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Objective: To investigate the safety and efficacy of permanent brachytherapy (BRT) delivered via implantation of ¹²⁵I seeds embedded in mesh (mesh BRT) following resection of deep cavity soft tissue sarcomas (STS).
Design: Retrospective case series, median follow-up of 26 months
Setting: Tertiary academic medical center
Patients: Forty-seven patients with STS involving the abdomen, chest or trunk treated with surgery and mesh BRT from 2000 to 2010 were retrospectively reviewed.
Interventions: All patients underwent resection followed by implantation of permanent ¹²⁵I seeds (0.25 to 0.60 Ci, half-life 60 d) in a mesh carrier. ¹²⁵I seeds contained within polygactin suture were threaded into absorbable polygactin woven mesh which was then sutured to the tumor bed.
Main Outcome Measures: Local recurrence rates within the tumor bed covered by mesh (“in field” recurrences) were identified. Associated post-operative complications were graded based on severity.
Results: “In-field” local recurrences were observed in 5 patients (11%). Post-operative complications were observed in 22 (47%) patients. Eleven (23%) patients developed grade III/IV complications resulting in percutaneous intervention in 6 patients and re-operation in 5 patients (Table 1). No patients required excision of the implanted mesh. There were no post-operative deaths.
Conclusions: Implantation of ¹²⁵I mesh BRT following surgery for deep cavity STS results in very low local recurrence rates, comparable to those for more traditional catheter BRT for extremity STS. However, this benefit should be weighed against the potential morbidity of the complications requiring intervention in nearly a quarter of the patients.

TABLE 1. List of complications and management in 22/47 (47%) patients (n = 30)
Complication (grade)	n
Seroma
No intervention (I)	2
Drainage in clinic (I)	1
Percutaneous drainage (III)	2
DVT/PE
Systemic anticoagulation (II)	5
Abscess
No intervention (II)	1
Operative intervention (III)	2
Percutaneous drainage (III)	1
Ileus/bowel obstruction
No intervention (I)	2
Operative intervention (III)	2
Ascites
No intervention (I)	1
Percutaneous drainage (III)	2
Hematoma
No intervention (II)	1
Operative intervention (III)	1
Enterocutaneous fistula
Total parental nutrition (II)	1
Operative intervention (III)	1
Wound infection
Antibiotic treatment (II)	1
Limb amputation (IV)	1
Pancreatic leak
Percutaneous drainage (III)	1
Axillary artery pseudoaneurysm
Endovascular stenting (III)	1
Pleural effusion
No intervention (I)	1
DVT indicates deep venous thrombosis; PE, pulmonary embolus