title: Salvage wide resection with intraoperative electron beam therapy or HDR brachytherapy in the management of isolated local recurrences of soft tissue sarcomas of the extremities and the superficial trunk.
abstract: OBJECTIVE
  To assess the toxicity and efficacy of salvage wide resection (SWR) with intraoperative electron beam radiation therapy (IOERT) or perioperative high-dose-rate brachytherapy (PHDRB) in previously unirradiated patients (PUP) vs. previously irradiated patients (PIP) with isolated local recurrence of soft tissue sarcomas (STS) of the extremities and the superficial trunk.
  
  
  METHODS
  PUP received SWR and IOERT/PHDRB with external beam radiation therapy. PIP received SWR and IOERT/PHDRB only.
  
  
  RESULTS
  Fifty patients were analyzed retrospectively. PUP (n = 24; 48%) received IOERT (n = 13) or PHDRB (n = 11). PIP (n = 26; 52%) received IOERT (n = 10) or PHDRB (n = 16). Reintervention because of complications was not required in PUP. Nine of 26 (34%) PIP required reintervention (p = 0.01). After a median followup of 3.7 years (range, 0.2-18.3), the 5-year rates of locoregional control, distant control, and overall survival were 54%, 66%, and 56%, respectively. Five-year locoregional control was higher in PUP than in PIP (81% vs. 26%, p = 0.01) and in the extremity locations compared with trunk locations (68% vs. 28%, p = 0.001). Five-year overall survival was superior in unifocal vs. multifocal presentations (70% vs. 36%, p = 0.03) and for tumor sizes <4 vs. ≥4 cm (74% vs. 50%, p = 0.05).
  
  
  CONCLUSIONS
  Prior irradiation is the main determinant of locoregional control in patients with isolated local recurrence of STS. The locoregional control rates in PUP were similar to those described in primary STS. In PIP, SWR + IOERT/PHDRB reirradiation yielded modest locoregional control rates and was associated with significant morbidity, especially in PHDRB cases.
authors.affiliation: Department of Oncology, University of Navarre, Pamplona, Spain. Electronic address: mcambeiro@unav.es.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Cambeiro
authors.affiliation: Department of Oncology, University of Navarre, Pamplona, Spain.
authors.forename: José Javier
authors.initials: JJ
authors.lastname: Aristu
authors.affiliation: Department of Oncology, University of Navarre, Pamplona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Moreno Jimenez
authors.affiliation: Department of Oncology, University of Navarre, Pamplona, Spain.
authors.forename: Leire
authors.initials: L
authors.lastname: Arbea
authors.affiliation: Department of Oncology, University of Navarre, Pamplona, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Ramos
authors.affiliation: Department of Orthopaedic Surgery, University of Navarre, Pamplona, Spain.
authors.forename: Mikel
authors.initials: M
authors.lastname: San Julian
authors.affiliation: Department of Oncology, Hospital San Jaime, Torrevieja, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Azinovic
authors.affiliation: Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Calvo
authors.affiliation: Department of Oncology, University of Navarre, Pamplona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Martínez-Monge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D004583:Electrons / Q000627:therapeutic use*; D005121:Extremities; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods; D012509:Sarcoma / Q000532:radiotherapy* / Q000601:surgery; D055815:Young Adult
keywords: HDR brachytherapy; IOERT; Locally recurrent; Salvage surgery; Soft tissue sarcomas