Salvage surgery and radiotherapy including intraoperative electron radiotherapy in isolated locally recurrent tumors: Predictors of outcome
Cambeiro M (1), Calvo FA (2), Aristu JJ (3), Jimenez MM (3), San-Julian M (4), Alcalde J (5), Hernandez-Lizoain JL (6), Jurado M (7), Martínez-Monge R (3).
(1) Department of Oncology, University of Navarre, Pamplona, Spain.
(2) Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
(3) Department of Oncology, University of Navarre, Pamplona, Spain.
(4) Department of Orthopaedic Surgery, University of Navarre, Pamplona, Spain.
(5) Department of Head and Neck Surgery, University of Navarre, Pamplona, Spain.
(6) Department of General Surgery, University of Navarre, Pamplona, Spain.
(7) Department of Gynaecology, University of Navarrena, Pamplona, Spain.
Magazine: Radiotherapy and Oncology
Date: Aug 1, 2015Orthopedic Surgery and Traumatology [SP] Otorhinolaryngology Radiation Oncology General and Digestive Surgery Gynaecology and Obstetrics
To evaluate the influence of equivalent dose (EQD2) in clinical outcomes of patients with isolated locally recurrent tumors (ILRT), treated with salvage surgery and intra-operative electron beam radiation therapy (IOERT).
METHODS AND MATERIALS
We retrospectively reviewed 128 patients with non-metastatic ILRT of different tissues (soft tissue sarcomas, head and neck, uterine, and colorectal). Patients had received salvage surgery (R0/R1/R2) and IOERT. Previously not irradiated patients had received additional external beam radiation therapy (EBRT).
IOERT was delivered at a median dose of 15 Gy (range, 5-25 Gy). Seventy-five patients (60.9%) received additional EBRT of 46 Gy. Median EQD2 of salvage program was 62 Gy and median EQD2 of exclusive IORT was 31.2 Gy. Median follow-up was 19.2 months (range: 1.3-220).
Thirty-one patients (24.2%) developed severe (grade 3-5) complications. New locoregional recurrence was documented in 86 (67.2%) of the 123 cases. Five-year rates were 31% for locoregional control, 57% for distant metastasis-free and 31% for overall survival. On multivariate analysis, R0-1 vs. R2 resection (HR 2.2, 95 CI: 1.2-4.1) was statistically significant for locoregional recurrence and EQD2 ⩾62 Gy for survival (HR 2.2, 95 CI: 1.1-4.1).
Surgical radicality (gross macroscopic resection) and radiation dose (EQD2 ⩾62 Gy in radiation salvage program) are the dominant prognostic factors beside ILRT histology. Modest rates of long-term disease control are expected when both factors are fulfilled.
CITATION Radiother Oncol. 2015 Aug;116(2):316-22. doi: 10.1016/j.radonc.2015.07.009. Epub 2015 Jul 28.
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