Use of intraoperative radiotherapy for upper-extremity soft-tissue sarcomas: Analysis of disease outcomes and toxicity

Jason A. Call, Scott L. Stafford, Ivy A Petersen, Michael Haddock

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13 Citations (Scopus)

Abstract

Objectives: To review outcomes for patients who received intraoperative radiotherapy (IORT) for upper-extremity sarcoma. Methods: We identified patients with upper-extremity tumors who were treated with external beam radiotherapy, surgery, and IORT, with or without chemotherapy. Kaplan-Meier estimates for overall survival (OS), central control (CC), local control (LC), and distant control (DC) were obtained. Results: Sixty-one patients were identified. Median age was 50 years (range, 13 to 95 y). Median follow-up was 5.9 years. Eleven patients had gross (R2; n=1) or microscopic (R1; n=10) disease at the time of IORT. IORT doses ranged from 7.50 to 20.00 Gy. External beam radiotherapy doses ranged from 19.80 to 54.00 Gy. OS at 5 and 10 years was 72% and 58%, respectively. LC at 5 and 10 years was 91% and 88%, respectively. DC at 5 and 10 years was 80% and 77%, respectively. Patients treated for recurrent disease had inferior 5-year OS compared with patients with first diagnoses (63% vs. 74%; P=0.02) and lower 5-year LC (67% vs. 94%; P<0.01). For patients with R1 or R2 resections, LC at 5 and 10 years was 100% and 86%, respectively; for patients with R0 resections, LC was 89% at both 5 and 10 years (P=0.98). Severe toxicity attributable to treatment was noted for 4 patients (7%). Conclusion: For upper-extremity sarcoma, treatment including IORT was associated with excellent LC, limb preservation, and survival. LC rates were excellent for patients with positive margins after resection. Patients with recurrent disease had worse outcomes, but limb preservation was achievable for most patients.

Original languageEnglish (US)
Pages (from-to)81-85
Number of pages5
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume37
Issue number1
DOIs
StatePublished - Feb 2014

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Upper Extremity
Sarcoma
Radiotherapy
Survival
Extremities
Kaplan-Meier Estimate
Drug Therapy

Keywords

  • extremity
  • intraoperative radiation
  • radiotherapy
  • sarcoma

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

@article{368b9902f3454ffc854ded7efabc35a0,
title = "Use of intraoperative radiotherapy for upper-extremity soft-tissue sarcomas: Analysis of disease outcomes and toxicity",
abstract = "Objectives: To review outcomes for patients who received intraoperative radiotherapy (IORT) for upper-extremity sarcoma. Methods: We identified patients with upper-extremity tumors who were treated with external beam radiotherapy, surgery, and IORT, with or without chemotherapy. Kaplan-Meier estimates for overall survival (OS), central control (CC), local control (LC), and distant control (DC) were obtained. Results: Sixty-one patients were identified. Median age was 50 years (range, 13 to 95 y). Median follow-up was 5.9 years. Eleven patients had gross (R2; n=1) or microscopic (R1; n=10) disease at the time of IORT. IORT doses ranged from 7.50 to 20.00 Gy. External beam radiotherapy doses ranged from 19.80 to 54.00 Gy. OS at 5 and 10 years was 72{\%} and 58{\%}, respectively. LC at 5 and 10 years was 91{\%} and 88{\%}, respectively. DC at 5 and 10 years was 80{\%} and 77{\%}, respectively. Patients treated for recurrent disease had inferior 5-year OS compared with patients with first diagnoses (63{\%} vs. 74{\%}; P=0.02) and lower 5-year LC (67{\%} vs. 94{\%}; P<0.01). For patients with R1 or R2 resections, LC at 5 and 10 years was 100{\%} and 86{\%}, respectively; for patients with R0 resections, LC was 89{\%} at both 5 and 10 years (P=0.98). Severe toxicity attributable to treatment was noted for 4 patients (7{\%}). Conclusion: For upper-extremity sarcoma, treatment including IORT was associated with excellent LC, limb preservation, and survival. LC rates were excellent for patients with positive margins after resection. Patients with recurrent disease had worse outcomes, but limb preservation was achievable for most patients.",
keywords = "extremity, intraoperative radiation, radiotherapy, sarcoma",
author = "Call, {Jason A.} and Stafford, {Scott L.} and Petersen, {Ivy A} and Michael Haddock",
year = "2014",
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T1 - Use of intraoperative radiotherapy for upper-extremity soft-tissue sarcomas

T2 - Analysis of disease outcomes and toxicity

AU - Call, Jason A.

