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High-dose-rate intraoperative radiation therapy (HDR-IORT) for retroperitoneal sarcomas.
Alektiar, K M; Hu, K; Anderson, L; Brennan, M F; Harrison, L B.
Affiliation
  • Alektiar KM; Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Int J Radiat Oncol Biol Phys ; 47(1): 157-63, 2000 Apr 01.
Article in En | MEDLINE | ID: mdl-10758318
PURPOSE: Retroperitoneal sarcomas represent a formidable challenge to the treating oncologist due to their location, large size, and poor prognosis. The purpose of this study was to determine if the addition of high-dose-rate intraoperative radiation therapy (HDR-IORT) to surgery and external beam radiotherapy (EBRT) would improve the outcome in these patients. METHODS AND MATERIALS: Thirty-two patients with retroperitoneal soft tissue sarcoma were prospectively treated according to a protocol that included maximal tumor resection, HDR-IORT, and postoperative EBRT when feasible. Twelve patients presented with primary and 20 with locally recurrent disease. The tumors were high-grade in 20 patients and low-grade in 12 patients. Complete gross resection was achieved in 30 patients. HDR-IORT was given to a dose of 12-15 Gy. Additional EBRT was given to 78% of patients to a dose of 45-50.4 Gy. The two patients with gross residual disease received an additional I-125 permanent implant to a median peripheral dose of 140-160 Gy. The median follow-up was 33 months (range 1-77 mo). RESULTS: The 5-year actuarial local control rate for the whole group was 62%. For patients with primary disease, the local control rate was 74% compared to 54% in patients with recurrent disease (p = 0.4). The overall 5-year distant metastasis-free survival rate was 82%. In patients with high-grade tumors the rate was 70% vs. 100% in those with low-grade tumors. This difference was statistically significant, p = 0.05. The 5-year disease-free and overall survival rates were 55% and 45%, respectively. The most common type of post-treatment complication was gastrointestinal obstruction (18%) followed by fistula formation (9%), peripheral neuropathy (6%), hydronephrosis (3%), and wound complication (3%). CONCLUSIONS: We are encouraged by the favorable local control rate and the acceptable morbidity with this new technique applied to a challenging patient population.
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Collection: 01-internacional Database: MEDLINE Main subject: Retroperitoneal Neoplasms / Sarcoma Type of study: Guideline / Observational_studies / Risk_factors_studies Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: En Journal: Int J Radiat Oncol Biol Phys Year: 2000 Document type: Article
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Collection: 01-internacional Database: MEDLINE Main subject: Retroperitoneal Neoplasms / Sarcoma Type of study: Guideline / Observational_studies / Risk_factors_studies Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: En Journal: Int J Radiat Oncol Biol Phys Year: 2000 Document type: Article