Intraoperative Radiotherapy in the Management of Locally Recurrent Extremity Soft Tissue Sarcoma

Abstract

Purpose. To investigate the efficacy and morbidity of limb-sparing surgery with intraoperative radiotherapy (IORT) for patients with locally recurrent extremity soft tissue sarcoma (ESTS). Methods and Materials. Twenty-six consecutively treated patients were identified in a single institution retrospective analysis of patients with locally recurrent ESTS treated with IORT following salvage limb-sparing resection from May 2000 to July 2011. Fifteen (58%) patients received external beam radiotherapy (EBRT) prior to recurrence (median dose 63 Gy), while 11 (42%) patients received EBRT following IORT (median dose 52 Gy). The Kaplan-Meier product limit method was used to estimate disease control and survival and subsets were compared using a log rank statistic, Cox's regression model was used to determine independent predictors of disease outcome, and toxicity was reported according to CTCAE v4.0 guidelines. Results. With a median duration of follow-up from surgery and IORT of 34.9 months (range: 4 to 139 mos.), 10 patients developed a local recurrence with 4 subsequently undergoing amputation. The 5-year estimate for local control (LC) was 58% (95% CI: 36–75%), for amputation-free was 81% (95% CI: 57–93%), for metastasis-free control (MFC) was 56% (95% CI: 31–75%), for disease-free survival (DFS) was 35% (95% CI: 17–54%), and for overall survival (OS) was 50% (95% CI: 24–71%). Prior EBRT did not appear to influence disease control (LC, p = 0.74; MFC, p = 0.66) or survival (DFS, p = 0.16; OS, p = 0.58). Grade 3 or higher acute and late toxicities were reported for 6 (23%) and 8 (31%) patients, respectively. The frequency of both acute and late grade 3 or higher toxicities occurred equally between patients who received EBRT prior to or after IORT. Conclusions. IORT in combination with oncologic resection of recurrent ESTS yields good rates of local control and limb-salvage with acceptable morbidity. Within the limitations of small subsets, these data suggest that prior EBRT does not significantly influence disease control or toxicity.

Intraoperative radiation therapy in non-breast cancer patients: A report of 26 cases from Shiraz, south of Iran

“…Although the outcome after recurrence is less favorable than primary sarcomas, the treatment protocols are the same as the primary tumors. In those patients with recurrent sarcoma of extremities, surgery and reirradiation, if possible, is the treatment of choice, but reirradiation has severe toxicities (9).…”

“…Estimated 5 years' local control was 58%. The main acute and late significant side effects were musculoskeletal related (9). We had 4 cases of lower extremity sarcoma who received IORT due to recurrence.…”

The role of radiotherapy in adult soft tissues sarcoma of the extremities

“…Several studies in literature have shown how the combination of limb sparing surgery, IORT and EBRT proved very high 5-year LC rates, 82–97% [ 37 ], 38 , furthermore associated with high limb preservation rates and good functional outcomes [ 37 , 38 ]. The good functional results are probably due to the fact that radiosensitive structures or organs at risk (like major nerves or skin) can be spared from the field of irradiation.…”

Value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in assessment of response to preoperative chemotherapy in pediatric sarcoma

“…A timely noninvasive evaluation of response to chemotherapy is recommended to improve patient management and to avoid unnecessary toxicity and costs. Sarcomas can also be adequately controlled with surgical excision and adjuvant radiotherapy [6].…”