title: Prognostic value of external beam radiation therapy in patients treated with surgical resection and intraoperative electron beam radiation therapy for locally recurrent soft tissue sarcoma: a multicentric long-term outcome analysis.
abstract: BACKGROUND
  A joint analysis of data from centers involved in the Spanish Cooperative Initiative for Intraoperative Electron Radiotherapy was performed to investigate long-term outcomes of locally recurrent soft tissue sarcoma (LR-STS) patients treated with a multidisciplinary approach.
  
  
  METHODS
  Patients with a histologic diagnosis of LR-STS (extremity, 43%; trunk wall, 24%; retroperitoneum, 33%) and no distant metastases who underwent radical surgery and intraoperative electron radiation therapy (IOERT; median dose, 12.5 Gy) were considered eligible for participation in this study. In addition, 62% received external beam radiation therapy (EBRT; median dose, 50 Gy).
  
  
  RESULTS
  From 1986 to 2012, a total of 103 patients from 3 Spanish expert IOERT institutions were analyzed. With a median follow-up of 57 months (range, 2-311 months), 5-year local control (LC) was 60%. The 5-year IORT in-field control, disease-free survival (DFS), and overall survival were 73%, 43%, and 52%, respectively. In the multivariate analysis, no EBRT to treat the LR-STS (P=.02) and microscopically involved margin resection status (P=.04) retained significance in relation to LC. With regard to IORT in-field control, only not delivering EBRT to the LR-STS retained significance in the multivariate analysis (P=.03).
  
  
  CONCLUSIONS
  This joint analysis revealed that surgical margin and EBRT affect LC but that, given the high risk of distant metastases, DFS remains modest. Intensified local treatment needs to be further tested in the context of more efficient concurrent, neoadjuvant, and adjuvant systemic therapy.
authors: Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Complutense University, Madrid, Spain.
authors: Felipe A
authors: FA
authors: Calvo
authors: Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Complutense University, Madrid, Spain; Service of Radiation Oncology, Instituto de Radiomedicina, Santiago, Chile. Electronic address: cvsole@uc.cl.
authors: Claudio V
authors: CV
authors: Sole
authors: Service of Radiation Oncology, Clínica Universitaria, Universidad de Navarra, Pamplona, Spain.
authors: Mauricio
authors: M
authors: Cambeiro
authors: Service of Radiation Oncology, Hospital Universitario Ramón y Cajal, Universidad de Alcala, Madrid, Spain.
authors: Angel
authors: A
authors: Montero
authors: Service of Radiation Oncology, Hospital Universitario Ramón y Cajal, Universidad de Alcala, Madrid, Spain.
authors: Alfredo
authors: A
authors: Polo
authors: School of Medicine, Complutense University, Madrid, Spain; Service of Radiation Oncology, Instituto de Radiomedicina, Santiago, Chile; Service of Radiation Oncology, Clínica Universitaria, Universidad de Navarra, Pamplona, Spain; Service of Radiation Oncology, Hospital Universitario Ramón y Cajal, Universidad de Alcala, Madrid, Spain; Service of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Carmen
authors: C
authors: Gonzalez
authors: Service of Orthopedics and Traumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Miguel
authors: M
authors: Cuervo
authors: Service of Orthopedics and Traumatology, Clínica Universitaria, Universidad de Navarra, Pamplona, Spain.
authors: Mikel
authors: M
authors: San Julian
authors: School of Medicine, Complutense University, Madrid, Spain; Service of General Surgery III, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Jose L
authors: JL
authors: Garcia-Sabrido
authors: Service of Radiation Oncology, Clínica Universitaria, Universidad de Navarra, Pamplona, Spain.
authors: Rafael
authors: R
authors: Martinez-Monge
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D004583:Electrons / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D011379:Prognosis; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*; D012509:Sarcoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D013030:Spain; D016896:Treatment Outcome; D055815:Young Adult