the high-dose region of the implant, although two patients had locoregional failures adjacent to the tumour bed at the edge of the radiation field. Three patients developed distant metastases. Side effects were noted in five patients. Wound breakdown and delayed wound healing occurred in two patients. One patient required an amputation as a result of chronic non-healing and wound pain. Pathological fractures occurred in two patients. Those patients who did not develop wound breakdown had good cosmetic and functional outcomes. Conclusion : Intra-operative implantation of the tumour bed in combination with tumour resection for soft-tissue sarcomas results in a high degree of local control with acceptable complications. This modality offers the patient a high chance of avoiding a more radical surgical procedure such as limb amputation.