title: Excellent local control with IOERT and postoperative EBRT in high grade extremity sarcoma: results from a subgroup analysis of a prospective trial.
abstract: BACKGROUND
  To report the results of a subgroup analysis of a prospective phase II trial focussing on radiation therapy and outcome in patients with extremity soft tissue sarcomas (STS).
  
  
  METHODS
  Between 2005 and 2010, 50 patients (pts) with high risk STS (size ≥ 5 cm, deep/extracompartimental location, grade II-III (FNCLCC)) were enrolled. The protocol comprised 4 cycles of neoadjuvant chemotherapy with EIA (etoposide, ifosfamide and doxorubicin), definitive surgery with IOERT, postoperative EBRT and 4 adjuvant cycles of EIA. 34 pts, who suffered from extremity tumors and received radiation therapy after limb-sparing surgery, formed the basis of this subgroup analysis.
  
  
  RESULTS
  Median follow-up from inclusion was 48 months in survivors. Margin status was R0 in 30 pts (88%) and R1 in 4 pts (12%). IOERT was performed as planned in 31 pts (91%) with a median dose of 15 Gy, a median electron energy of 6 MeV and a median cone size of 9 cm. All patients received postoperative EBRT with a median dose of 46 Gy after IOERT or 60 Gy without IOERT. Median time from surgery to EBRT and median EBRT duration was 36 days, respectively. One patient developed a local recurrence while 11 patients showed nodal or distant failures. The estimated 5-year rates of local control, distant control and overall survival were 97%, 66% and 79%, respectively. Postoperative wound complications were found in 7 pts (20%), resulting in delayed EBRT (>60 day interval) in 3 pts. Acute radiation toxicity mainly consisted of radiation dermatitis (grade II: 24%, no grade III reactions). 4 pts developed grade I/II radiation recall dermatitis during adjuvant chemotherapy, which resolved during the following cycles. Severe late toxicity was observed in 6 pts (18%). Long-term limb preservation was achieved in 32 pts (94%) with good functional outcome in 81%.
  
  
  CONCLUSIONS
  Multimodal therapy including IOERT and postoperative EBRT resulted in excellent local control and good overall survival in patients with high risk STS of the extremities with acceptable acute and late radiation side effects. Limb preservation with good functional outcome was achieved in the majority of patients.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01382030, EudraCT 2004-002501-72, 17.06.2011.
authors.affiliation: Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. Falk.Roeder@med.uni-heidelberg.de.
authors.forename: Falk
authors.initials: F
authors.lastname: Roeder
authors.forename: Burkhard
authors.initials: B
authors.lastname: Lehner
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmitt
authors.forename: Bernd
authors.initials: B
authors.lastname: Kasper
authors.forename: Gerlinde
authors.initials: G
authors.lastname: Egerer
authors.forename: Oliver
authors.initials: O
authors.lastname: Sedlaczek
authors.forename: Carsten
authors.initials: C
authors.lastname: Grüllich
authors.forename: Gunhild
authors.initials: G
authors.lastname: Mechtersheimer
authors.forename: Patrick
authors.initials: P
authors.lastname: Wuchter
authors.forename: Frank W
authors.initials: FW
authors.lastname: Hensley
authors.forename: Peter E
authors.initials: PE
authors.lastname: Huber
authors.forename: Juergen
authors.initials: J
authors.lastname: Debus
authors.forename: Marc
authors.initials: M
authors.lastname: Bischof
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005858:Germany; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal / Q000009:adverse effects; D012509:Sarcoma / Q000473:pathology / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005047:Etoposide; D004317:Doxorubicin; D007069:Ifosfamide