Intraoperative radiotherapy for primary and locally recurrent soft tissue sarcoma: morbidity and long-term prognosis

Introduction: Sok tissue sarcoma has a high risk of local recurrence. There fore, extensive surgical resection has been combined with radiotherapy to i mprove long-term results. Because external beam radiation doses may be limi ted by adjacent radiosensitive tissue, intraoperative boost radiation has b een devised to achieve a higher total radiation dose in combination with ex ternal beam radiotherapy. We report our experience with this multimodal app roach for primary and recurrent soft tissue sarcoma. Methods: Clinical and pathological data were extracted from a prospective d ata base including all patients with a diagnosis of soft tissue sarcoma tre ated at the Department of Surgery, University of Heidelberg between 1988 an d 1999. Intraoperative radiotherapy dosages were 12-15 Gy for the extrernit ies and 15 18 Gy for the trunk and the retroperitoneum. Additional external beam radiotherapy was given at 40 Gy, whenever possible. Results: Between 1988 and 1999, a total of 251 patients with primary or rec urrent soft tissue sarcoma of the extremities, the trunk ol the retroperito neum were treated. The mean (+/-SD) age of 136 men and 115 women was 53 +/- 6 years. Five of 251 patients died post-operatively, giving a a mortality rate of 2.0%. Intraoperative radiotherapy (TORT) was used in 92 patients (3 7%). Surgical complications were more frequent in IORT patients (30 of 92, 33%) compared to non-IORT patients (36 of 159; 23% P = 0.1). Infectious com plications were significantly more frequent in patients receiving TORT (P = 0.03). Two hundred and foul patients were macroscopically tumour-free (R0, R1 rese ction). For these patients multivariate analysis identifed grading (relativ e risk (RR) 3.1-6.6; P < 0.001), age lover 55 years; (RR) 1.8, P < 0.008) a nd tumour location in the retroperitoneum (RR 2.2, P < 0.004) as independen tly associated with recurrence-free survival. The use of IORT (P < 0.02) re duced the relative risk of death or recurrence by 40% (RR 0.6; P < 0.02). S ex, primary vs recurrent tumour, T classification and R-status (R0 vs R1) w ere not significantly related to recurrence-free survival. Conclusions: In this prospective, non-randomized study of soft tissue sarco ma IORT was associated with a higher rate of infectious complications, but the the risk of death or recurrence was reduced by 40%. (C) 2000 Harcourt P ublishers Ltd.