Intraoperative Electron Radiation Therapy Combined with External Beam Radiation Therapy after Gross Total Resection in Extremity Soft Tissue Sarcoma: A European Pooled Analysis

Roeder, Falk; Paoli, Antonino De; Saleh-Ebrahimi, L.; Alldinger, Ingo; Bertola, G.; Boz, G.; Navarria, Federico; Cuervo, M.; Uhl, Matthias; Alvarez, A.; Buechler, Markus W.; Lehner, Burkhard; Debus, Jürgen; Krempien, Robert

doi:10.1245/s10434-018-6787-9

Cited by 15 publications

(48 citation statements)

References 46 publications

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“…Further fine tuning of radiation therapy with regard to an optimal functional outcome may be achieved by the use of alternative boosting techniques (IORT or brachytherapy) in patients at high risk for local failure [19]. Data from a recent European analysis demonstrated a 5-year local control rate of 86% combining EBRT with an IORT boost in an unfavourable patient cohort (29% R1 resections) with good functional outcome [20]. Aside from their high efficacy driven by the use of large single doses, IORT or brachytherapy boosts usually result in much smaller irradiated volumes compared to external-beam boosts, which seems to allow dose escalation without an increase in functional deficits by late side effects.…”

Section: Perioperative Rt In Extremity/trunk Sarcomasmentioning

confidence: 99%

Radiation Therapy in Adult Soft Tissue Sarcoma—Current Knowledge and Future Directions: A Review and Expert Opinion

Roeder

2020

Cancers

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Radiation therapy (RT) is an integral part of the treatment of adult soft-tissue sarcomas (STS). Although mainly used as perioperative therapy to increase local control in resectable STS with high risk features, it also plays an increasing role in the treatment of non-resectable primary tumors, oligometastatic situations, or for palliation. Modern radiation techniques, like intensity-modulated, image-guided, or stereotactic body RT, as well as special applications like intraoperative RT, brachytherapy, or particle therapy, have widened the therapeutic window allowing either dose escalation with improved efficacy or reduction of side effects with improved functional outcome. This review summarizes the current evidence for RT in adult STS including typical indications, outcomes, side effects, dose and fractionation regimens, and target volume definitions based on tumor localization and risk factors. It covers the different overall treatment approaches including RT either as part of a multimodal treatment strategy or as a sole treatment, namely its use as an adjunct to surgery in resectable STS (perioperative RT), as a primary treatment in non-resectable tumors (definitive RT), as a local treatment modality in oligometastatic disease or as palliative therapy. Due to the known differences in clinical course, general treatment options and, consequently, outcome depending on lesion localization, the main part of perioperative RT is divided into three sections according to body site (extremity/trunk wall, retroperitoneal, and head and neck STS) including the discussion of special applications of radiation techniques specifically amenable to this region. The review of the current evidence is accompanied by a summary on ongoing clinical research pointing at future directions of RT in STS.

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Section: Perioperative Rt In Extremity/trunk Sarcomasmentioning

confidence: 99%

Radiation Therapy in Adult Soft Tissue Sarcoma—Current Knowledge and Future Directions: A Review and Expert Opinion

Roeder

2020

Cancers

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“…Dabei lag die Rate an langfristigem Extremitätenerhalt bei 90 %, in 80 % davon mit guter Funktionalität. Diese Ergebnisse konnten kürzlich in einer gepoolten Analyse mehrerer europäischer Zentren an 259 Patienten bestätigt werden [32]. Auch eine Einbindung in komplexe multimodale Konzepte ist möglich.…”

Section: Alternative Boostverfahren Am Beispiel Der Intraoperativen Runclassified

Indikation zur prä-, post- und intraoperativen Strahlentherapie von Liposarkomen des Erwachsenenalters

Roeder

2020

Zentralbl Chir

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ZusammenfassungRadiotherapie ist ein integraler Bestandteil der Behandlung von Weichteilsarkomen des Erwachsenen. Während die Indikationsstellung zur additiven Radiotherapie bisher im Wesentlichen auf den bekannten allgemeinen Prognosefaktoren wie Tumorgröße, Lokalisation, Grading und (antizipiertem) Resektionsrand basierte, rückt der histologische Subtyp jetzt zunehmend in den Vordergrund. Außerdem haben sich die radiotherapeutischen Techniken deutlich weiterentwickelt, sodass eine adäquate Therapie in einigen Lokalisationen überhaupt erst möglich geworden ist. Diese Übersichtsarbeit fasst daher zunächst die allgemeinen radioonkologischen Therapieprinzipien für alle Weichteilsarkome, getrennt für die Hauptlokalisationen Extremitäten/Körperstamm und Retroperitoneum, zusammen. Dabei werden sowohl die vorliegende Evidenz für eine additive Radiotherapie per se als auch das optimale Timing (prä- vs. postoperativ) sowie grundlegende technische Prinzipien einschl. alternativer Boostverfahren wie der intraoperativen Radiotherapie erörtert. Weiterhin liegt ein besonderer Schwerpunkt auf der Indikation und Durchführung einer additiven Radiotherapie bei Liposarkomen. Hierzu werden sowohl die grundlegenden Unterschiede zwischen Liposarkomen und anderen Weichteilsarkomen als auch zwischen den einzelnen Subgruppen der Liposarkome (gut differenziert, dedifferenziert, myxoid und pleomorph) dargestellt und ihre Implikationen auf Indikationsstellung und Durchführung einer additiven Radiotherapie mit dem Ziel einer übersichtlichen Orientierungshilfe erörtert.

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“…In this issue of Annals of Surgical Oncology, Roeder et al present the results of a large European pooled analysis of patients treated with intraoperative electron radiation therapy (IORT) combined with external beam radiation therapy (EBRT) after gross total resection of extremity soft tissue sarcoma. 1 The authors offer compelling, confirmatory evidence that this treatment strategy yields high rates of local tumor control with excellent rates of preserved limb function.…”

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confidence: 92%

Fine Tuning the Radiation Treatment for Extremity Soft Tissue Sarcomas

DeLaney

2018

Ann Surg Oncol

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Intraoperative Electron Radiation Therapy Combined with External Beam Radiation Therapy after Gross Total Resection in Extremity Soft Tissue Sarcoma: A European Pooled Analysis

Cited by 15 publications

References 46 publications

Radiation Therapy in Adult Soft Tissue Sarcoma—Current Knowledge and Future Directions: A Review and Expert Opinion

Radiation Therapy in Adult Soft Tissue Sarcoma—Current Knowledge and Future Directions: A Review and Expert Opinion

Indikation zur prä-, post- und intraoperativen Strahlentherapie von Liposarkomen des Erwachsenenalters

Fine Tuning the Radiation Treatment for Extremity Soft Tissue Sarcomas

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