Erschienen in:
01.10.2014 | Original article
Limb-sparing management with surgical resection, external-beam and intraoperative electron-beam radiation therapy boost for patients with primary soft tissue sarcoma of the extremity
A multicentric pooled analysis of long-term outcomes
verfasst von:
Felipe A. Calvo, M.D., Ph.D., Claudio V. Sole, M.D., Alfredo Polo, M.D., Ph.D., Mauricio Cambeiro, M.D., Ph.D., Angel Montero, M.D., Ana Alvarez, M.D., Miguel Cuervo, M.D., Mikel San Julian, M.D., Rafael Martinez-Monge, M.D., Ph.D.
Erschienen in:
Strahlentherapie und Onkologie
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Ausgabe 10/2014
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Abstract
Background or purpose
A joint analysis of data from three contributing centres within the intraoperative electron-beam radiation therapy (IOERT) Spanish program was performed to investigate the main contributions of IORT to the multidisciplinary treatment of high-risk extremity soft tissue sarcoma (STS).
Methods and materials
Patients with an histologic diagnosis of primary extremity STS, with absence of distant metastases, undergoing limb-sparing surgery with radical intent, external beam radiotherapy (median dose 45 Gy) and IOERT (median dose 12.5 Gy) were considered eligible for participation in this study.
Results
From 1986–2012, a total of 159 patients were analysed in the study from three Spanish institutions. With a median follow-up time of 53 months (range 4–316 years), 5-year local control (LC) was 82 %. The 5-year IOERT in-field control, disease-free survival (DFS) and overall survival (OS) were 86, 62 and 72 %, respectively. On multivariate analysis, only microscopically involved margin (R1) resection status retained significance in relation to LC (HR 5.20, p < 0.001). With regard to IOERT in-field control, incomplete resection (HR 4.88, p = 0.001) and higher IOERT dose (≥ 12.5 Gy; HR 0.32, p = 0.02) retained a significant association in multivariate analysis.
Conclusion
From this joint analysis emerges the fact that an IOERT dose ≥ 12.5 Gy increases the rate of IOERT in-field control, but DFS remains modest, given the high risk of distant metastases. Intensified local treatment needs to be tested in the context of more efficient concurrent, neo- and adjuvant systemic therapy.