Intraoperative radiotherapy in soft tissue sarcomas of the extremities and retroperitoneum: review of the evidence and therapeutic approach at the Instituto Nacional de Cancerología, Colombia

Authors

DOI:

https://doi.org/10.35509/01239015.974

Keywords:

radiotherapy, surgical procedures, operative, electrons, radiation dosage, sarcoma, soft tissue neoplasms, general surgery

Abstract

Soft tissue sarcomas are low-incidence tumors, representing 1% of malignant tumors in adults (1). Surgery is the mainstay of treatment, with curative intent; nevertheless, due to the high risk of local recurrence, other multimodal treatment strategies have been used, both neoadjuvant and adjuvant. Intraoperative radiotherapy is an alternative that has been used in conjunction with neoadjuvant or adjuvant radiation therapy. Given that there are no controlled clinical trials that respond to the benefit of intraoperative radiotherapy in the management of patients with soft tissue sarcomas of the extremities and retroperitoneum, a literature review was conducted on the evidence of intraoperative radiotherapy in local control, overall survival, disease-free survival, and safety, in order to establish precise indications for intraoperative radiotherapy in patients with soft tissue sarcomas located in the extremities and retroperitoneum at the Instituto Nacional de Cancerología (Bogotá, Colombia).

Author Biographies

Sara Mendoza-Díaz, Residente de la Especialización en Oncología Radioterápica, convenio Universidad Militar Nueva Granada - Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

1. Residente de la Especialización en Oncología Radioterápica, convenio Universidad Militar Nueva Granada - Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

Juanita Martínez-Villacrés, Especialista en entrenamiento de la Especialización en Cirugía de Mama y Tejidos Blandos, convenio Fundación Universitaria de Ciencias de la Salud - Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

2. Especialista en entrenamiento de la Especialización en Cirugía de Mama y Tejidos Blandos, convenio Fundación Universitaria de Ciencias de la Salud - Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

Alfonso Márquez-Ustáriz, Especialista en entrenamiento de la Especialización en Cirugía Oncológica, convenio Universidad Militar Nueva Granada - Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

3. Especialista en entrenamiento de la Especialización en Cirugía Oncológica, convenio Universidad Militar Nueva Granada - Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

Luis Meneses-Riascos, Residente de la Especialización en Oncología Radioterápica, convenio Universidad Militar Nueva Granada - Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

1. Residente de la Especialización en Oncología Radioterápica, convenio Universidad Militar Nueva Granada - Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

Eduardo Guerrero-Lizcano, Grupo Área de Oncología Radioterápica, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

4. Grupo Área de Oncología Radioterápica, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

Alex Alvarez-Martinez, Grupo Área de Oncología Radioterápica, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

4. Grupo Área de Oncología Radioterápica, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

Andrea Marcela Zuluaga-Liberato, Unidad de Oncología Clínica, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

5. Unidad de Oncología Clínica, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

Carlos Lehmann-Mosquera, Unidad Funcional de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

6. Unidad Funcional de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

Mauricio García-Mora, Unidad Funcional de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

6. Unidad Funcional de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

Iván Mariño-Lozano, Unidad Funcional de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

6. Unidad Funcional de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

Hollman Ballesteros-Gómez, Grupo Área de Oncología Radioterápica, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

4. Grupo Área de Oncología Radioterápica, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

Javier Ángel-Aristizábal, Unidad Funcional de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

6. Unidad Funcional de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

Carlos Alfonso Duarte-Torres, Unidad Funcional de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

6. Unidad Funcional de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

Raúl Suárez-Rodríguez, Unidad Funcional de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

6. Unidad Funcional de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

Luis Felipe Torres-Silva, Grupo Área de Oncología Radioterápica, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

4. Grupo Área de Oncología Radioterápica, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

José Alejandro Esguerra-Cantillo, Grupo Área de Oncología Radioterápica, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

4. Grupo Área de Oncología Radioterápica, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

Sandra Esperanza Díaz-Casas, Unidad Funcional de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

6. Unidad Funcional de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia.

References

Hui J. Epidemiology and etiology of sarcomas. Surg Clin North Am. 2016;96(5):901-14. http://dx.doi.org/10.1016/j.suc.2016.05.005

American Cancer Society. Cancer facts and figures 2022. Atlanta: American Cancer Society; 2022 [citado 2023 my. 3]. Disponible en: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2022/2022-cancer-facts-and-figures.pdf

Instituto Nacional de Cancerología (INC). Anuario estadístico 2015. Bogotá; 2015. Disponible en: https://www.cancer.gov.co/recursos_user/files/libros/archivos/Anuario%20INC

Porpiglia A, Reddy S, Farma J. Retroperitoneal sarcomas. Surg Clin North Am. 2016;96(5):993-1001. http://dx.doi.org/10.1016/j.suc.2016.05.009

