Limb-Sparing Sx With Intraoperative RX Yeilds “Good” Control

October 13, 2015

Limb-Sparing Sx With Intraoperative RX Yeilds “Good” Control

by David Wild
In patients with locally recurrent extremity soft tissue sarcoma, limb-salvage therapy with intraoperative radiation therapy (IORT) can deliver focal therapy and achieve local control for patients who otherwise may need more radical surgical procedures, according to a study by investigators at the University of California, San Francisco.

The investigators reached this conclusion after examining medical records from 26 patients with locally recurrent disease who underwent IORT following salvage limb-sparing surgery (Sarcoma2015;2015:913565, PMID: 26346118). Fifteen of these patients (58%) had received external beam radiation therapy (EBRT) before recurrence, whereas 11 (42%) received EBRT after IORT.

Records indicated that 58% of the tumors were located in the upper extremity, 85% were in the superficial fascia and 14 patients had at least one tumor larger than 5 cm in diameter. Most tumors were high grade. The median duration of follow-up after surgery and IORT was 34.9 months (range, four to 139 months).

The investigators said 10 patients developed a local recurrence and four of these individuals required subsequent amputation. Extrapolating from the data, they developed the following five-year estimates with the combined approach: 58% likelihood of local disease control, 81% likelihood of amputation-free control, 56% likelihood of metastasis-free control, 35% chance of disease-free survival and 50% chance of overall survival. These estimates were not affected by use of EBRT, the researchers said.

Safety results showed six and eight acute and late grade 3 or higher toxicities, respectively, which were distributed equally among those who did or did not undergo EBRT before IORT.
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