Scientific publications

Intraoperative radiotherapy electron boost followed by moderate doses of external beam radiotherapy in resected soft-tissue sarcoma of the extremities

Azinovic I, Martinez Monge R, Javier Aristu J [SP], Salgado E, Villafranca E, Fernandez Hidalgo O, Amillo S [SP], San Julian M, Villas C [SP], Manuel Aramendía J [SP], Calvo FA.
Department of Oncology, Radiation Oncology Division, Clínica Universitaria, School of Medicine, University of Navarre, Av. Pio XII, 36, 31008 Pamplona, Spain.

Magazine: Radiotherapy and Oncology

Date: Jun 1, 2003

Medical Oncology Orthopedic Surgery and Traumatology [SP] Radiation Oncology

To analyze the patterns of failure and the toxicity profile of intraoperative electron beam radiotherapy (IOERT) after resection of soft tissue sarcomas of the extremities (STS).

Forty-five patients with extremity STS were treated with IOERT and moderate-dose postoperative radiotherapy (45-50 Gy). Twenty-six patients were treated for primary disease (PD) and 19 patients for an isolated recurrence (ILR). Tumor size was >5 cm (maximum diameter) in 36 patients (80%), and high-grade histology in PD patients was present in 14 patients (54%). In nine patients, IOERT was used alone, due to previous irradiation or patient refusal. Chemotherapy (neoadjuvant and/or adjuvant) was mainly given to high-grade tumors.

Nine patients relapsed in the extremity (20%), and 12 patients in distant sites (28%). Actuarial local control at 5 years was 88% for patients with negative/close margins and 57% for patients presenting positive margins (P=0.04). Five patients (11%) developed neuropathy associated with the treatment. Extremity preservation was achieved in 40 patients (88%). With a median follow-up of 93 months (range: 27-143 months) for the patients at risk, 25 patients remain alive (a 7-year actuarial survival rate of 75% for PD and 47% for ILR; P=0.01).

IOERT combined with moderate doses of external beam irradiation yields high local control and extremity preservation rates in resected extremity STS. Peripheral nerves in the IOERT field are dose-limiting structures requiring a dose compromise in the IOERT component to avoid severe neurological damage.

CITATION  Radiother Oncol. 2003 Jun;67(3):331-7

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