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Intraoperative electron radiotherapy (IOeRT) for the treatment of retroperitoneal sarcomas: Results of a multi-institutional pooled analysis
reports of practical oncology and radiotherapy 1 8 ( 2 0 1 3 ) S107–S108
Available online at www.sciencedirect.com
journal homepage: http://www.elsevier.com/locate/rpor
Soft tissue sarcomas
Intraoperative electron radiotherapy (IOeRT) for the treatment of retroperitoneal sarcomas: Results of a multiinstitutional pooled analysis ˜ 5, A. Montero 1 , A. Álvarez 2 , A. Polo 1 , C. González-sansegundo 3 , R. Hernanz 1 , J. García-sabrido 4 , L. Cabanas L. González-bayón 4 , A. Ramos 1 , F. Calvo 3 1 (UHRYC), Department, Spain 2 (HUGM), Radiation Oncology, Spain 3 University Hospital Gregorio Maranon, ˜ Radiation Oncology, Spain 4 University Hospital Gregorio Maranon, ˜ Department, Spain 5 University Hospital Ramon y Cajal, Surgery, Spain Background. Retroperitoneal sarcomas are rare presentation for soft-tissue sarcomas. Due to scarcity of these tumors, a pooled analysis with data from 2 experienced centres in the use of IOeRT was performed. The aim of present analysis is to update the evolutive experience containing IOeRT in the multimodal approach to retroperitoneal soft-tissue sarcomas. Patients and methods. From January 1996 to December 2011, 49 patients (p) (39 from UHGM and 9 from UHRYC) with pathologically confirmed retroperitoneal soft tissue sarcoma were entered into a data registry of IOeRT as a component of multidisciplinary treatment. Patients’ registry included 29 females and 19 males with a median age of 49 years (range 4–75 years). Thirty p presented with local recurrences of previously treated intra-abdominal sarcomas (64%) while in 18 cases (46%) was a newly diagnosed disease. Histological subtypes treated were: liposarcoma in 22 p (46%), leiomyosarcoma in 11 p (23%), malignant fibrous histiocytoma 3 p (6%), rhabdomyosarcoma 3 p (6%), extraskeletal Ewing’s sarcoma 2 p (4%) and sarcoma not otherwise specified (NOS), extraskeletal chondrosarcoma, fibrosarcoma, malignant hemangiopericytoma, malignant mesenchimoma, malignant schwannoma and PNET in 1 patient each (15%). All patients underwent a surgical procedure achieving an R0 resection in 27 p (56%), R1 resection in 17 p (35%), R2 resection in 3 p (6%). No information was available from 1 patient (Rx resection). IOeRT was delivered by using electron-beams (median energy: 9MeV, range 4–18 MeV) from non-dedicated linear accelerators. A median dose of 12.5 Gy (range 10–20 Gy) was delivered with maximal diameter dimension ranging from 5 cm to 24 cm (median 10 cm). Seven p (15%) had preoperative external beam radiotherapy (EBRT) up to a total median dose of 54 Gy (range 45–58 Gy), whereas 27 p (56%) underwent postoperative EBRT to a median dose of 45 Gy (range 39.6–54 Gy). In 12 p (25%) systemic chemotherapy was administered. Results. Response to multidisciplinary treatment was considered as complete in 46 p (96%) while partial in 2 p (2%). Twenty-six (54%) out of the 46 p achieving a complete response developed locoregional relapse (29%), distant metastases (10%) or both (15%). With a median follow-up of 35 months (range 9–192 months), 5-year actuarial overall survival (OS) locoregional relapse free survival (LRRFS) and distant metastases free survival (DMFS) were 52%, 48% and 66% respectively. Toxicity was registered in 47 p. Acute side-effects were observed in 26 p (54%), including 5 p with fatal toxicity grade 5, whereas late complications were recorded in 13 p (27%). Conclusions. IOeRT is a feasible and attractive alternative for the treatment of retroperitoneal soft-tissue sarcomas in the context of a multidisciplinary approach. Joint analysis of data from expert centres performing similar multimodal treatments is a valid alternative to achieve robust and reliable data for results interpretation. http://dx.doi.org/10.1016/j.rpor.2013.03.834
