Clinical investigation
Sarcoma
Intraoperative electron-beam therapy for primary and recurrent retroperitoneal soft-tissue sarcoma

https://doi.org/10.1016/j.ijrobp.2006.01.028Get rights and content

Purpose: This study assesses the long-term outcome of patients with retroperitoneal soft-tissue sarcomas treated by maximal resection in combination with intraoperative electron-beam therapy (IOERT) and postoperative external-beam radiotherapy.

Methods and Materials: From 1991 to 2004, 67 patients were treated with curative intent for primary (n = 26) or recurrent (n = 41) retroperitoneal soft-tissue sarcoma. All patients underwent maximal resection in combination with IOERT (mean dose, 15 Gy), 45 patients underwent additional postoperative EBRT, and 20 patients were previously irradiated.

Results: The 5-year actuarial overall survival (OS), disease-free survival, local control (LC), and freedom from metastatic disease of all patients was 64%, 28%, 40%, and 50%, respectively. The 5-year LC inside the IOERT field was 72%. For patients who completed IOERT and EBRT after R0-resection 5-year and 10-year OS was 80%, and 5-year and 10-year LC was 100%. Only 1 of the 21 patients after R0-resection and only 8 of 34 patients after R1-resection compared with 9 of 12 patients after R2-resection experienced inside IOERT–field relapse. Grade II or higher late complications were seen in 21% of the patients, but only 2 patients required surgical intervention because of late complications.

Conclusion: In selected patients, IOERT results in excellent local control and survival, with acceptable morbidity.

Introduction

The retroperitoneal space is the site of origin for 15% to 20% of soft-tissue sarcomas (STSs) (1, 2). Patients affected often present with large, locally advanced tumors, as symptoms occur late because of the general mobility of the retroperitoneal viscera and the large volume of space available for organ displacement. Complete surgical resection remains the mainstay of treatment but is possible in less than 70% of patients who present with primary disease (2, 3). Moreover, as a consequence of the aforementioned late tumor presentation, wide surgical resection with microscopically negative margins is usually not possible (4). Consequently, local recurrence rates are high (5, 6, 7, 8).

Randomized trials have demonstrated that the addition of radiation to surgery unequivocally improves local tumor control for patients with extremity and superficial trunk STSs (3, 9, 10). This finding has led to considerable interest in the use of surgery plus radiation for patients with retroperitoneal STSs (2). The efficacy of postoperative external-beam irradiation (EBRT) is limited by the inability to deliver adequate doses of irradiation on account of the dose tolerance limits of small bowel, spinal cord, stomach, kidney, and liver (11). The experience with extremity STSs shows that a high probability of local control can be achieved with doses of 60 to 70 Gy (12, 13). Intraoperative electron-beam radiotherapy (IOERT) in combination with EBRT and surgery has been used in the management of these tumors to overcome these dose limitations (14, 15, 16, 17, 18, 19). This report reviews the results of the combination of maximal resection with IOERT and postoperative EBRT in 67 consecutive patients treated with curative intent for primary and recurrent retroperitoneal STS.

Section snippets

Patients and methods

Between 1991 and 2004, more than 1,300 patients were treated with an intraoperative electron boost (IOERT) in Heidelberg, 320 of which suffered from STSs. These tumors were located in the retroperitoneal space in 67 cases of traceable adult patients. Preoperative investigation included physical examination and computerized tomography (CT) or magnetic resonance imaging (MRI) of the tumor site, the chest, and the abdomen. Indication for IOERT plus EBRT in patients with retroperitoneal STS is

Results

All patients underwent maximal tumor resection and IOERT; 31% had a complete resection (R0), 51% had microscopically residual disease (R1), and 18% had macroscopically residual tumor (R2). For the entire group of patients, the 1-year, 2-year, 5-year, and 10-year actuarial overall survival rates were 91%, 83%, 64%, and 58%, respectively (Fig. 1). The only factor with significant impact on survival was resection status, with a 5-year overall survival of 87% for R0-resected patients and 50% for

Discussion

The present retrospective analysis was performed from a compiled database of 67 consecutive patients with primary or recurrent retroperitoneal sarcomas, seen in a single institution between 1991 and 2003, with the same and predefined treatment policy. The overall survival rate at 10 years after combined definitive surgery, IOERT, and EBRT was 58%, and the 5-year disease-free survival and local recurrence–free survival was 28% and 40%, respectively. The results, considering the patients

References (31)

  • J.E. Tepper et al.

    Radiation therapy of retroperitoneal soft tissue sarcomas

    Int J Radiat Oncol Biol Phys

    (1984)
  • E.G. Shaw et al.

    Peripheral nerve and ureteral tolerance to intraoperative radiation therapyclinical and dose-response analysis

    Radiother Oncol

    (1990)
  • K.M. Alektiar et al.

    High-dose-rate intraoperative radiation therapy (HDR-IORT) for retroperitoneal sarcomas

    Int J Radiat Oncol Biol Phys

    (2000)
  • P.W.T. Pisters

    Soft tissue sarcoma

  • W.M. Mendenhall et al.

    Retroperitoneal soft tissue sarcoma

    Cancer

    (2005)
  • Cited by (0)

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