1
|
Roeder F, Krempien R. Intraoperative radiation therapy (IORT) in soft-tissue sarcoma. Radiat Oncol 2017; 12:20. [PMID: 28100249 PMCID: PMC5244699 DOI: 10.1186/s13014-016-0751-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 12/21/2016] [Indexed: 12/18/2022] Open
Abstract
Soft-tissue sarcoma (STS) represent a rare tumor entity, accounting for less than 1% of adult malignancies. The cornerstone of curative intent treatment is surgery with free margins, although the extent of the surgical approach has been subject to change in the last decades. Multimodal approaches usually including radiation therapy have replaced extensive surgical procedures in order to preserve functionality while maintaining adequate local control. However, the possibility to apply adequate radiation doses by external beam radiation therapy (EBRT) can be limited in some situation especially in case of directly adjacent organs at risk with low radiation tolerance. Application of at least a part of the total dose via intraoperative radiation therapy (IORT) with a single fraction during the surgical procedure may overcome those limitations, because radiosensitive structures can be moved out of the radiation field resulting in reduced toxicity while the enhanced biological effectivity of the high single dose improves local control. The current review summarizes rationale, techniques, oncological and functional outcomes including possible pitfalls and associated toxicities based on the published literature for IORT focusing on extremity and retroperitoneal STS. In extremity STS, combination of limb-sparing surgery, IORT and pre- or postoperative EBRT with moderate doses consistently achieved excellent local control rates at least comparable to approaches using EBRT alone but usually including patient cohorts with higher proportions of unfavourable prognostic factors. Further on, IORT containing approaches resulted in very high limb preservation rates and good functional outcome, probably related to the smaller high dose volume. In retroperitoneal STS, the combination of preoperative EBRT, surgery and IORT consistently achieved high local control rates which seem superior to surgery alone or surgery with EBRT at least with regard to local control and in some reports even to overall survival. Further on, preoperative EBRT in combination with IORT seems to be superior to the opposite combination with regard to local control and toxicity. No major differences in wound healing disturbances or postoperative complication rates can be observed with IORT compared to non-IORT containing approaches. Neuropathy of major nerves remains a dose limiting toxicity requiring dose restrictions or exclusion from target volume. Gastrointestinal structures and ureters should be excluded from the IORT area whenever possible and the IORT volume should be restricted to the available minimum. Nevertheless, IORT represents an ideal boosting method if combined with EBRT and properly executed by experiences users which should be further evaluated preferably in prospective randomized trials.
Collapse
Affiliation(s)
- Falk Roeder
- Department of Radiation Oncology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany. .,Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Robert Krempien
- Department of Radiation Oncology, Helios Clinic Berlin-Buch, Berlin-Buch, Germany
| |
Collapse
|
2
|
Sarmento S, Costa F, Pereira A, Lencart J, Dias A, Cunha L, Sousa O, Silva JP, Santos L. Erratum: Attenuation measurements show that the presence of a TachoSil surgical patch will not compromise target irradiation in intra-operative electron radiation therapy or high-dose-rate brachytherapy. Radiat Oncol 2015; 10:256. [PMID: 26670669 PMCID: PMC4681036 DOI: 10.1186/s13014-015-0565-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 12/09/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sandra Sarmento
- Medical Physics Department, Portuguese Institute of Oncology, Porto, Portugal. .,Medical Physics, Radiobiology and Radiation Protection Group, Research Centre, Portuguese Institute of Oncology, Porto, Portugal.
| | - Filipa Costa
- Medical Physics, Radiobiology and Radiation Protection Group, Research Centre, Portuguese Institute of Oncology, Porto, Portugal
| | - Alexandre Pereira
- Medical Physics Department, Portuguese Institute of Oncology, Porto, Portugal.,Medical Physics, Radiobiology and Radiation Protection Group, Research Centre, Portuguese Institute of Oncology, Porto, Portugal
| | - Joana Lencart
- Medical Physics Department, Portuguese Institute of Oncology, Porto, Portugal.,Medical Physics, Radiobiology and Radiation Protection Group, Research Centre, Portuguese Institute of Oncology, Porto, Portugal
| | - Anabela Dias
- Medical Physics Department, Portuguese Institute of Oncology, Porto, Portugal.,Medical Physics, Radiobiology and Radiation Protection Group, Research Centre, Portuguese Institute of Oncology, Porto, Portugal
| | - Luís Cunha
- Medical Physics Department, Portuguese Institute of Oncology, Porto, Portugal.,Medical Physics, Radiobiology and Radiation Protection Group, Research Centre, Portuguese Institute of Oncology, Porto, Portugal
| | - Olga Sousa
- Radiation Oncology Department, Portuguese Institute of Oncology, Porto, Portugal
| | - José Pedro Silva
- Surgical Oncology Department, Portuguese Institute of Oncology, Porto, Portugal
| | - Lúcio Santos
- Surgical Oncology Department, Portuguese Institute of Oncology, Porto, Portugal.,Experimental Pathology and Therapeutics Group, Research Centre, Portuguese Institute of Oncology, Porto, Portugal
| |
Collapse
|