Claudio V Sole1, Felipe A Calvo2, Alfredo Polo3, Mauricio Cambeiro4, Ana Alvarez5, Carmen Gonzalez5, Jose Gonzalez6, Mikel San Julian7, Rafael Martinez-Monge4. 1. Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Complutense University, Madrid, Spain; Service of Radiation Oncology, Instituto de Radiomedicina, Santiago, Chile. Electronic address: cvsole@uc.cl. 2. Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Complutense University, Madrid, Spain. 3. Service of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain. 4. Service of Radiation Oncology, Clínica Universidad de Navarra, Pamplona, Spain. 5. Service of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 6. Service of Pediatric Orthopedics and Traumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 7. Service of Orthopedics and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain.
Abstract
PURPOSE: To perform a joint analysis of data from 3 contributing centers within the intraoperative electron-beam radiation therapy (IOERT)-Spanish program, to determine the potential of IOERT as an anticipated boost before external beam radiation therapy in the multidisciplinary treatment of pediatric extremity soft-tissue sarcomas. METHODS AND MATERIALS: From June 1993 to May 2013, 62 patients (aged <21 years) with a histologic diagnosis of primary extremity soft-tissue sarcoma with absence of distant metastases, undergoing limb-sparing grossly resected surgery, external beam radiation therapy (median dose 40 Gy) and IOERT (median dose 10 Gy) were considered eligible for this analysis. RESULTS: After a median follow-up of 66 months (range, 4-235 months), 10-year local control, disease-free survival, and overall survival was 85%, 76%, and 81%, respectively. In multivariate analysis after adjustment for other covariates, tumor size >5 cm (P=.04) and R1 margin status (P=.04) remained significantly associated with local relapse. In regard to overall survival only margin status (P=.04) retained association on multivariate analysis. Ten patients (16%) reported severe chronic toxicity events (all grade 3). CONCLUSIONS: An anticipated IOERT boost allowed for external beam radiation therapy dose reduction, with high local control and acceptably low toxicity rates. The combined radiosurgical approach needs to be tested in a prospective trial to confirm these results.
PURPOSE: To perform a joint analysis of data from 3 contributing centers within the intraoperative electron-beam radiation therapy (IOERT)-Spanish program, to determine the potential of IOERT as an anticipated boost before external beam radiation therapy in the multidisciplinary treatment of pediatric extremity soft-tissue sarcomas. METHODS AND MATERIALS: From June 1993 to May 2013, 62 patients (aged <21 years) with a histologic diagnosis of primary extremity soft-tissue sarcoma with absence of distant metastases, undergoing limb-sparing grossly resected surgery, external beam radiation therapy (median dose 40 Gy) and IOERT (median dose 10 Gy) were considered eligible for this analysis. RESULTS: After a median follow-up of 66 months (range, 4-235 months), 10-year local control, disease-free survival, and overall survival was 85%, 76%, and 81%, respectively. In multivariate analysis after adjustment for other covariates, tumor size >5 cm (P=.04) and R1 margin status (P=.04) remained significantly associated with local relapse. In regard to overall survival only margin status (P=.04) retained association on multivariate analysis. Ten patients (16%) reported severe chronic toxicity events (all grade 3). CONCLUSIONS: An anticipated IOERT boost allowed for external beam radiation therapy dose reduction, with high local control and acceptably low toxicity rates. The combined radiosurgical approach needs to be tested in a prospective trial to confirm these results.
Authors: Esther Carbó-Laso; Pablo Sanz-Ruiz; José Antonio Calvo-Haro; Miguel Cuervo-Dehesa; Rubén Pérez-Mañanes; Lydia Mediavilla-Santos; Coral Sánchez-Pérez; Ana Álvarez-González; Javier Vaquero-Martín Journal: Int J Clin Oncol Date: 2017-07-17 Impact factor: 3.402