Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Radiation Oncology
Published in: Radiation Oncology 1/2020

01-12-2020 | Brachytherapy | Research

Intraoperative radiotherapy with low energy x-rays for primary and recurrent soft-tissue sarcomas

Authors: Gustavo R. Sarria, Vera Petrova, Frederik Wenz, Yasser Abo-Madyan, Elena Sperk, Frank A. Giordano

Published in: Radiation Oncology | Issue 1/2020

Login to get access

Abstract

Background

Soft tissue sarcomas (STS) treatment remains a therapeutic challenge. Intraoperative radiotherapy (IORT) resembles a safe and efficient for STS treatment. The first data on electronic-IORT (eIORT) using low-energy photons is herein presented.

Methods

Thirty-one patients with newly and recurrent STS were retrospectively assessed. EIORT was applied with low-energy photons during surgery. The dose was either prescribed to the applicator surface (spherical applicators) or 5 mm depth (flat applicators). Overall progression-free survival (O-PFS), local progression-free survival (L-PFS), overall survival (OS) and adverse events were evaluated.

Results

Median follow-up was 4.88 (1.0–8.95) years. Twenty-five patients (80.6%) had recurrent STS with prior treatment. The resection status was R1 in 25.8% and R2 in 6.5%. The distribution was 51.7% for extremities, 35.5% for abdomen and pelvis, 9.7% for thorax and 3.2% for head and neck tumors. The median O-PFS was 11.0 months, with 42.6% 5-year estimated O-PFS. The only local recurrence in the primary setting occurred after 22 months. Median L-PFS in recurrent STS was 12.5 months, with 65.5% 5-year estimated L-PFS. The 5-year OS estimated rate was 94.7% (3 events after 7 years). No G3 toxicity related to eIORT was observed. Two patients exhibited G2 acute neuropathic pain. Late neuropathic pain was seen in 6 patients being 3 graded as G1 and 3 as G2. No wound-related toxicity was found.

