Azinovic Ignacio, Martinez Monge Rafael, Javier Aristu Jose, Salgado Esteban, Villafranca Elena, Fernandez Hidalgo Oscar, Amillo Santiago, San Julian Miguel, Villas Carlos, Manuel Aramendía Jose, Calvo Felipe A
Department of Oncology, Radiation Oncology Division, Clínica Universitaria, School of Medicine, University of Navarre, Av. Pio XII, 36, 31008 Pamplona, Spain.
Radiother Oncol. 2003 Jun;67(3):331-7. doi: 10.1016/s0167-8140(03)00163-4.
To analyze the patterns of failure and the toxicity profile of intraoperative electron beam radiotherapy (IOERT) after resection of soft tissue sarcomas of the extremities (STS).
Forty-five patients with extremity STS were treated with IOERT and moderate-dose postoperative radiotherapy (45-50 Gy). Twenty-six patients were treated for primary disease (PD) and 19 patients for an isolated recurrence (ILR). Tumor size was >5 cm (maximum diameter) in 36 patients (80%), and high-grade histology in PD patients was present in 14 patients (54%). In nine patients, IOERT was used alone, due to previous irradiation or patient refusal. Chemotherapy (neoadjuvant and/or adjuvant) was mainly given to high-grade tumors.
Nine patients relapsed in the extremity (20%), and 12 patients in distant sites (28%). Actuarial local control at 5 years was 88% for patients with negative/close margins and 57% for patients presenting positive margins (P=0.04). Five patients (11%) developed neuropathy associated with the treatment. Extremity preservation was achieved in 40 patients (88%). With a median follow-up of 93 months (range: 27-143 months) for the patients at risk, 25 patients remain alive (a 7-year actuarial survival rate of 75% for PD and 47% for ILR; P=0.01).
IOERT combined with moderate doses of external beam irradiation yields high local control and extremity preservation rates in resected extremity STS. Peripheral nerves in the IOERT field are dose-limiting structures requiring a dose compromise in the IOERT component to avoid severe neurological damage.
分析肢体软组织肉瘤（STS）切除术后术中电子束放疗（IOERT）的失败模式和毒性特征。
45例肢体STS患者接受了IOERT和中等剂量术后放疗（45 - 50 Gy）。26例患者治疗原发性疾病（PD），19例患者治疗孤立性复发（ILR）。36例患者（80%）肿瘤大小>5 cm（最大直径），PD患者中14例（54%）为高级别组织学类型。9例患者因先前接受过放疗或患者拒绝，仅接受了IOERT治疗。化疗（新辅助和/或辅助化疗）主要用于高级别肿瘤。
9例患者肢体复发（20%），12例患者远处复发（28%）。切缘阴性/接近切缘的患者5年精算局部控制率为88%，切缘阳性的患者为57%（P = 0.04）。5例患者（11%）出现与治疗相关的神经病变。40例患者（88%）实现了肢体保留。对有风险的患者进行中位93个月（范围：27 - 143个月）的随访，25例患者仍存活（PD患者7年精算生存率为75%，ILR患者为47%；P = 0.01）。
IOERT联合中等剂量外照射在切除的肢体STS中可产生较高的局部控制率和肢体保留率。IOERT照射野内的周围神经是剂量限制结构，在IOERT治疗中需要在剂量上进行权衡以避免严重的神经损伤。
