Intraoperative electron radiation therapy in retroperitoneal sarcoma
Menée à partir de données portant sur 156 patients atteints d'un sarcome rétropéritonéal des tissus mous (durée médiane de suivi : 38 mois), cette étude analyse la faisabilité et l'efficacité, du point de vue du contrôle local de la maladie et de la survie globale, d'un traitement comportant une intervention chirurgicale, une radiothérapie intra-opératoire à faisceaux d'électrons et une radiothérapie externe
Background : To report our experience with surgery, IORT and EBRT in retroperitoneal soft-tissue sarcoma. Methods : We conducted a retrospective evaluation of 156 patients (69 primary, 87 recurrent) treated with IORT since 1991. The dominant histology was dedifferentiated liposarcoma (49%), 89% of lesions were high-grade. Median tumor size was 11cm. Surgery resulted in gross complete resection in 92%, 65% had microscopically positive margins. Median IORT dose was 15Gy. 114 patients (73%) received additional EBRT (preoperatively n=38, postoperatively n=76, median dose 45Gy). Results : Median follow-up was 38 months (49 months in survivors). 3- and 5-year-LC was 57% and 50%. On univariate analysis, LC was significantly associated with primary vs recurrent status, histology, grade, UICC stage, resection margin and addition of EBRT. 5-year-LC was 71% in primary situation and 79% following R0 resection. On multivariate analysis, only disease status, grade, resection margin and addition of EBRT remained statistically significant. 3- and 5-year-OS were 66% and 56%. On univariate analysis, OS was significantly associated with primary vs. recurrent status, histology, grade, UICC stage, resection margin and timing of EBRT. 5-year-OS was 63% in primary situation and 68% following R0-resection. On multivariate analysis, only disease status, grade and resection margin remained independent prognostic factors. Perioperative mortality was 1%, major complications occurred in 34% (mainly wound complications). Conclusions : Treatment with surgery, IORT and EBRT is feasible and resulted in good LC and OS with acceptable morbidity in this unfavourable patient cohort. Incomplete resection and recurrent status resulted in clearly inferior outcome. Reasonable efforts should be made already during primary treatment to prevent the onset of a local recurrence.
http://www.redjournal.org/article/S0360-3016(17)34041-5/fulltext 2017