AU - Stafford, Scott L.

AU - Petersen, Ivy A

AU - Haddock, Michael

PY - 2014/2

Y1 - 2014/2

N2 - Objectives: To review outcomes for patients who received intraoperative radiotherapy (IORT) for upper-extremity sarcoma. Methods: We identified patients with upper-extremity tumors who were treated with external beam radiotherapy, surgery, and IORT, with or without chemotherapy. Kaplan-Meier estimates for overall survival (OS), central control (CC), local control (LC), and distant control (DC) were obtained. Results: Sixty-one patients were identified. Median age was 50 years (range, 13 to 95 y). Median follow-up was 5.9 years. Eleven patients had gross (R2; n=1) or microscopic (R1; n=10) disease at the time of IORT. IORT doses ranged from 7.50 to 20.00 Gy. External beam radiotherapy doses ranged from 19.80 to 54.00 Gy. OS at 5 and 10 years was 72% and 58%, respectively. LC at 5 and 10 years was 91% and 88%, respectively. DC at 5 and 10 years was 80% and 77%, respectively. Patients treated for recurrent disease had inferior 5-year OS compared with patients with first diagnoses (63% vs. 74%; P=0.02) and lower 5-year LC (67% vs. 94%; P<0.01). For patients with R1 or R2 resections, LC at 5 and 10 years was 100% and 86%, respectively; for patients with R0 resections, LC was 89% at both 5 and 10 years (P=0.98). Severe toxicity attributable to treatment was noted for 4 patients (7%). Conclusion: For upper-extremity sarcoma, treatment including IORT was associated with excellent LC, limb preservation, and survival. LC rates were excellent for patients with positive margins after resection. Patients with recurrent disease had worse outcomes, but limb preservation was achievable for most patients.

AB - Objectives: To review outcomes for patients who received intraoperative radiotherapy (IORT) for upper-extremity sarcoma. Methods: We identified patients with upper-extremity tumors who were treated with external beam radiotherapy, surgery, and IORT, with or without chemotherapy. Kaplan-Meier estimates for overall survival (OS), central control (CC), local control (LC), and distant control (DC) were obtained. Results: Sixty-one patients were identified. Median age was 50 years (range, 13 to 95 y). Median follow-up was 5.9 years. Eleven patients had gross (R2; n=1) or microscopic (R1; n=10) disease at the time of IORT. IORT doses ranged from 7.50 to 20.00 Gy. External beam radiotherapy doses ranged from 19.80 to 54.00 Gy. OS at 5 and 10 years was 72% and 58%, respectively. LC at 5 and 10 years was 91% and 88%, respectively. DC at 5 and 10 years was 80% and 77%, respectively. Patients treated for recurrent disease had inferior 5-year OS compared with patients with first diagnoses (63% vs. 74%; P=0.02) and lower 5-year LC (67% vs. 94%; P<0.01). For patients with R1 or R2 resections, LC at 5 and 10 years was 100% and 86%, respectively; for patients with R0 resections, LC was 89% at both 5 and 10 years (P=0.98). Severe toxicity attributable to treatment was noted for 4 patients (7%). Conclusion: For upper-extremity sarcoma, treatment including IORT was associated with excellent LC, limb preservation, and survival. LC rates were excellent for patients with positive margins after resection. Patients with recurrent disease had worse outcomes, but limb preservation was achievable for most patients.

KW - extremity

KW - intraoperative radiation

KW - radiotherapy

KW - sarcoma

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