T. Lehnert et al., Intraoperative radiotherapy for primary and locally recurrent soft tissue sarcoma: morbidity and long-term prognosis, EUR J SUR O, 26, 2000, pp. S21-S24
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.