Long‐term experience with intraoperative electron radiation therapy boost in extremity sarcoma

Abstract

Background In patients with extremity soft tissue sarcoma (eSTS), we describe outcomes of preoperative external beam radiation therapy (EBRT), limb‐sparing surgery (LSS), and intraoperative electron radiation therapy (IOERT). Methods One hundred and eighteen patients with eSTS treated between October 17, 2002 and July 28, 2021 were identified. EBRT was delivered preoperatively followed by LSS and IOERT. Results The median follow‐up was 24.9 months. The presentation was primary in 102 (94%) patients and recurrent in 6 (6%) patients. Tumor location was lower extremity in 82 (76%) patients and upper extremity in 26 (24%) patients. Stage distribution was as follows: 3 (3%) IA, 24 (22%) IB, 31 (29%) II, 24 (22%) IIIA, and 25 (23%) IIIB. Final surgical margins were negative in 96 (89%) patients. The 5‐year local control, failure‐free survival, and overall survival were 94%, 75%, and 64%, respectively. Univariate analysis identified age >50, lower extremity, and higher grade as significant negative prognostic factors for overall survival. Grade 3 fracture or osteoradionecrosis requiring surgical fixation, neuropathy, and lymphedema occurred in 7 (6%), 1 (1%), and 0 patients, respectively. Conclusions This study represents one of the largest series using preoperative EBRT, LSS, and IOERT for eSTS, with high local control and a low rate of late severe toxicity.

A novel nomogram and prognostic factor for metastatic soft tissue sarcoma survival

“…For early-stage STS, surgery is often the preferred primary treatment. However, for advanced or locally advanced cases, previous studies have proposed that surgery may be combined with radiation or chemotherapy to optimize therapeutic outcomes compared to surgery alone, such as mastectomy ( 37 , 38 ). Chemotherapy plays a crucial role in STS treatment, employing pharmaceutical intervention to disrupt cancer cell growth and division.…”

What’s New in Musculoskeletal Tumor Surgery

“…The authors also reported good local control and overall survival outcomes, indicating the potential effectiveness of this treatment strategy. Laughlin et al reviewed their long-term experience with an intraoperative electron radiation therapy boost in extremity sarcoma treatment and demonstrated favorable local control rates and overall survival with low rates of toxicity 52 . Finally, Wang et al evaluated the clinical outcomes of patients with localized soft-tissue sarcoma treated with neoadjuvant chemoradiotherapy or radiation therapy 53 .…”