title: Intraoperative radiotherapy electron boost followed by moderate doses of external beam radiotherapy in resected soft-tissue sarcoma of the extremities.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Oncology, Radiation Oncology Division, Clínica Universitaria, School of Medicine, University of Navarre, Av. Pio XII, 36, 31008 Pamplona, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Azinovic
authors.forename: Rafael
authors.initials: R
authors.lastname: Martinez Monge
authors.forename: Jose
authors.initials: J
authors.lastname: Javier Aristu
authors.forename: Esteban
authors.initials: E
authors.lastname: Salgado
authors.forename: Elena
authors.initials: E
authors.lastname: Villafranca
authors.forename: Oscar
authors.initials: O
authors.lastname: Fernandez Hidalgo
authors.forename: Santiago
authors.initials: S
authors.lastname: Amillo
authors.forename: Miguel
authors.initials: M
authors.lastname: San Julian
authors.forename: Carlos
authors.initials: C
authors.lastname: Villas
authors.forename: Jose
authors.initials: J
authors.lastname: Manuel Aramendía
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Calvo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005121:Extremities / Q000528:radiation effects / Q000601:surgery; D005260:Female; D006801:Humans; D007432:Intraoperative Period / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D010525:Peripheral Nerves / Q000528:radiation effects; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy / Q000009:adverse effects* / Q000379:methods*; D012509:Sarcoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016019:Survival Analysis; D017211:Treatment Failure