Falk Roeder1,2, Antonino de Paoli3, Ladan Saleh-Ebrahimi4, Ingo Alldinger5, Giulio Bertola6, Giovanni Boz3, Federico Navarria3, Miguel Cuervo7, Matthias Uhl8, Ana Alvarez9, Markus Buechler10, Burkhard Lehner11, Juergen Debus8,12, Felipe A Calvo9, Robert Krempien13. 1. Department of Radiation Oncology, University Hospital LMU Munich, Munich, Germany. Falk.Roeder@med.uni-muenchen.de. 2. CCU Molecular and Radiation Oncology, German Cancer Research Center, Heidelberg, Germany. Falk.Roeder@med.uni-muenchen.de. 3. Department of Radiation Oncology, National Cancer Institute, CRO, Aviano, Italy. 4. Strahlentherapie Freising und Dachau, Dachau, Germany. 5. CPZ Düsseldorf, Düsseldorf, Germany. 6. Department of Surgical Oncology, National Cancer Institute, CRO, Aviano, Italy. 7. Musculoskeletal Tumor Unit, University Hospital Gregorio Maranon, Complutense University, Madrid, Spain. 8. Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany. 9. Department of Radiation Oncology, University Hospital Gregorio Maranon, Complutense University, Madrid, Spain. 10. Department of Surgery, University of Heidelberg, Heidelberg, Germany. 11. Department of Orthopedics and Traumatology, University of Heidelberg, Heidelberg, Germany. 12. CCU Radiation Oncology, German Cancer Research Center, Heidelberg, Germany. 13. Department of Radiotherapy, Helios Hospital Berlin-Buch, Berlin, Germany.
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.
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.
Authors: Gustavo R Sarria; Vera Petrova; Frederik Wenz; Yasser Abo-Madyan; Elena Sperk; Frank A Giordano Journal: Radiat Oncol Date: 2020-05-14 Impact factor: 3.481