title: Salvage surgery and radiotherapy including intraoperative electron radiotherapy in isolated locally recurrent tumors: Predictors of outcome.
abstract: OBJECTIVE
  To evaluate the influence of equivalent dose (EQD2) in clinical outcomes of patients with isolated locally recurrent tumors (ILRT), treated with salvage surgery and intra-operative electron beam radiation therapy (IOERT).
  
  
  METHODS
  We retrospectively reviewed 128 patients with non-metastatic ILRT of different tissues (soft tissue sarcomas, head and neck, uterine, and colorectal). Patients had received salvage surgery (R0/R1/R2) and IOERT. Previously not irradiated patients had received additional external beam radiation therapy (EBRT).
  
  
  RESULTS
  IOERT was delivered at a median dose of 15 Gy (range, 5-25 Gy). Seventy-five patients (60.9%) received additional EBRT of 46 Gy. Median EQD2 of salvage program was 62 Gy and median EQD2 of exclusive IORT was 31.2 Gy. Median follow-up was 19.2 months (range: 1.3-220). Thirty-one patients (24.2%) developed severe (grade 3-5) complications. New locoregional recurrence was documented in 86 (67.2%) of the 123 cases. Five-year rates were 31% for locoregional control, 57% for distant metastasis-free and 31% for overall survival. On multivariate analysis, R0-1 vs. R2 resection (HR 2.2, 95 CI: 1.2-4.1) was statistically significant for locoregional recurrence and EQD2 ⩾62 Gy for survival (HR 2.2, 95 CI: 1.1-4.1).
  
  
  CONCLUSIONS
  Surgical radicality (gross macroscopic resection) and radiation dose (EQD2 ⩾62 Gy in radiation salvage program) are the dominant prognostic factors beside ILRT histology. Modest rates of long-term disease control are expected when both factors are fulfilled.
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, 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: José Javier
authors.initials: JJ
authors.lastname: Aristu
authors.affiliation: Department of Oncology, University of Navarre, Pamplona, Spain.
authors.forename: Marta Moreno
authors.initials: MM
authors.lastname: Jimenez
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 Head and Neck Surgery, University of Navarre, Pamplona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Alcalde
authors.affiliation: Department of General Surgery, University of Navarre, Pamplona, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Hernandez-Lizoain
authors.affiliation: Department of Gynaecology, University of Navarrena, Pamplona, Spain.
authors.forename: Matías
authors.initials: M
authors.lastname: Jurado
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; D002648:Child; D003131:Combined Modality Therapy; D004583:Electrons / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome
keywords: EBRT; EQD2; IOERT; Locally recurrent; Salvage surgery