Intraoperative Brachytherapy Insertion, Planning and Removal

1. Soft Tissue Sarcoma
Brachytherapy
Dr Manish Chandra
Radiation Oncologist
Jupiter Hospital, Thane

2. History and Examination
• 38 yr old male with H/O retinal detachment since age of 20 yrs
• On treatment for retinal detachment at other centre
• Presented with gradually increasing swelling on left mid thigh for
about 7 -8 months gradually increasing
• No other comorbidity
• 8 x 6 cm in upper part of left thigh with restricted mobility, skin over
the mass appeared normal

3. MRI Left Thigh
• 5 x 4.8 x 8 cm in muscle belly of
sartorius in left upper thigh, it
was in close relation with deep
femoral vessels with no sign of
encasement or invasion. It was
not invading in to any other
muscle and was confined to
sartorius belly only

4. MRI

5. Biopsy
• Mixoid Liposarcoma

6. Surgery Planned
• Wide Local Excision of lesion with brachytherapy catheter insertion
under Spinal Anaesthesia
• Excision was done and it was well encapsulated
• Tumor bed was identified and surgical clips were placed to mark
boundary of tumor bed and base
• Femoral neurovascular structure were identified
• It was burried to avoid direct contact with catheters

7. Final HPR
• Gross: Glistening white tumor seen measuring 10 x 6 x 4 cm
• Cut margins are >1 cm away
• Microscopy: Mixoid Liposarcoma, Grade I; tumor with lipoblasts and
mature adipocytes, chicken wire pattern of vascular arrangement and
myxoid stroma; tumor invades adjacent skeletal muscle; no necrosis
and mitosis seen;
• IHC: MDM2; S100: focally positive; CD34: Positive

8. Burying the neurovascular bundle

9. Placement of Catheters

10. Placement of Catheters

11. Planning Images

12. Planning Images

13. Before Removal

14. After Removal

15. THANK YOU

16. Thank You