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Open Access Research article

Excellent local control with IOERT and postoperative EBRT in high grade extremity sarcoma: results from a subgroup analysis of a prospective trial

Falk Roeder12*, Burkhard Lehner3, Thomas Schmitt4, Bernd Kasper5, Gerlinde Egerer4, Oliver Sedlaczek6, Carsten Grüllich7, Gunhild Mechtersheimer8, Patrick Wuchter4, Frank W Hensley2, Peter E Huber12, Juergen Debus12 and Marc Bischof2

Author Affiliations

1 Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany

2 Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany

3 Department of Orthopedics, University of Heidelberg, Heidelberg, Germany

4 Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany

5 Interdisciplinary Tumor Center Mannheim, Mannheim University Medical Center, Mannheim, Germany

6 Department of Radiology, University of Heidelberg, Heidelberg, Germany

7 Department of Translational Oncology, National Center for Tumor Diseases, Heidelberg, Germany

8 Institute of Pathology, University of Heidelberg, Heidelberg, Germany

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BMC Cancer 2014, 14:350  doi:10.1186/1471-2407-14-350

Published: 20 May 2014

Abstract

Background

To report the results of a subgroup analysis of a prospective phase II trial focussing on radiation therapy and outcome in patients with extremity soft tissue sarcomas (STS).

Methods

Between 2005 and 2010, 50 patients (pts) with high risk STS (size ≥ 5 cm, deep/extracompartimental location, grade II-III (FNCLCC)) were enrolled. The protocol comprised 4 cycles of neoadjuvant chemotherapy with EIA (etoposide, ifosfamide and doxorubicin), definitive surgery with IOERT, postoperative EBRT and 4 adjuvant cycles of EIA. 34 pts, who suffered from extremity tumors and received radiation therapy after limb-sparing surgery, formed the basis of this subgroup analysis.

Results

Median follow-up from inclusion was 48 months in survivors. Margin status was R0 in 30 pts (88%) and R1 in 4 pts (12%). IOERT was performed as planned in 31 pts (91%) with a median dose of 15 Gy, a median electron energy of 6 MeV and a median cone size of 9 cm. All patients received postoperative EBRT with a median dose of 46 Gy after IOERT or 60 Gy without IOERT. Median time from surgery to EBRT and median EBRT duration was 36 days, respectively. One patient developed a local recurrence while 11 patients showed nodal or distant failures. The estimated 5-year rates of local control, distant control and overall survival were 97%, 66% and 79%, respectively. Postoperative wound complications were found in 7 pts (20%), resulting in delayed EBRT (>60 day interval) in 3 pts. Acute radiation toxicity mainly consisted of radiation dermatitis (grade II: 24%, no grade III reactions). 4 pts developed grade I/II radiation recall dermatitis during adjuvant chemotherapy, which resolved during the following cycles. Severe late toxicity was observed in 6 pts (18%). Long-term limb preservation was achieved in 32 pts (94%) with good functional outcome in 81%.

Conclusion

Multimodal therapy including IOERT and postoperative EBRT resulted in excellent local control and good overall survival in patients with high risk STS of the extremities with acceptable acute and late radiation side effects. Limb preservation with good functional outcome was achieved in the majority of patients.

Trial registration

ClinicalTrials.gov NCT01382030, EudraCT 2004-002501-72, 17.06.2011

Keywords:
Soft tissue sarcoma; Extremity; Neoadjuvant chemotherapy; Intraoperative radiation therapy; Postoperative radiation therapy; Prospective trial