Soft tissue sarcomaIntraoperative electron radiation therapy combined with external beam radiation therapy and limb sparing surgery in extremity soft tissue sarcoma: a retrospective single center analysis of 183 cases
Section snippets
Materials and methods
We conducted a retrospective evaluation of 301 patients with extremity STS who have been treated with IOERT at our institution since 1991. Patients were eligible for the analysis if they suffered from primary or recurrent extremity STS (according to WHO), had received gross total limb-sparing surgery (documented pathological margin) and IOERT at our institution and had received additional (pre- or postoperative) EBRT in conventional fractionation. Patients with metastasectomy prior or during
Results
The median follow-up for the entire cohort was 64 months (6–231 months) and 78 months in surviving patients. Surgery resulted in free margins in 125 patients (68%), while 58 patients (32%) showed microscopically positive margins.
The estimated 5- and 10-year-LC rates for the entire cohort were 86% and 84%, respectively (Fig. 1). Median time to onset of a local recurrence was 20 months (5–88 months). LC was significantly associated with resection margin, primary vs recurrent situation and grading in
Discussion
Here we report the largest series of patients with extremity STS treated with a combination of limb-sparing surgery, IOERT and EBRT. Using this approach, we observed encouraging results in terms of LC (5-year-rate 86%), DC (68%) and OS (77%) with acceptable postoperative complications and limited late toxicity transferring into high rates of limb preservation (95%) with good functional outcome in the majority of patients (83%).
Our results are in line with other major retrospective series using
Conflict of interest statement
All authors declare no conflicts of interest.
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Cited by (32)
Validation of Monte Carlo-based calculations for megavolt electron beams for IORT and FLASH-IORT
2022, HeliyonCitation Excerpt :It allows a single dose of radiation to be administered directly to the tumour whilst displacing normal tissue and organs [3]. IORT treatment has been described for rectal cancer, soft tissue sarcoma, pancreatic cancer and also for the conservative therapy of breast cancer [4, 5, 6]. During the last years, recommendations have been published on the IORT with electrons in breast cancer [7], borderline-resected pancreatic cancer [8], soft tissue sarcoma [9] and rectal cancer [10].
Surgical resection, intraoperative radiotherapy and immediate plastic reconstruction: A good option for the treatment of distal extremity soft tissue sarcomas
2020, Reports of Practical Oncology and RadiotherapyCommissioning, dosimetric characterization and machine performance assessment of the LIAC HWL mobile accelerator for Intraoperative Radiotherapy
2020, Zeitschrift fur Medizinische PhysikIntraoperative radiation therapy (IORT) for soft tissue sarcoma – ESTRO IORT Task Force/ACROP recommendations
2020, Radiotherapy and OncologyCitation Excerpt :Those results seem at least equal to major non-IORT series, reporting 5-year LC rates of 83–93% [11,39–47], especially considering the higher proportions of patients with unfavourable prognostic factors in the IORT series [4]. Aside from direct oncological outcomes, IORT-containing approaches result consistently in very high limb preservation rates (81–100%) [4,26,27–31,33,35–37] with good functional outcome (59–100%) [4,27–29,33,35,36]. This might be attributed to the smaller high-dose volume compared to an EBRT boost, as field size was clearly associated with increased late toxicity in a randomized trial using EBRT alone [15].
A systematic review of functional outcomes after nerve reconstruction in extremity soft tissue sarcomas: A need for general implementation in the armamentarium
2020, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :While motor defects may also be reconstructed using tendon transfers or free-functioning muscle transfers, sensory loss can only be compensated with nerve reconstructions.61 Furthermore, after the resection of nerves, neuropathic pain is not rare in STS.62,63 One study reported a prevalence of 25% of surgically treated sarcomas.63
- 1
Addresses ‘a (F. Roeder, R. Krempien, M. Bischof)’, ‘b (F. Roeder, L. Saleh-Ebrahimi)’ and ‘c (F.W. Hensley)’ are former departments of respective authors.