Clinical investigation: sarcoma
Long-term results of intraoperative electron beam radiotherapy for primary and recurrent retroperitoneal soft tissue sarcoma

https://doi.org/10.1016/S0360-3016(00)01589-3Get rights and content

Abstract

Purpose: This study assesses the long-term outcome of patients with retroperitoneal sarcoma treated by preoperative external beam radiotherapy, resection, and intraoperative electron beam radiation (IOERT).

Methods and Materials: From 1980 to 1996, 37 patients were treated with curative intent for primary or recurrent retroperitoneal soft tissue sarcoma. All patients underwent external beam radiotherapy with a median dose of 45 Gy. This was followed by laparotomy, resection, and IOERT, if feasible. Twenty patients received 10–20 Gy of IOERT with 9–15 MeV electrons. These patients were compared to a group of 17 patients receiving preoperative irradiation without IOERT.

Results: The 5-yr actuarial overall survival (OS), disease-free survival, local control (LC), and freedom from distant disease of all 37 patients was 50%, 38%, 59%, and 54%, respectively. After preoperative irradiation, 29 patients (78%) underwent gross total resection. For 16 patients undergoing gross total resection and IOERT, OS and LC were 74% and 83%, respectively. In contrast, these results were less satisfactory for 13 patients undergoing gross total resection without IOERT. For these patients, OS and LC were 30% and 61%, respectively. Four patients experienced treatment-related morbidity.

Conclusions: In selected patients, IOERT results in excellent local control and disease-free survival with acceptable morbidity.

Introduction

The treatment of retroperitoneal soft tissue sarcoma by surgery alone has resulted in poor local control and survival 1, 2, 3. Because of the infiltrative nature of these tumors and their anatomic origin, wide resection margins are difficult to achieve. The efficacy of postoperative external beam irradiation (EBRT) is limited by the inability to deliver adequate doses of irradiation secondary to the dose tolerance limits of small bowel, spinal cord, stomach, kidney, and liver. The experience with extremity soft tissue sarcoma shows that a high probability of local control can be achieved with doses of 60 to 70 Gy (4). Intraoperative electron beam radiotherapy (IOERT) in combination with EBRT and surgery has been utilized in the management of these tumors at the Massachusetts General Hospital (MGH) to overcome these dose limitations (5). This report expands and updates our experience with this treatment approach.

Section snippets

Methods and materials

From 1980 to 1996, 37 patients with retroperitoneal sarcoma were treated with curative intent. Of these, 29 patients had primary sarcoma, and 8 patients had recurrent disease. There were 20 women and 17 men treated. The median age was 45 years, with a range of 10 to 84 years. All patients were fully evaluated preoperatively by physical examination and computerized tomography (CT scan) of the chest and abdomen and had no metastatic disease. Surgical procedures before preoperative radiotherapy

Results

After preoperative EBRT, 35 patients (95%) underwent exploratory laparotomy: 29 (79%) had a complete resection, 4 (11%) had a partial resection, and 2 (5%) were found to be unresectable secondary to sarcomatosis. Two patients did not undergo further surgery because of tumor progression during radiotherapy. Twenty of 37 patients received IOERT. IOERT was not administered for the following reasons: sarcomatosis or other metastases (3 patients), tumor progression during EBRT (2 patients), or

Discussion

In the initial publication (5) of the MGH experience in the treatment of retroperitoneal sarcoma using IOERT, 17 of 20 patients were able to undergo resection; of these, 14 had a complete resection. The 4-year actuarial local control and disease-free survival of resectable patients was 81% and 64%, respectively. Of these 17 patients, 12 received IOERT, and 5 did not. Three patients who received IOERT had a local recurrence. The 5 patients who had only EBRT were locally controlled. During the

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