Bonvalot S, Rivoire M, Castaing M, Stoeckle E, Le Cesne A, Blay J, et al. Primary retroperitoneal sarcomas: a multivariate analysis of surgical factors associated with local control. J Clin Oncol. 2009;27(1):31-7. http://dx.doi.org/10.1200/JCO.2008.18.0802

Gronchi A, Lo Vullo S, Fiore M, Mussi C, Stacchiotti S, Collini P, et al. Aggressive surgical policies in a retrospectively reviewed single-institution case series of retroperitoneal soft tissue sarcoma patients. J Clin Oncol. 2009;27(1):24-30. http://dx.doi.org/10.1200/JCO.2008.17.8871

Rosenberg S, Tepper J, Glatstein E, Costa J, Baker A, Brennam M, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. 1982;196(3):305-15. http://dx.doi.org/10.1097/00000658-198209000-00009

O'Sullivan B, Davis A, Turcotte R, Bell R, Catton C, Chabot P, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002;359(9325):2235-41. http://dx.doi.org/10.1016/s0140-6736(02)09292-9

Crago A, Lee A. Multimodality management of soft tissue tumors in the extremity. Surg Clin North Am. 2016;96(5):977-92. http://dx.doi.org/10.1016/j.suc.2016.05.001

Halperin E, Wazer M, Perez C, Brady L. Principles and practice of radiation oncology. Philadelphia: Editorial Wolters Kluwer; 2018.

Esposito E, Anninga B, Harris S, Capasso I, D’Aiuto M, Rinaldo M, et al. Intraoperative radiotherapy in early breast cancer. Br J Surg. 2015;102(6):599-610. https://doi.org/10.1002/bjs.9781

Keshtgar M, Pigott K, Wenz F, editores. Targeted intraoperative radiotherapy in oncology. Berlin, Heidelberg: Springer Berlin Heidelberg; 2014.

Gunderson L, Willett C, Calvo F, Harrison L, editores. Intraoperative irradiation: techniques and results. Totowa, Nueva Jersey: Humana Press; 2011.

International Commission on Radiation Units and Measurements (ICRU). Report 50 prescribing, recording, and reporting photon beam therapy. ICRU. [citado 2023 abr. 13]. Disponible en: https://www.icru.org/report/prescribing-recording-and-reporting-photon-beam-therapy-report-50/

van Kampen M, Eble M, Lehnert T, Bernd L, Jensen K, Hensley F, et al. Correlation of intraoperatively irradiated volume and fibrosis in patients with soft-tissue sarcoma of the extremities. Int J Radiat Oncol Biol Phys. 2001;51(1):94-9. http://dx.doi.org/10.1016/s0360-3016(01)01620-0

Calvo F, Sole C, Polo A, Cambeiro M, Montero A, Alvarez A, et al. Limb-sparing management with surgical resection, external-beam and intraoperative electron-beam radiation therapy boost for patients with primary soft tissue sarcoma of the extremity: a multicentric pooled analysis of long-term outcomes. Strahlenther Onkol. 2014;190:891-8. http://dx.doi.org/10.1007/s00066-014-0640-2

Tinkle C, Weinberg V, Braunstein S, Wustrack R, Horvai A, Jahan T, et al. Intraoperative radiotherapy in the management of locally recurrent extremity soft tissue sarcoma. Sarcoma. 2015:913565. http://dx.doi.org/10.1155/2015/913565

Calvo F, Meirino R, Orecchia R. Intraoperative radiation therapy: First part: Rationale and techniques. Crit Rev Oncol Hematol. 2006;59(2):106-15. http://dx.doi.org/10.1016/j.critrevonc.2005.11.004

Roeder F, de Paoli A, Saleh-Ebrahimi L, Alldinger I, Bertola G, Boz G, et al. Intraoperative electron radiation therapy combined with external beam radiation therapy after gross total resection in extremity soft tissue sarcoma: a European pooled analysis. Ann Surg Oncol. 2018;25:3833-42. https://doi.org/10.1245/s10434-018-6787-9

Bevers T, Helvie M, Bonaccio E, Calhoun K, Daly M, Farrar W, et al. Breast cancer screening and diagnosis, version 3.2018. J Natl Compr Cancer Netw. 2018;16(11):1362-89. https://doi.org/10.6004/jnccn.2018.0083

Pawlik T, Pisters P, Mikula L, Feig B, Hunt K, Cormier J, et al. Long-term results of two prospective trials of preoperative external beam radiotherapy for localized intermediate- or high grade retroperitoneal soft tissue sarcoma. Ann Surg Oncol. 2006;13(4):508-17. https://doi.org/10.1245/aso.2006.05.035

