title: Combination of external-beam radiotherapy with intraoperative electron-beam therapy is effective in incompletely resected pediatric malignancies.
abstract: OBJECTIVE
  Intraoperative electron-beam radiotherapy (IOERT) has been applied for local dose escalation in over 1,400 patients in Heidelberg since 1991. Among these were 30 children, in 18 of whom IOERT was employed in radiation treatment with external-beam radiotherapy (EBRT) on account of incomplete resection. We address the question whether IOERT is able to compensate for microscopic or macroscopic tumor residue if employed in the overall radiation regimen.
  
  
  METHODS
  The data of the aforementioned 18 children were analyzed with regard to local recurrence, overall survival, and complication rates. All children suffered from either sarcomas or neuroblastomas. In all children, IOERT was employed for local dose escalation after or before EBRT.
  
  
  RESULTS
  After a median follow-up of 60.5 months, 15 of the treated children are alive. One local failure has been observed. Six children show clinically significant late morbidity, including the loss of a treated limb (Radiation Therapy Oncology Group Grade 4 [RTOG 4]), a severe nerve lesion (RTOG 3), an orthopedic complication (RTOG 2), a ureteral stenosis (not clinically significant), and a kidney hypotrophy (not clinically significant). In 1 child a fracture due to radionecrosis (RTOG 4) was diagnosed; however, in the follow-up, local tumor relapse was diagnosed as another possible reason for the fracture.
  
  
  CONCLUSIONS
  Regarding the low incidence of local failure, IOERT seems to be able to compensate incomplete tumor resection in childhood sarcoma and neuroblastoma patients. The incidence of late morbidity is low enough to justify the employment of IOERT as part of the radiation treatment regimen for pediatric patients.
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Oertel
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Niethammer
authors.forename: Robert
authors.initials: R
authors.lastname: Krempien
authors.forename: Falk
authors.initials: F
authors.lastname: Roeder
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Eble
authors.forename: Claudia
authors.initials: C
authors.lastname: Baer
authors.forename: Peter E
authors.initials: PE
authors.lastname: Huber
authors.forename: Andreas
authors.initials: A
authors.lastname: Kulozik
authors.forename: Karl-Ludwig
authors.initials: KL
authors.lastname: Waag
authors.forename: Martina
authors.initials: M
authors.lastname: Treiber
authors.forename: Juergen
authors.initials: J
authors.lastname: Debus
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D008297:Male; D018365:Neoplasm, Residual; D009447:Neuroblastoma / Q000532:radiotherapy* / Q000601:surgery; D012186:Retroperitoneal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D012187:Retroperitoneal Space; D012509:Sarcoma / Q000532:radiotherapy* / Q000601:surgery