Intraoperative radiotherapy in the multidisciplinary management of soft tissue sarcomas

From 1984 to 1989 locally advanced stages of soft tissue sarcomas have been systematically approached with maximal surgical resection, IORT (10-20 Gy) boost to the tumor bed (high risk or residual disease areas) and conventional fractionated external beam postoperative radiotherapy. Chemotherapy was given to patients with high cellular grade sarcomas. Nineteen patients with localized soft tissue sarcomas of the extremities were treated and local control was obtained in 18/19 cases (95%). Distant metastasis developed in 2 patients and 15 patients are alive with no evidence of disease. The median follow-up time of the entire group is 27+ months (range 2+ to 43+ months). Severe IORT toxicity consisting in unreversible peripheral neuropathy has been observed in 3 patients. Another group of 24 patients had tumor located in central anatomical areas (3 head and neck, 7 trunk, 6 retroperitoneal, 3 glutens, 3 pelvis, 1 rectal, 1 bladder). Local control has been obtained in 15 patients (62%). Distant metastasis developed in 3 patients and 11 are alive and free of malignant disease. The median follow-up in this group is 14.5+ months (range from 4 to 50+ months). Severe neuropathy was observed in 1 patient. Severe neurological damage is a preoccupying finding that merits a word of caution in the development of IORT protocols, as what single dose can be selected in areas including nerves in treatment field