Intraoperative Radiotherapy in the Management of Locally Recurrent Extremity Soft Tissue Sarcoma.

Authors:
Christopher L Tinkle
Christopher L Tinkle
The Rockefeller University
United States
Vivian Weinberg
Vivian Weinberg
University of California
United States
Steve E Braunstein
Steve E Braunstein
New York University Medical Center
United States
Andrew Horvai
Andrew Horvai
University of California
United States
Thierry Jahan
Thierry Jahan
University of California
United States
Alexander R Gottschalk
Alexander R Gottschalk
University of California San Francisco
United States

Sarcoma 2015 9;2015:913565. Epub 2015 Aug 9.

Department of Radiation Oncology, University of California, San Francisco, 1600 Divisadero Street, MZ Building R H1031, San Francisco, CA 94143, USA.

Purpose. To investigate the efficacy and morbidity of limb-sparing surgery with intraoperative radiotherapy (IORT) for patients with locally recurrent extremity soft tissue sarcoma (ESTS). Methods and Materials. Twenty-six consecutively treated patients were identified in a single institution retrospective analysis of patients with locally recurrent ESTS treated with IORT following salvage limb-sparing resection from May 2000 to July 2011. Fifteen (58%) patients received external beam radiotherapy (EBRT) prior to recurrence (median dose 63 Gy), while 11 (42%) patients received EBRT following IORT (median dose 52 Gy). The Kaplan-Meier product limit method was used to estimate disease control and survival and subsets were compared using a log rank statistic, Cox's regression model was used to determine independent predictors of disease outcome, and toxicity was reported according to CTCAE v4.0 guidelines. Results. With a median duration of follow-up from surgery and IORT of 34.9 months (range: 4 to 139 mos.), 10 patients developed a local recurrence with 4 subsequently undergoing amputation. The 5-year estimate for local control (LC) was 58% (95% CI: 36-75%), for amputation-free was 81% (95% CI: 57-93%), for metastasis-free control (MFC) was 56% (95% CI: 31-75%), for disease-free survival (DFS) was 35% (95% CI: 17-54%), and for overall survival (OS) was 50% (95% CI: 24-71%). Prior EBRT did not appear to influence disease control (LC, p = 0.74; MFC, p = 0.66) or survival (DFS, p = 0.16; OS, p = 0.58). Grade 3 or higher acute and late toxicities were reported for 6 (23%) and 8 (31%) patients, respectively. The frequency of both acute and late grade 3 or higher toxicities occurred equally between patients who received EBRT prior to or after IORT. Conclusions. IORT in combination with oncologic resection of recurrent ESTS yields good rates of local control and limb-salvage with acceptable morbidity. Within the limitations of small subsets, these data suggest that prior EBRT does not significantly influence disease control or toxicity.

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http://dx.doi.org/10.1155/2015/913565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546758PMC

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September 2015
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