Adjuvant
radiation therapy by the
brachytherapy technique has been suggested by us to diminish local recurrence following resection of extremity and superficial truncal
soft-tissue sarcoma. However, loading of the
catheters with radioactive sources on the first through the fifth postoperative days results in a 48% significant
wound-complication rate. Our previous animal experiments would suggest that delay of application of radiation to one week after wounding is accompanied by significant improvement in
wound-breaking strength, new H3
hydroxyproline accumulation, and improved force-tension curves. As part of our ongoing prospective randomized trial of the effects of
brachytherapy on local control, one change was made: the
catheters were loaded five or more days after operation.
Wound complications were then reviewed in 50 patients following this single change in
brachytherapy delivery. Of the 21 patients receiving
brachytherapy, 14% had significant
wound complications; 10% of the 29 patients who did not receive radiation had
wound complications of similar severity. This decrease in
wound complications represents a major improvement over our prior experience and suggests that the timing of radioactive source loading in the postoperative period is a major factor in radiation-induced wound-healing delay.