Conclusion

Electronic IORT with low-energy photons is a safe treatment option for STS, yielding similar outcomes as historical series reporting IORT with electrons or HDR brachytherapy.
Literature
1.
2.
Mastrangelo G, Coindre JM, Ducimetiere F, et al. Incidence of soft tissue sarcoma and beyond: a population-based prospective study in 3 European regions. Cancer. 2012;118(21):5339–48.PubMedCrossRef
3.
Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.CrossRefPubMed
4.
5.
6.
Nandra R, Hwang N, Matharu GS, et al. One-year mortality in patients with bone and soft tissue sarcomas as an indicator of delay in presentation. Ann R Coll Surg Engl. 2015;97(6):425–33.PubMedPubMedCentralCrossRef
7.
Daigeler A, Zmarsly I, Hirsch T, et al. Long-term outcome after local recurrence of soft tissue sarcoma: a retrospective analysis of factors predictive of survival in 135 patients with locally recurrent soft tissue sarcoma. Br J Cancer. 2014;110(6):1456–64.PubMedPubMedCentralCrossRef
8.
Trovik CS, Bauer HCF, Alvegård TA, et al. Surgical margins, local recurrence and metastasis in soft tissue sarcomas. Eur J Cancer. 2000;36(6):710–6.PubMedCrossRef
9.
Rosenberg SA, Tepper J, Glatstein E, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. 1982;196(3):305–15.PubMedPubMedCentralCrossRef
10.
Casali PG, Abecassis N, Bauer S, et al. Soft tissue and visceral sarcomas: ESMO–EURACAN clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29:iv51–67.PubMedCrossRef
11.
Pisters PW, Harrison LB, Leung DH, et al. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol. 1996;14(3):859–68.PubMedCrossRef
12.
Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16(1):197–203.PubMedCrossRef
13.
Shah C, Verma V, Takiar R, et al. Radiation therapy in the Management of Soft Tissue Sarcoma: a Clinician's guide to timing, techniques, and targets. Am J Clin Oncol. 2016;39(6):630–5.PubMedCrossRef
14.
Nussbaum DRC, Lane W, Cardona D, Kirsch D, Peterson B, et al. Preoperative or postoperative radiotherapy versus surgery alone for retroperitoneal sarcoma: a case-control, propensity score-matched analysis of a nationwide clinical oncology database. Lancet Oncol. 2016;17(7):966–75.PubMedCrossRef
15.
Muratori F, Frenos F, Bettini L, et al. Liposarcoma: Clinico-pathological analysis, prognostic factors and survival in a series of 307 patients treated at a single institution. J Orthop Sci. 2018;23(6):1038–44.PubMedCrossRef
16.
17.
Abe M, Takahashi M. Intraoperative radiotherapy: the Japanese experience. Int J Radiat Oncol Biol Phys. 1981;7(7):863–8.PubMedCrossRef
18.
Kinsella TJ, Sindelar WF, Lack E, et al. Preliminary results of a randomized study of adjuvant radiation therapy in resectable adult retroperitoneal soft tissue sarcomas. J Clin Oncol. 1988;6(1):18–25.PubMedCrossRef
19.
20.
Manir KS, Basu A, Choudhury KB, et al. Interstitial brachytherapy in soft tissue sarcoma: a 5 years institutional experience with cobalt 60-based high-dose-rate brachytherapy system. J Contemp Brachytherapy. 2018;10(5):431–8.PubMedPubMedCentralCrossRef
21.
Schneider F, Clausen S, Tholking J, et al. A novel approach for superficial intraoperative radiotherapy (IORT) using a 50 kV X-ray source: a technical and case report. J Appl Clin Med Phys. 2014;15(1):4502.PubMedCrossRef
22.
Vaidya JS, Wenz F, Bulsara M, et al. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet. 2014;383(9917):603–13.PubMedCrossRef
23.
Giordano FA, Brehmer S, Murle B, et al. Intraoperative radiotherapy in newly diagnosed Glioblastoma (INTRAGO): an open-label, Dose-Escalation Phase I/II Trial. Neurosurgery. 2018.
24.
Wenz F, Schneider F, Neumaier C, et al. Kypho-IORT--a novel approach of intraoperative radiotherapy during kyphoplasty for vertebral metastases. Radiat Oncol. 2010;5:11.PubMedPubMedCentralCrossRef
25.
Schmidt R, Wenz F, Reis T, et al. Kyphoplasty and intra-operative radiotheray, combination of kyphoplasty and intra-operative radiation for spinal metastases: technical feasibility of a novel approach. Int Orthop. 2012;36(6):1255–60.PubMedPubMedCentralCrossRef
26.
27.
Maretty-Nielsen K, Aggerholm-Pedersen N, Keller J, et al. Relative mortality in soft tissue sarcoma patients: a Danish population-based cohort study. BMC Cancer. 2014;14:682.PubMedPubMedCentralCrossRef
28.
Cahlon O, Brennan MF, Jia X, et al. A postoperative nomogram for local recurrence risk in extremity soft tissue sarcomas after limb-sparing surgery without adjuvant radiation. Ann Surg. 2012;255(2):343–7.PubMedCrossRef
29.
Kosela-Paterczyk H, Szacht M, Morysinski T, et al. Preoperative hypofractionated radiotherapy in the treatment of localized soft tissue sarcomas. Eur J Surg Oncol. 2014;40(12):1641–7.PubMedCrossRef
30.
Abatzoglou S, Turcotte RE, Adoubali A, et al. Local recurrence after initial multidisciplinary management of soft tissue sarcoma: is there a way out? Clin Orthop Relat Res. 2010;468(11):3012–8.PubMedPubMedCentralCrossRef
31.
Kim HJ, Koom WS, Cho J, et al. Efficacy of postoperative radiotherapy using modern techniques in patients with retroperitoneal soft tissue sarcoma. Yonsei Med J. 2018;59(9):1049–56.PubMedPubMedCentralCrossRef
32.
Call JA, Stafford SL, Petersen IA, et al. Use of intraoperative radiotherapy for upper-extremity soft-tissue sarcomas: analysis of disease outcomes and toxicity. Am J Clin Oncol. 2014;37(1):81–5.PubMedCrossRef
