title: Intraoperative radiation therapy for locally advanced and recurrent soft-tissue sarcomas in adults.
abstract: OBJECTIVE
  To analyze the outcomes of and identify prognostic factors for patients treated with surgery and intraoperative radiotherapy (IORT) for locally advanced and recurrent soft-tissue sarcoma in adults from a single institution.
  
  
  METHODS
  We retrospectively reviewed 50 consecutive patients treated with IORT to 62 sites of disease. Primary sites included retroperitoneum-pelvis (78%), extremity (8%), and other (14%). Seventy percent of patients had recurrent disease failing prior surgery (70%) and/or radiation (32%). Mean disease-free interval (DFI) before IORT was 1.9 years (range, 2 weeks-5.4 years). The IORT was delivered with orthovoltage X-rays using individually sized beveled cone applicators. Clinical characteristics were as follows: mean tumor size, 10 cm (range, 1-25 cm); high-grade histologic subtype (72%); and mean dose, 1,159 cGy (range, 600-1,600 cGy). Postoperative radiation or chemotherapy was administered to 37% of IORT Sites and 32% of patients, respectively. Outcomes measured were infield control (IFC), locoregional control (LRC), distant metastasis-free survival (DMFS), disease-specific survival (DSS), and treatment-related complications. Mean and median follow-up of alive patients were 59 and 35 months, respectively.
  
  
  RESULTS
  Kaplan-Meier 5-year IFC, LRC, DMFS, and DSS probabilities for the entire group were 55%, 26%, 51%, and 25%, respectively. Prognostic factors found to be significant (p < 0.05) on multivariate analysis were prior DFI and tumor size for LRC, extremity location and leiomyosarcoma histologic subtype for DMFS, and prior DFI for DSS. Our cohort had five Grade 3/4 complications associated with treatment or a 5-year Kaplan-Meier Grade 3/4 complication-free survival rate of 85%.
  
  
  CONCLUSIONS
  IORT after tumor reductive surgery is well tolerated and seems to confer IFC in carefully selected patients.
authors.affiliation: Department of Radiation Oncology, Stanford Cancer Center, Stanford, CA 94305, USA.
authors.forename: Phuoc T
authors.initials: PT
authors.lastname: Tran
authors.forename: Wendy
authors.initials: W
authors.lastname: Hara
authors.forename: Zheng
authors.initials: Z
authors.lastname: Su
authors.forename: H Jill
authors.initials: HJ
authors.lastname: Lin
authors.forename: Pavan K
authors.initials: PK
authors.lastname: Bendapudi
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Norton
authors.forename: Nelson
authors.initials: N
authors.lastname: Teng
authors.forename: Christopher R
authors.initials: CR
authors.lastname: King
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Kapp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D016019:Survival Analysis; D015996:Survival Rate