title: Intraoperative electron radiation therapy combined with external beam radiation therapy and limb sparing surgery in extremity soft tissue sarcoma: a retrospective single center analysis of 183 cases.
abstract: OBJECTIVE
  To report our experience with limb-sparing surgery, IOERT and EBRT in extremity STS.
  
  
  METHODS
  183 patients were retrospectively analyzed. 78% presented in primary situation, with 80% located in the lower limb. Stage at presentation was: I: 6%, IIa: 25%, IIb: 21%, III: 42%, IV: 7%. The majority showed high-grade lesions (grade 1: 5%, 2: 31%, 3: 64%). IOERT was applied to the tumor bed (median 15Gy) and preceded (9%) or followed (91%) by EBRT (median 45Gy) in all patients.
  
  
  RESULTS
  Median follow-up was 64months (78months in survivors). Surgery was complete in 68%, while 32% had microscopic residual disease. 5- and 10-year-LC was 86% and 84%, respectively. LC was significantly higher in primary compared to recurrent disease and tended to be higher after complete resection. Estimated 5- and 10-year-DC was 68% and 66%, while corresponding OS was 77% and 66%, respectively. OS was significantly affected by grading and stage. Severe postoperative complications and late toxicities were observed in 19% and 20%, respectively. Limb-preservation rate was 95% with good function in 83%.
  
  
  CONCLUSIONS
  Combination of limb-sparing surgery, IOERT and EBRT achieved encouraging LC and OS in this unfavorable patient group with acceptable postoperative complications and low rates of late toxicities resulting in a high limb-preservation rate and good functional outcome.
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, Germany; CCU Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; CCU Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, University of Munich (LMU), Germany. Electronic address: Falk.Roeder@med.uni-muenchen.de.
authors.forename: Falk
authors.initials: F
authors.lastname: Roeder
authors.affiliation: Department of Orthopedics, University of Heidelberg, Germany. Electronic address: Burkhard.Lehner@med.uni-heidelberg.de.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Lehner
authors.affiliation: CCU Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, University of Munich (LMU), Germany. Electronic address: Ladan.SalehEbrahimi@med.uni-muenchen.de.
authors.forename: Ladan
authors.initials: L
authors.lastname: Saleh-Ebrahimi
authors.affiliation: CCU Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. Electronic address: Frank.Hensley@med.uni-heidelberg.de.
authors.forename: Frank W
authors.initials: FW
authors.lastname: Hensley
authors.affiliation: Department of Surgery, University of Heidelberg, Germany. Electronic address: Alexis.Ulrich@med.uni-heidelberg.de.
authors.forename: Alexis
authors.initials: A
authors.lastname: Ulrich
authors.affiliation: Department of Surgery, University of Heidelberg, Germany. Electronic address: Ingo.Alldinger@med.uni-heidelberg.de.
authors.forename: Ingo
authors.initials: I
authors.lastname: Alldinger
authors.affiliation: Institute of Pathology, University of Heidelberg, Germany. Electronic address: Gunhild.Mechtersheimer@med.uni-heidelberg.de.
authors.forename: Gunhild
authors.initials: G
authors.lastname: Mechtersheimer
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, Germany; CCU Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. Electronic address: p.huber@dkfz.de.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Huber
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, Germany; Department of Radiation Oncology, Helios Clinic Berlin-Buch, Germany. Electronic address: Robert.krempien@helios-kliniken.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Krempien
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, Germany; Department of Radiation Oncology, SLK Clinic Heilbronn, Germany. Electronic address: Marc.Bischof@slk-kliniken.de.
authors.forename: Marc
authors.initials: M
authors.lastname: Bischof
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, Germany; CCU Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. Electronic address: Juergen.Debus@med.uni-heidelberg.de.
authors.forename: Juergen
authors.initials: J
authors.lastname: Debus
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, Germany. Electronic address: Matthias.Uhl@med.uni-heidelberg.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Uhl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004583:Electrons; D005121:Extremities / Q000528:radiation effects / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: EBRT; Extremity; IOERT; Limb-sparing surgery; Soft tissue sarcoma