Intraoperative Radiotherapy of Soft Tissue Sarcoma of the Extremity

Abstract

In patients with high-risk soft tissue sarcomas, IORT +/- EBRT after limb-preserving surgery achieves high local control rates. The risk of normal tissue toxicities is comparable to conventional limb-sparing treatment.

Excellent Local Control With IOERT and Postoperative EBRT in High-Grade Extremity Sarcoma: Results From a Subgroup Analysis of a Prospective Trial

“…These results seem to compare favourably with major retrospective series using similar combinations of intraoperative and external beam radiation therapy (see Table 6, [13][14][15][16][17][18], which reported consistently 5-year local control rates of 80-90%, although keeping in mind that the percentage of incomplete resections in our trial was lower than in most of these series (12% vs. 39-58%). This might be at least partly attributable to the use of neoadjuvant chemotherapy, although major responses according to RECIST criteria were rare.…”

“…Intraoperative radiation therapy is a treatment technique, which has been developed for dose escalation in body regions, where such doses are hardly achievable with external beam radiotherapy alone because of adjacent organs at risk which much lower tolerance than in extremity regions. However intraoperative radiation therapy has been introduced by several groups including ours also in the treatment of extremity tumors [13][14][15][16] to replace the external beam boost mainly because of its unique opportunity to guide a high single dose directly to the high risk region for close or positive margins under visual control during surgery. Further advantages in comparison to an external boost include at least theoretically smaller field sizes (because safety margins for daily positioning errors can be omitted), the possibility to exclude organ at risk like major nerves or skin from the irradiation field and the reduction of overall treatment time.…”

Extremity and Trunk Soft-Tissue Sarcomas

“…Kretzler et al evaluated a series of 28 patients with extremity soft-tissue sarcomas from Munich for outcome after IORT [53]. These patients were treated between June 1989 and June 1999 for localized sarcomas as part of an interdisciplinary treatment plan and were all felt to be at high risk for local relapse.…”

Bösartige Weichgewebsgeschwülste

“…auch unter Einschluss von präoperativen hyperthermen Perfusionsverfahren mit TNF-α (TNF: Tumornekrosefaktor, letzteres Verfahren ist noch als klinisch experimentell zu bezeichnen) oder intraoperativer bzw. prä-oder postoperativer Radiotherapie anzustreben [1,7,12,16,17,25,31].…”