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Intraoperative Electron Radiation Therapy Combined with External Beam Radiation Therapy after Gross Total Resection in Extremity Soft Tissue Sarcoma: A European Pooled Analysis

  • Sarcoma
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Abstract

Introduction

We report a pooled analysis evaluating the combination of gross complete limb-sparing surgery, intraoperative electron radiation therapy (IOERT), and external beam radiation therapy (EBRT) in patients with extremity soft tissue sarcoma (STS).

Methods

Individual data of 259 patients (median follow-up 63 months) with extremity STS from three European expert centers were pooled. Median age was 55 years and median tumor size was 8 cm. Eighty percent of patients presented with primary disease, mainly located in the lower limb (81%). Union for International Cancer Control 7th edition stage at presentation was as follows: stage I: 9%; stage II: 47%; stage III: 39%; stage IV: 5%. Most patients showed high-grade lesions (91%), predominantly liposarcoma (31%). Median IOERT dose was 12 Gy, preceeded (17%) or followed (83%) by EBRT, with a median dose of 45 Gy.

Results

Surgery resulted in R0 resections in 71% of patients and R1 resections in 29% of patients. The 5-year local control (LC) rate was 86%, and significant factors in univariate analysis were disease status and resection margin. Only margin remained significant in multivariate analysis. The 5-year distant control rate was 69%, and significant factors in univariate analysis were histology, grading, resection margin, and metastases prior to/at IOERT. Only grading and metastases remained significant in multivariate analysis. Actuarial 5-year rates of freedom from treatment failure and OS were 61% and 78%, respectively. Significant factors for OS were grading and metastases prior to/at IOERT (univariate, multivariate). Limb preservation and good functional outcome were achieved in 95% and 81% of patients.

Conclusions

Our pooled analysis confirmed prior reports of encouraging LC and survival, with excellent rates of preserved limb function with this treatment approach. Resection margin remained the most important factor for LC, while grading and metastases prior to/at IOERT mainly predicted survival.

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Acknowledgment

The authors thank Alexandra Diwo and Christiane Boos for their assistance in data handling and database management. No writing assistance was involved.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital LMU Munich, Munich, Germany

    Falk Roeder MD

  2. CCU Molecular and Radiation Oncology, German Cancer Research Center, Heidelberg, Germany

    Falk Roeder MD

  3. Department of Radiation Oncology, National Cancer Institute, CRO, Aviano, Italy

    Antonino de Paoli MD, Giovanni Boz MD & Federico Navarria MD

  4. Strahlentherapie Freising und Dachau, Dachau, Germany

    Ladan Saleh-Ebrahimi MD

  5. CPZ Düsseldorf, Düsseldorf, Germany

    Ingo Alldinger MD

  6. Department of Surgical Oncology, National Cancer Institute, CRO, Aviano, Italy

    Giulio Bertola MD

  7. Musculoskeletal Tumor Unit, University Hospital Gregorio Maranon, Complutense University, Madrid, Spain

    Miguel Cuervo MD

  8. Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany

    Matthias Uhl MD & Juergen Debus MD, PhD

  9. Department of Radiation Oncology, University Hospital Gregorio Maranon, Complutense University, Madrid, Spain

    Ana Alvarez MD & Felipe A. Calvo MD

  10. Department of Surgery, University of Heidelberg, Heidelberg, Germany

    Markus Buechler MD

  11. Department of Orthopedics and Traumatology, University of Heidelberg, Heidelberg, Germany

    Burkhard Lehner MD

  12. CCU Radiation Oncology, German Cancer Research Center, Heidelberg, Germany

    Juergen Debus MD, PhD

  13. Department of Radiotherapy, Helios Hospital Berlin-Buch, Berlin, Germany

    Robert Krempien MD

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  1. Falk Roeder MD
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  14. Felipe A. Calvo MD
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Correspondence to Falk Roeder MD.

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Conflict of interest

Falk Roeder, Antonino de Paoli, Ladan Saleh-Ebrahimi, Ingo Alldinger, Giulio Bertola, Giovanni Boz, Federico Navarria, Miguel Cuervo, Matthias Uhl, Ana Alvarez, Markus Buechler, Burkhard Lehner, Juergen Debus, Felipe A. Calvo, and Robert Krempien declare no conflicts of interest.

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Roeder, F., de Paoli, A., Saleh-Ebrahimi, L. et al. Intraoperative Electron Radiation Therapy Combined with External Beam Radiation Therapy after Gross Total Resection in Extremity Soft Tissue Sarcoma: A European Pooled Analysis. Ann Surg Oncol 25, 3833–3842 (2018). https://doi.org/10.1245/s10434-018-6787-9

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