1507-1367/$ – see front matter
Available online at www.sciencedirect.com
journal homepage: http://www.elsevier.com/locate/rpor
Soft tissue sarcomas
Intraoperative electron radiotherapy (IOeRT) for the treatment of retroperitoneal sarcomas: Results of a multiinstitutional pooled analysis ˜ 5, A. Montero 1 , A. Álvarez 2 , A. Polo 1 , C. González-sansegundo 3 , R. Hernanz 1 , J. García-sabrido 4 , L. Cabanas L. González-bayón 4 , A. Ramos 1 , F. Calvo 3 1 (UHRYC), Department, Spain 2 (HUGM), Radiation Oncology, Spain 3 University Hospital Gregorio Maranon, ˜ Radiation Oncology, Spain 4 University Hospital Gregorio Maranon, ˜ Department, Spain 5 University Hospital Ramon y Cajal, Surgery, Spain Background. Retroperitoneal sarcomas are rare presentation for soft-tissue sarcomas. Due to scarcity of these tumors, a pooled analysis with data from 2 experienced centres in the use of IOeRT was performed. The aim of present analysis is to update the evolutive experience containing IOeRT in the multimodal approach to retroperitoneal soft-tissue sarcomas. Patients and methods. From January 1996 to December 2011, 49 patients (p) (39 from UHGM and 9 from UHRYC) with pathologically confirmed retroperitoneal soft tissue sarcoma were entered into a data registry of IOeRT as a component of multidisciplinary treatment. Patients’ registry included 29 females and 19 males with a median age of 49 years (range 4–75 years). Thirty p presented with local recurrences of previously treated intra-abdominal sarcomas (64%) while in 18 cases (46%) was a newly diagnosed disease. Histological subtypes treated were: liposarcoma in 22 p (46%), leiomyosarcoma in 11 p (23%), malignant fibrous histiocytoma 3 p (6%), rhabdomyosarcoma 3 p (6%), extraskeletal Ewing’s sarcoma 2 p (4%) and sarcoma not otherwise specified (NOS), extraskeletal chondrosarcoma, fibrosarcoma, malignant hemangiopericytoma, malignant mesenchimoma, malignant schwannoma and PNET in 1 patient each (15%). All patients underwent a surgical procedure achieving an R0 resection in 27 p (56%), R1 resection in 17 p (35%), R2 resection in 3 p (6%). No information was available from 1 patient (Rx resection). IOeRT was delivered by using electron-beams (median energy: 9MeV, range 4–18 MeV) from non-dedicated linear accelerators. A median dose of 12.5 Gy (range 10–20 Gy) was delivered with maximal diameter dimension ranging from 5 cm to 24 cm (median 10 cm). Seven p (15%) had preoperative external beam radiotherapy (EBRT) up to a total median dose of 54 Gy (range 45–58 Gy), whereas 27 p (56%) underwent postoperative EBRT to a median dose of 45 Gy (range 39.6–54 Gy). In 12 p (25%) systemic chemotherapy was administered. Results. Response to multidisciplinary treatment was considered as complete in 46 p (96%) while partial in 2 p (2%). Twenty-six (54%) out of the 46 p achieving a complete response developed locoregional relapse (29%), distant metastases (10%) or both (15%). With a median follow-up of 35 months (range 9–192 months), 5-year actuarial overall survival (OS) locoregional relapse free survival (LRRFS) and distant metastases free survival (DMFS) were 52%, 48% and 66% respectively. Toxicity was registered in 47 p. Acute side-effects were observed in 26 p (54%), including 5 p with fatal toxicity grade 5, whereas late complications were recorded in 13 p (27%). Conclusions. IOeRT is a feasible and attractive alternative for the treatment of retroperitoneal soft-tissue sarcomas in the context of a multidisciplinary approach. Joint analysis of data from expert centres performing similar multimodal treatments is a valid alternative to achieve robust and reliable data for results interpretation. http://dx.doi.org/10.1016/j.rpor.2013.03.834
1507-1367/$ – see front matter