Zlotecki R, Katz T, Morris C, Lind D, Hochwald S. Adjuvant radiation therapy for resectable retroperitoneal soft tissue sarcoma: the University of Florida experience. Am J Clin Oncol. 2005;28(3):310-6. https://doi.org/10.1097/01.coc.0000158441.96455.31

Bonvalot S, Roussy G, Haas R. Surgery with or without radiation therapy in untreated nonmetastatic retroperitoneal sarcoma (STRASS). [Internet]. EORTC; 2023. Disponible en: https://clinicaltrials.gov/ct2/show/NCT01344018

Sindelar W, Kinsella T, Chen P, DeLaney T, Tepper J, Rosenberg S, et al. Intraoperative radiotherapy in retroperitoneal sarcomas. Final results of a prospective, randomized, clinical trial. Arch Surg. 1993;128(4):402-10. http://dx.doi.org/10.1001/archsurg.1993.01420160040005

Nussbaum D, Rushing C, Lane W, Cardona D, Kirsch D, Peterson B, et al. Preoperative or postoperative radiotherapy versus surgery alone for retroperitoneal sarcoma: a case-control, propensity score-matched analysis of a nationwide clinical oncology database. Lancet Oncol. 2016;17(7):966-75. http://dx.doi.org/10.1016/s1470-2045(16)30050-x

Krempien R, Roeder F, Oertel S, Weitz J, Hensley F, Timke C, et al. Intraoperative electron-beam therapy for primary and recurrent retroperitoneal soft-tissue sarcoma. Int J Radiat Oncol Biol Phys. 2006;65(3):773-9. http://dx.doi.org/10.1016/j.ijrobp.2006.01.028

Petersen I, Haddock M, Donohue J, Nagorney D, Grill J, Sargent D, et al. Use of intraoperative electron beam radiotherapy in the management of retroperitoneal soft tissue sarcomas. Int J Radiat Oncol Biol Phys. 2002;52(2):469-75. http://dx.doi.org/10.1016/s0360-3016(01)02595-0

Gieschen H, Spiro I, Suit H, Ott M, Rattner D, Ancukiewicz M, et al. Long-term results of intraoperative electron beam radiotherapy for primary and recurrent retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 2001;50(1):127-31. http://dx.doi.org/10.1016/s0360-3016(00)01589-3

Cox J, Stetz J, Pajak T. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31(5):1341-6. http://dx.doi.org/10.1016/0360-3016(95)00060-C

Mornex F, Pavy J, Denekamp J, Bolla M. Système d’évaluation des effets tardifs des radiations sur les tissus normaux: l’échelle SOMA-LENT. Cancer Radiother. 1997;1(6):622-7. http://dx.doi.org/10.1016/s1278-3218(97)82941-1

Yang J, Chang A, Baker A, Sindelar W, Danforth D, Topalian S, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16(1):197-203. http://dx.doi.org/10.1200/JCO.1998.16.1.197

Beane J, Yang J, White D, Steinberg S, Rosenberg S, Rudloff U. Efficacy of adjuvant radiation therapy in the treatment of soft tissue sarcoma of the extremity: 20-year follow-up of a randomized prospective trial. Ann Surg Oncol. 2014;21:2484-9. http://dx.doi.org/10.1245/s10434-014-3732-4

Hui A, Ngan S, Wong K, Powell G, Choong P. Preoperative radiotherapy for soft tissue sarcoma: The Peter MacCallum Cancer Centre experience. Eur J Surg Oncol. 2006;32(10):1159-64. http://dx.doi.org/10.1016/j.ejso.2006.04.003

Roeder F, Krempien R. Intraoperative radiation therapy (IORT) in soft-tissue sarcoma. Radiat Oncol. 2017;12:20. http://dx.doi.org/10.1186/s13014-016-0751-2

Willett C, Suit H, Convery K, Tepper J, Mankin H, Rosenberg A, et al. Intraoperative electron beam radiation therapy for retroperitoneal soft tissue sarcoma. Cancer. 1991;68(2):278-83. https://doi.org/10.1002/1097-0142(19910715)68:2%3C278::aid-cncr2820680211%3E3.0.co;2-c

Bobin J, Al-Lawati T, Granero L, Adham M, Romestaing P, Chapet O, et al. Surgical management of retroperitoneal sarcomas associated with external and intraoperative electron beam radiotherapy. Eur J Surg Oncol. 2003;29(8):676-81. http://dx.doi.org/10.1016/s0748-7983(03)00139-2

How to Cite

[1]
Mendoza Díaz, S.D. et al. 2024. Intraoperative radiotherapy in soft tissue sarcomas of the extremities and retroperitoneum: review of the evidence and therapeutic approach at the Instituto Nacional de Cancerología, Colombia. Revista Colombiana de Cancerología. 28, 1 (Mar. 2024), 57–68. DOI:https://doi.org/10.35509/01239015.974.

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2024-03-29

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