Intraoperative radiotherapy for the treatment of soft tissue sarcomas of central anatomical sites

The results of intense therapy for soft tissue sarcomas located in central anatomic sites using an intraoperative electron boost (10–20 Gy) during surgery, integrated in a multimodal approach including external beam irradiation with or without chemotherapy, are analyzed. The relevant clinical data include a total of 30 patients treated, 13 recurrent tumors, 11 primary locally advanced stages, 15 high grade lesions, common location in the trunk (10 cases) and retroperitoneum (8 cases), and macroscopic residual disease after surgery in 9 cases. The median follow-up time for the entire series is 25 months (range 4–98+ months). Severe toxicity related to the combined therapy includes peripheral neuropathy in 3 patients, 1 myelopathy, 1 chronic enteritis, 1 rectovaginal fistula, and 1 lethal sepsis. Overall local control rate is 53% (65% in cases with microscopic residual disease and 35% in confirmed macrotumor residue). Subgroup analysis of local control shows a value of 72% (13/18) in patients with lesions of 10 cm (4/12). Actuarial survival rates are 36% for the entire series and 53% and 20% for patients with primary and recurrent disease, respectively. It is concluded that intraoperative radiotherapy (IORT) is feasible to be integrated in multidisciplinary programs as a local intensification treatment technique. Peripheral nerves are dose-limiting structures for IORT trials. Local tumor control rates in central sarcomas appear to be related to the status of postsurgical margins and tumor size. Long-term survivors are followed with no evidence of disease both in primary (81+ months) and recurrent disease (98+ months) patients. © 1995 Wiley-Liss, Inc.