33.
Haddock MG, Petersen IA, Pritchard D, et al. IORT in the management of extremity and limb girdle soft tissue sarcomas. Front Radiat Ther Oncol. 1997;31:151–2.PubMedCrossRef
34.
Roeder F, Lehner B, Schmitt T, et al. Excellent local control with IOERT and postoperative EBRT in high grade extremity sarcoma: results from a subgroup analysis of a prospective trial. BMC Cancer. 2014;14:350.PubMedPubMedCentralCrossRef
35.
Calvo FA, Sole CV, Polo A, et al. Limb-sparing management with surgical resection, external-beam and intraoperative electron-beam radiation therapy boost for patients with primary soft tissue sarcoma of the extremity: a multicentric pooled analysis of long-term outcomes. Strahlenther Onkol. 2014;190(10):891–8.PubMedCrossRef
36.
Roeder F, Ulrich A, Habl G, et al. Clinical phase I/II trial to investigate preoperative dose-escalated intensity-modulated radiation therapy (IMRT) and intraoperative radiation therapy (IORT) in patients with retroperitoneal soft tissue sarcoma: interim analysis. BMC Cancer. 2014;14:617.PubMedPubMedCentralCrossRef
37.
Tom MC, Joshi N, Vicini F, et al. The American brachytherapy society consensus statement on intraoperative radiation therapy. Brachytherapy. 2019;18(3):242–57.PubMedCrossRef
38.
Liu Q, Schneider F, Ma L, et al. Relative biologic effectiveness (RBE) of 50 kV X-rays measured in a phantom for intraoperative tumor-bed irradiation. Int J Radiat Oncol Biol Phys. 2013;85(4):1127–33.PubMedCrossRef
39.
Albertsmeier M, Rauch A, Roeder F, et al. External beam radiation therapy for Resectable soft tissue sarcoma: a systematic review and meta-analysis. Ann Surg Oncol. 2018;25(3):754–67.PubMedCrossRef
40.
Albertsmeier M, Roeder F, Angele MK. ASO Author Reflections: Radiation Therapy in Soft Tissue Sarcoma: Who Benefits and How? Ann Surg Oncol. 2018;25(Suppl 3):934-5.
41.
Palma DA, Olson R, Harrow S, et al. Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. Lancet. 2019;393(10185):2051–8.PubMedCrossRef
42.
Trans-Atlantic Retroperitoneal Sarcoma Working G. Management of metastatic retroperitoneal sarcoma: a consensus approach from the trans-Atlantic retroperitoneal sarcoma working group (TARPSWG). Ann Oncol. 2018;29(4):857–71.CrossRef
43.
Marconi R, Strolin S, Bossi G, et al. A meta-analysis of the abscopal effect in preclinical models: is the biologically effective dose a relevant physical trigger? PLoS One. 2017;12(2):e0171559.PubMedPubMedCentralCrossRef
44.
Brix N, Tiefenthaller A, Anders H, et al. Abscopal, immunological effects of radiotherapy: narrowing the gap between clinical and preclinical experiences. Immunol Rev. 2017;280(1):249–79.PubMedCrossRef
45.
Palma DA, Olson RA, Harrow S, et al. Stereotactic ablative radiation therapy for the comprehensive treatment of oligometastatic tumors (SABR-COMET): results of a randomized trial. Int J Radiat Oncol Biol Phys. 2018;102(3):S3–4.CrossRef
46.
Folkert MR, Tong WY, LaQuaglia MP, et al. 20-year experience with intraoperative high-dose-rate brachytherapy for pediatric sarcoma: outcomes, toxicity, and practice recommendations. Int J Radiat Oncol Biol Phys. 2014;90(2):362–8.PubMedCrossRef
47.
Roeder F, de Paoli A, Saleh-Ebrahimi L, et al. Intraoperative Electron radiation therapy combined with external beam radiation therapy after gross Total resection in extremity soft tissue sarcoma: a European pooled analysis. Ann Surg Oncol. 2018;25(13):3833–42.PubMedCrossRef
48.
Mailhot Vega R, Talcott W, Ishaq O, et al. A national survey of HDR source knowledge among practicing radiation oncologists and residents: establishing a willingness-to-pay threshold for cobalt-60 usage. Brachytherapy. 2017;16(4):910–5.PubMedCrossRef
49.
Goubert M, Parent L. Dosimetric characterization of INTRABEAM(R) miniature accelerator flat and surface applicators for dermatologic applications. Phys Med. 2015;31(3):224–32.PubMedCrossRef
50.
51.
Calvo F, Sole C, Herranz R, et al. Intraoperative radiotherapy with electrons: fundamentals, results, and innovation. Ecancermedicalscience. 2013;7:339.PubMedPubMedCentral
Metadata
Title
Intraoperative radiotherapy with low energy x-rays for primary and recurrent soft-tissue sarcomas
Authors
Gustavo R. Sarria
Vera Petrova
Frederik Wenz
Yasser Abo-Madyan
Elena Sperk
Frank A. Giordano
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2020
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-020-01559-7

Other articles of this Issue 1/2020

Radiation Oncology 1/2020 Go to the issue

Case report

Squamous cell carcinoma (SCC) of the Pyriform sinus with multiple metachronous brain metastases, a case report

Review

First statement on preparation for the COVID-19 pandemic in large German Speaking University-based radiation oncology departments

Research

Study on the ability of 3D gamma analysis and bio-mathematical model in detecting dose changes caused by dose-calculation-grid-size (DCGS)

Research

Feasibility of hippocampus-sparing VMAT for newly diagnosed glioblastoma treated by chemoradiation: pattern of failure analysis

Research

Radioprotective efficacy of plastic polymer against the toxicogenomic effects of radiopharmaceutical 18F-FDG on human lymphocytes

Research

Magnetic resonance imaging features of tumor and lymph node to predict clinical outcome in node-positive cervical cancer: a retrospective analysis