Intraoperative radiotherapy for extremity soft-tissue sarcomas: can long-term local control be achieved?

BACKGROUND: Intraoperative electron-beam radiation therapy (IOERT) during limb-sparing surgery has the advantage of delivering a single high boost dose to sarcoma residues and surgical bed area near to radiosensitive structures with limited toxicity. Retrospective studies have suggested that IOERT may improve local control compared to standard radiotherapy and we aimed to demonstrate this theory. Therefore, we performed an observational prospective study to determine (1) if it is possible to achieve high local control by adding IOERT to external-beam radiation therapy (EBRT) in extremity soft-tissue sarcomas (STS), (2) if it is possible to improve long-term survival rates, and (3) if toxicity could be reduced with IOERT MATERIALS AND METHODS: From 1995-2003, 39 patients with extremity STS were treated with IOERT and postoperative radiotherapy. The median follow-up time was 13.2 years (0.7-19). Complications, locoregional control and survival rates were collected. RESULTS: Actuarial local control was attained in 32 of 39 patients (82%). Control was achieved in 88% of patients with primary disease and in 50% of those with recurrent tumors (p = 0.01). Local control was shown in 93% of patients with negative margins and in 50% of those with positive margins (p = 0.002). Limb-sparing was achieved in 32 patients (82%). The overall survival rate was 64%. 13% of patients had grade ≥3 acute toxicity, and 12% developed grade ≥3 chronic toxicity. CONCLUSION: IOERT used as a boost to EBRT provides high local control and limb-sparing rates in patients with STS of the extremities, with less toxicity than EBRT alone.

Extremity high-grade sarcomas in elderly patients, are they candidates for surgery? Experience in a sarcoma referral center.

The number of elderly patients diagnosed with cancer is increasing. However, knowledge regarding cancer in elderly patients is very scarce. The aim of this study is to analyze the differences in management and outcomes of high-grade extremity sarcomas between elderly and middle-aged patients. Two cohorts were made (> 70 and 30/50 years old) among patients treated in a multidisciplinary unit of a national reference center between 2011 and 2017 with a minimum of 2 years of follow-up. The management and outcomes between these two cohorts were compared. Seventy patients were included, 34 young patients and 36 elderly patients. The only difference between the treatment schemes was the chemotherapy used, 67.6% of the young patients received chemotherapy versus 16.7% of the elderly patients (p = 0.000015). There were no differences either in the overall survival or the progression-free survival between groups at 1 and 2-year follow-up. Deceases for other causes were nearly exclusive of elderly patients at a median of 45.57 months. Surgery is the treatment of choice for sarcomas in both elderly and young patients having similar results in terms of progression-free survival, overall survival, and surgery outcomes. The use of chemotherapy is the only difference in the treatment schemes between both groups. In the elderly patient with minimal or no comorbidity and good functional reserve, surgical curative treatment should be chosen. As for frail elderly patients, the therapeutic objectives must be focused mainly on quality of life and palliation of symptoms.