High-dose-rate intraoperative radiation therapy (HDR-IORT) for retroperitoneal sarcomas Journal Article


Authors: Alektiar, K. M.; Hu, K.; Anderson, L.; Brennan, M. F.; Harrison, L. B.
Article Title: High-dose-rate intraoperative radiation therapy (HDR-IORT) for retroperitoneal sarcomas
Abstract: 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. Copyright (C) 2000 Elsevier Science Inc.
Keywords: adult; clinical article; treatment outcome; aged; middle aged; survival analysis; clinical trial; fistula; radiation dose; combined modality therapy; chemotherapy; cancer staging; prospective studies; neoplasm recurrence, local; radiotherapy dosage; peripheral neuropathy; radiotherapy; sarcoma; postoperative complications; survival time; iodine 125; feasibility studies; intraoperative period; brachytherapy; recurrent disease; retroperitoneal neoplasms; phase 1 clinical trial; intestine obstruction; wound infection; hydronephrosis; retroperitoneal sarcoma; humans; human; male; female; priority journal; article; high-dose-rate intraoperative radiation therapy
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 47
Issue: 1
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2000-04-01
Start Page: 157
End Page: 163
Language: English
DOI: 10.1016/s0360-3016(99)00546-5
PUBMED: 10758318
PROVIDER: scopus
DOI/URL:
Notes: Export Date: 18 November 2015 -- Source: Scopus
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MSK Authors
  1. Murray F Brennan
    837 Brennan
  2. Kaled M Alektiar
    262 Alektiar
  3. Kenneth S Hu
    10 Hu