title: Intraoperative electron beam radiotherapy followed by moderate doses of external beam radiotherapy in the treatment of resected soft tissue sarcomas of the extremities.
abstract: OBJECTIVE
  Soft tissue sarcomas (STS) have a high incidence of local recurrence. In an effort to improve the local control rate and the survival in patients with STS, treatment strategies employing intraoperative electron beam radiotherapy (IOERT) in combination with external beam radiotherapy (EBRT) and extensive surgical resection have been explored. This study assesses the rate of overall survival (OS), local control and toxicity of this multimodal approach for primary and recurrent STS of the extremities.
  
  
  METHODS
  From 1999 to 2004, 36 patients were treated at Agios Savvas Cancer Hospital for primary or recurrent extremity STS with IOERT as a component of their treatment. All patients underwent surgical resection, IOERT, and most of them received postoperative EBRT with a median dose of 45 Gy. Chemotherapy was given to patients with high grade tumors. Thirteen patients were treated for primary disease and 23 for isolated local recurrence.The locations of the tumors were as follows: upper limbs n=19, lower limbs n=17. Tumor size was >5 cm in 16 (44%) patients and high-grade histology (II-III) was present in 24 (67%) patients. Six (17%) patients had positive surgical margins.
  
  
  RESULTS
  With a median follow up of 24 months (range 6-48) OS was 72% (84.5% for patients with low grade lesions compared to 65% for high grade lesions, p=0.127, and 90% for tumors <5 cm compared to 50% for tumors >5 cm, p=0.0136). Overall local tumor control rate was 89% (92% in primary disease group versus 87% in isolated local recurrence group, p=0.136, and 93% for patients with negative surgical margins versus 67% for those with positive margins, p=0.0013). Distant metastases occurred in 10 patients (1 of 13 (8%) with primary disease, and 9 of 23 (39%) with isolated local recurrence). All distant metastases were to the lungs. Twelve (33%) patients developed moderate neurotoxicity.
  
  
  CONCLUSIONS
  In selected patients, IOERT results in excellent local control and OS with acceptable toxicity.
authors.affiliation: Department of Radiation Oncology-B, Metaxa Cancer Hospital, Piraeus, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Beroukas
authors.forename: E
authors.initials: E
authors.lastname: Peponi
authors.forename: G
authors.initials: G
authors.lastname: Soulimioti
authors.forename: Z
authors.initials: Z
authors.lastname: Kalaitzi
authors.forename: A
authors.initials: A
authors.lastname: Potamianou
authors.forename: I
authors.initials: I
authors.lastname: Skarlatos
authors.forename: G
authors.initials: G
authors.lastname: Economou
authors.forename: A E
authors.initials: AE
authors.lastname: Athanassiou
authors.forename: K
authors.initials: K
authors.lastname: Beroukas