Soft tissue sarcoma
Intraoperative 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

https://doi.org/10.1016/j.radonc.2015.11.014Get rights and content

Abstract

Background and purpose

To report our experience with limb-sparing surgery, IOERT and EBRT in extremity STS.

Materials and methods

183 patients were retrospectively analyzed. 78% presented in primary situation, with 80% located in the lower limb. Stage at presentation was: I: 6%, IIa: 25%, IIb: 21%, III: 42%, IV: 7%. The majority showed high-grade lesions (grade 1: 5%, 2: 31%, 3: 64%). IOERT was applied to the tumor bed (median 15 Gy) and preceded (9%) or followed (91%) by EBRT (median 45 Gy) in all patients.

Results

Median follow-up was 64 months (78 months in survivors). Surgery was complete in 68%, while 32% had microscopic residual disease. 5- and 10-year-LC was 86% and 84%, respectively. LC was significantly higher in primary compared to recurrent disease and tended to be higher after complete resection. Estimated 5- and 10-year-DC was 68% and 66%, while corresponding OS was 77% and 66%, respectively. OS was significantly affected by grading and stage. Severe postoperative complications and late toxicities were observed in 19% and 20%, respectively. Limb-preservation rate was 95% with good function in 83%.

Conclusions

Combination of limb-sparing surgery, IOERT and EBRT achieved encouraging LC and OS in this unfavorable patient group with acceptable postoperative complications and low rates of late toxicities resulting in a high limb-preservation rate and good functional outcome.

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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