OC-0521: IORT after gross total resection combined with EBRT in extremity soft tissue sarcoma: a pooled analysis

Roeder, Falk; Paoli, Antonino De; Alldinger, Ingo; Bertola, G.; Boz, G.; Garcia-Sabredo, J.L.; Uhl, Matthias; Alvarez, A. Valiente; Lehner, Burkhard; Calvo, Francisco Alberto Gimeno; Krempien, Robert

doi:10.1016/s0167-8140(15)40516-x

Cited by 3 publications

(6 citation statements)

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“…Pro IORT Although randomized trials comparing EBRT + IORT versus EBRT alone are not available, retrospective series and the more recent pooled analyses report encouraging results on local control with excellent rates of preserved limb function [4,16]. Our institutional approach will likely continue to include IORT after preoperative EBRT ± chemotherapy in selected patients for limb-sparing surgery in ESTS when close or positive margins of resection are expected.…”

Section: Against Iortmentioning

confidence: 99%

Is there a role for intraoperative radiation therapy in resectable extremity soft tissue sarcoma beyond external beam radiation therapy?

Paoli

Sangalli

Baldi

2017

CBN

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Section: Against Iortmentioning

confidence: 99%

Is there a role for intraoperative radiation therapy in resectable extremity soft tissue sarcoma beyond external beam radiation therapy?

Paoli

Sangalli

Baldi

2017

CBN

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“…In summary, the combination of limb-sparing surgery, IORT and EBRT resulted consistently in excellent 5-year LC rates of 82–97% [5, 6, 29, 30, 35, 36, 39, 40] in patients with extremity STS. Those results are at least equal to major Non-IORT series, which consistently report 5-year LC rates of 83–93% [15, 42–50], especially if the higher proportions of patients with unfavourable prognostic factors in the IORT series are taken into account.…”

Section: Introductionmentioning

confidence: 97%

“…Two groups have performed pooled data analyses so far [39, 40]. The first one, recently published by Calvo et al [40], included 159 patients from three Spanish expert centers.…”

Section: Introductionmentioning

confidence: 99%

“…The second pooled analysis, which has been recently published in abstract form [39], included patients from three european centers (Heidelberg, Madrid, Aviano). After a first attempt including 320 patients, which had been presented at the ISIORT meeting 2008 in Madrid [41], the authors decided to tighten the inclusion criteria similarly to the above mentioned latest series from Heidelberg because of large inhomogeneities in the cohort.…”

Section: Introductionmentioning

confidence: 99%

“…After a first attempt including 320 patients, which had been presented at the ISIORT meeting 2008 in Madrid [41], the authors decided to tighten the inclusion criteria similarly to the above mentioned latest series from Heidelberg because of large inhomogeneities in the cohort. The actual analysis, presented at the ISIORT meeting 2015 in Barcelona [39], comprises 259 patients with extremity STS (as defined by WHO criteria) who received at least gross complete resection, IOERT and additional EBRT. The cohort includes 20% patients already in recurrent situation and 29% patients with microscopically positive margins.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative radiation therapy (IORT) in soft-tissue sarcoma

Roeder

Krempien

2017

Radiat Oncol

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Soft-tissue sarcoma (STS) represent a rare tumor entity, accounting for less than 1% of adult malignancies. The cornerstone of curative intent treatment is surgery with free margins, although the extent of the surgical approach has been subject to change in the last decades. Multimodal approaches usually including radiation therapy have replaced extensive surgical procedures in order to preserve functionality while maintaining adequate local control. However, the possibility to apply adequate radiation doses by external beam radiation therapy (EBRT) can be limited in some situation especially in case of directly adjacent organs at risk with low radiation tolerance. Application of at least a part of the total dose via intraoperative radiation therapy (IORT) with a single fraction during the surgical procedure may overcome those limitations, because radiosensitive structures can be moved out of the radiation field resulting in reduced toxicity while the enhanced biological effectivity of the high single dose improves local control. The current review summarizes rationale, techniques, oncological and functional outcomes including possible pitfalls and associated toxicities based on the published literature for IORT focusing on extremity and retroperitoneal STS. In extremity STS, combination of limb-sparing surgery, IORT and pre- or postoperative EBRT with moderate doses consistently achieved excellent local control rates at least comparable to approaches using EBRT alone but usually including patient cohorts with higher proportions of unfavourable prognostic factors. Further on, IORT containing approaches resulted in very high limb preservation rates and good functional outcome, probably related to the smaller high dose volume. In retroperitoneal STS, the combination of preoperative EBRT, surgery and IORT consistently achieved high local control rates which seem superior to surgery alone or surgery with EBRT at least with regard to local control and in some reports even to overall survival. Further on, preoperative EBRT in combination with IORT seems to be superior to the opposite combination with regard to local control and toxicity. No major differences in wound healing disturbances or postoperative complication rates can be observed with IORT compared to non-IORT containing approaches. Neuropathy of major nerves remains a dose limiting toxicity requiring dose restrictions or exclusion from target volume. Gastrointestinal structures and ureters should be excluded from the IORT area whenever possible and the IORT volume should be restricted to the available minimum. Nevertheless, IORT represents an ideal boosting method if combined with EBRT and properly executed by experiences users which should be further evaluated preferably in prospective randomized trials.

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Surgical resection, intraoperative radiotherapy and immediate plastic reconstruction: A good option for the treatment of distal extremity soft tissue sarcomas

Hanna

Munhoz

Perina

et al. 2020

Reports of Practical Oncology & Radiotherapy

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OC-0521: IORT after gross total resection combined with EBRT in extremity soft tissue sarcoma: a pooled analysis

Cited by 3 publications

References 0 publications

Is there a role for intraoperative radiation therapy in resectable extremity soft tissue sarcoma beyond external beam radiation therapy?

Is there a role for intraoperative radiation therapy in resectable extremity soft tissue sarcoma beyond external beam radiation therapy?

Intraoperative radiation therapy (IORT) in soft-tissue sarcoma

Surgical resection, intraoperative radiotherapy and immediate plastic reconstruction: A good option for the treatment of distal extremity soft tissue sarcomas

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