title: Definitive intraoperative radiotherapy for musculoskeletal sarcomas and malignant lymphoma in combination with surgical excision.
abstract: BACKGROUND
  . The purpose was to estimate retrospectively the outcome of patients with musculoskeletal sarcoma or malignant lymphoma treated with intraoperative radiotherapy (IORT).
  
  
  METHODS
  Between 1988 and 1999, definitive IORT in combination with surgical excision was performed in 24 patients with musculoskeletal sarcoma (malignant fibrous histiocytoma, 10; osteosarcoma, 6; liposarcoma, 2; chondrosarcoma, 1; synovial sarcoma, 1; Ewing's sarcoma, 1; angiosarcoma, 1; epithelioid sarcoma, 1; malignant schwannoma, 1) and 3 patients with malignant lymphoma. The tumor was excised by marginal margin excision, intralesional margin excision, or wide margin excision; 15-45 Gy electrons was then delivered to the affected sites.
  
  
  RESULTS
  In the 8 patients without distant metastases at the first visit, 4 patients are alive 6.5-11.5 years after IORT, and 4 patients died <4.5 years after IORT. The incidence of local recurrence was 13%. In the 19 patients with distant metastases at the first visit, 3 patients are alive 2.5-6.7 years after IORT, and 16 patients died 0.2-5.7 years after IORT. The incidence of local recurrence was 45%. Complications after IORT were found in 5 patients: neuropathy, 1 patient; skin necrosis, 1 patient; myelopathy, 1 patient; enteritis ileus, 1 patient; and edema, 1 patient.
  
  
  CONCLUSIONS
  IORT with a radiation dose of 15-45 Gy in combination with surgical excision appeared to be useful for local control and to be more effective in patients without distant metastases at the first visit than in patients with distant metastases.
authors.affiliation: Department of Orthopaedic Surgery, Ehime University, School of Medicine, Shitsukawa, Shigenobu-cho, Onsen-gun, Ehime 791-0295, Japan. kenshi@m.ehime-u.ac.jp
authors.forename: Kenshi
authors.initials: K
authors.lastname: Sakayama
authors.forename: Teruki
authors.initials: T
authors.lastname: Kidani
authors.forename: Taketsugu
authors.initials: T
authors.lastname: Fujibuchi
authors.forename: Haruyasu
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Taihoh
authors.initials: T
authors.lastname: Shibata
authors.forename: Takashi
authors.initials: T
authors.lastname: Fujii
authors.forename: Takashi
authors.initials: T
authors.lastname: Ochi
authors.forename: Masashi
authors.initials: M
authors.lastname: Kawamura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D008223:Lymphoma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy; D012189:Retrospective Studies; D018570:Risk Assessment; D012509:Sarcoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome