Study: Triple therapy approach shows promise for soft-tissue sarcomas

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The combination of surgery, intraoperative radiotherapy (IORT) and external beam radiotherapy (EBRT) yields favorable local control and survival data that are well within the range of the results reported in the literature, according to a study published Aug. 26 in Radiation Oncology.

The study authors did find a complication rate trend, although not severe.

Marcus Niewald, MD, PhD, from the radio-oncology department at the Saarland University Hospital in Homburg, Germany, and colleagues retrospectively evaluated survival data for patients after a regimen of surgery, IORT and EBRT for soft-tissue sarcomas.

In the study, 38 consecutive patients underwent IORT for soft-tissue sarcoma; 29 were treated for primary tumors, nine for recurrences. The researchers said that there were 14 cases with liposarcomas, eight with leiomyosarcomas and seven with malignant fibrous histiocytomas. They located 71 percent of tumors in the extremities, the remaining ones in the retroperitoneum or the chest. Radical resection was attempted in all patients; a R0-resection was achieved in 40 percent of patients, R1 in 32 percent of patients and R2 in 11 percent of patients.

Niewald and colleagues performed IORT using a J-125 source and a high-dose rate afterloading machine after suturing silicone flaps to the tumor bed. The total dose applied ranged from 8 -15 Gy/0.5 cm tissue depth measured from the flap surface. After wound healing, EBRT was applied in 82 percent of patients with total doses of 23-56 Gy dependent on resection status and wound situation. The mean duration of follow-up was 2.3 years.

The investigators found local recurrence in 28 percent of patients, lymph node metastases in 6 percent of patients, and distant metastases in 17 percent of patients. They reported the actuarial local control rate was 63 percent at five years, and the overall survival rate was 57 percent at five years.

According to the authors, there was no statistically significant difference between the results after treatment for primaries or for recurrences. Late toxicity to the skin was found in 42 percent of patients, wound healing problems in 16 percent of patients.

Niewald and colleagues did not find neuropathy.

“The complication rates, however, are considerable; although the complications are not severe, they should be taken into account when therapy decisions are made,” the authors wrote.