Prognostic Value of External Beam Radiation Therapy in Patients Treated With Surgical Resection and Intraoperative Electron Beam Radiation Therapy for Locally Recurrent Soft Tissue Sarcoma: A Multicentric Long-Term Outcome Analysis

Sole, Claudio V.; Cambeiro, Mauricio; Montero, Á.; Polo, Alfredo; González, Carmen González; Cuervo, M.; Julián, Mikel San; García-Sabrido, J.L.; Martı́nez-Monge, Rafael

doi:10.1016/j.ijrobp.2013.10.021

Cited by 16 publications

(13 citation statements)

References 22 publications

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“…In a multi-centric, long-term outcomes analysis by the Spanish Cooperative Initiative [101] for Intraoperative electron radiotherapy, 103 patients were investigated to analyse long-term outcomes of locally recurrent soft-tissue sarcoma (LR-STS) patients treated with a multidisciplinary approach. The 5-year IORT in-field control, disease-free survival (DFS), and overall survival were 73%, 43%, and 52%, respectively.…”

Section: Clinical Results With Iortmentioning

confidence: 99%

Intraoperative radiotherapy: review of techniques and results

Pilar¹,

Gupta²,

Laskar³

et al. 2017

ecancer

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Intraoperative radiotherapy (IORT) is a technique that involves precise delivery of a large dose of ionising radiation to the tumour or tumour bed during surgery. Direct visualisation of the tumour bed and ability to space out the normal tissues from the tumour bed allows maximisation of the dose to the tumour while minimising the dose to normal tissues. This results in an improved therapeutic ratio with IORT. Although it was introduced in the 1960s, it has seen a resurgence of popularity with the introduction of self-shielding mobile linear accelerators and low-kV IORT devices, which by eliminating the logistical issues of transport of the patient during surgery for radiotherapy or building a shielded operating room, has enabled its wider use in the community.Electrons, low-kV X-rays and HDR brachytherapy are all different methods of IORT in current clinical use. Each method has its own unique set of advantages and disadvantages, its own set of indications where one may be better suited than the other, and each requires a specific kind of expertise.IORT has demonstrated its efficacy in a wide variety of intra-abdominal tumours, recurrent colorectal cancers, recurrent gynaecological cancers, and soft-tissue tumours. Recently, it has emerged as an attractive treatment option for selected, early-stage breast cancer, owing to the ability to complete the entire course of radiotherapy during surgery. IORT has been used in a multitude of roles across these sites, for dose escalation (retroperitoneal sarcoma), EBRT dose de-escalation (paediatric tumours), as sole radiation modality (early breast cancers) and as a re-irradiation modality (recurrent rectal and gynaecological cancers).This article aims to provide a review of the rationale, techniques, and outcomes for IORT across different sites relevant to current clinical practice.

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Section: Clinical Results With Iortmentioning

confidence: 99%

Intraoperative radiotherapy: review of techniques and results

Pilar¹,

Gupta²,

Laskar³

et al. 2017

ecancer

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“…The principal treatment of potentially operable lesions is complete resection of the tumor by surgery, and high-risk patients should receive postoperative adjuvant therapy. [11] The treatment choices for metastatic LPS are limited, and NCCN guidelines for soft tissue sarcomas [3] offer some recommendations for treatment regimens. For example, anthracycline-based combination regimens (doxorubicin or epirubicin with ifosfamide and/or dacarbazine) can be used as 1st-line therapy; gemcitabine, docetaxel, PLD, vinorelbine, and temozolomide may be effective choices if 1st-line chemotherapy fails.…”

Section: Discussionmentioning

confidence: 99%

Breast liposarcoma with solitary metastasis to the pleura

et al. 2017

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Rationale:Breast cancer is the most prevalent malignancy in women worldwide. Our patient presented with a history of breast liposarcoma (LPS) and was found to have pleural metastasis during the initial workup.Patient concerns:The patient was complaining about chest pain and dyspnea that had persisted for a week.Diagnoses:After a full evaluation and histological diagnosis, she was diagnosed as metastatic breast LPS.Interventions:We adopted 6 cycles of pegylated liposomal doxorubicin (PLD) plus ifosfamide as 1st-line palliative chemotherapy, combined with local pleural effusion management.Outcomes:The patient's symptoms were notably relieved, and both malignant metastatic lesions and pleural effusion were controlled.Lessons:Although metastatic breast LPS is rarely reported and incurable, more clinical experience and use of next-generation sequencing should be helpful in finding the effective treatment for metastatic LPS.

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“…Of patients that developed recurrences, 83% were distant metastases. Prior literature show an OS rate of 55%-60% for RPS and a DFS rate of 43%-84% and OS rate of 52%-78% for extremity tumors [15,17,21,22,24,29] . We found a lower DFS of 28.9%.…”

Section: Discumentioning

confidence: 98%

“…Advances in radiation therapy allow for more conformal target coverage, yet normal tissue tolerances limit dose [6,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] . Intraoperative radiation therapy (IORT) techniques permit high dose delivery to areas at risk while sparing adjacent surrounding normal tissues.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative radiation therapy for high risk soft tissue sarcoma resection margins

Oxenberg

Malhotra²,

Attwood³

et al. 2014

JST

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Background and objectives: External beam radiation (EBRT) can reduce local recurrence (LR) of soft tissue sarcomas (STS). The addition of intraoperative radiation therapy (IORT) can deliver high dose radiation boost to anticipated "high risk" margins while sparing adjacent structures. Methods: A retrospective review (2004-2012) was performed of STS treated with surgical resection and IORT using HDR brachytherapy for anticipated close/positive margins. Results: Twenty-four patients underwent 25 resections with IORT (1 patient had 2 separate recurrences). Tumors were primary in 72%, deep in 96% and intermediate/high grade in 84%. Tumor locations were extremity (44%), retroperitoneal (40%), truncal (12%) and neck (4%). Common histologies included pleomorphic (32%), liposarcoma (12%) and myxofibrosarcoma (12%). Neoadjuvantly, 3 received chemotherapy and 13 received EBRT (median 50Gy; range 45-54). Median IORT dose was 12Gy (range 10-17.5). Margins were microscopically positive in 20%; none were grossly positive. Adjuvantly, 5 received EBRT (median 46Gy, range 45-50) and 2 received chemotherapy. Median follow-up was 20.1 months (range 2.7-96.4). No recurrences occurred at the IORT sites. Two-year LR free survival was 60.8% and disease specific survival was 84%. Conclusion: Use of IORT at time of STS resection was effective at preventing LR at the treated site despite "high risk" features.

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Prognostic Value of External Beam Radiation Therapy in Patients Treated With Surgical Resection and Intraoperative Electron Beam Radiation Therapy for Locally Recurrent Soft Tissue Sarcoma: A Multicentric Long-Term Outcome Analysis

Cited by 16 publications

References 22 publications

Intraoperative radiotherapy: review of techniques and results

Intraoperative radiotherapy: review of techniques and results

Breast liposarcoma with solitary metastasis to the pleura

Intraoperative radiation therapy for high risk soft tissue sarcoma resection margins

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