title: Long-term outcomes with intraoperative radiotherapy as a component of treatment for locally advanced or recurrent uterine sarcoma.
abstract: OBJECTIVE
  To report our institutional experience with intraoperative radiotherapy (IORT) as a component of treatment for women with locally advanced or recurrent uterine sarcoma.
  
  
  METHODS
  From 1990 to 2010, 16 women with primary (n = 3) or locoregionally recurrent (n = 13) uterine sarcoma received IORT as a component of combined modality treatment. Tumor histology studies found leiomyosarcoma (n = 9), endometrial stromal sarcoma (n = 4), and carcinosarcoma (n = 3). Surgery consisted of gross total resection in 2 patients, subtotal resection in 6 patients, and resection with close surgical margins in 8 patients. The median IORT dose was 12.5 Gy (range, 10-20 Gy). All patients received perioperative external beam radiotherapy (EBRT; median dose, 50.4 Gy; range, 20-62.5 Gy), and 6 patients also received perioperative systemic therapy.
  
  
  RESULTS
  Seven of the 16 patients are alive at a median follow-up of 44 months (range, 11-203 months). The 3-year Kaplan-Meier estimate of local relapse (within the EBRT field) was 7%, and central control (within the IORT field) was 100%. No local failures occurred in any of the 6 patients who underwent subtotal resection. The 3-year freedom from distant relapse was 48%, with failures occurring most frequently in the lungs or mediastinum. Median survival was 18 months, and 3-year Kaplan-Meier estimates of cause-specific and overall survival were 58% and 53%, respectively. Three patients (19%) experienced late Grade 3 toxicity.
  
  
  CONCLUSIONS
  A combined modality approach with perioperative EBRT, surgery, and IORT for locally advanced or recurrent uterine sarcoma resulted in excellent local disease control with acceptable toxicity, even in patients with positive resection margins. With this approach, some patients were able to experience long-term freedom from recurrence.
authors: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA. barney.brandon@mayo.edu
authors: Brandon M
authors: BM
authors: Barney
authors: Ivy A
authors: IA
authors: Petersen
authors: Sean C
authors: SC
authors: Dowdy
authors: Jamie N
authors: JN
authors: Bakkum-Gamez
authors: Michael G
authors: MG
authors: Haddock
mesh_terms: D000328:Adult; D000368:Aged; D002296:Carcinosarcoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007890:Leiomyosarcoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D008175:Lung Neoplasms / Q000556:secondary; D008479:Mediastinal Neoplasms / Q000556:secondary; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D018203:Sarcoma, Endometrial Stromal / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery