Intraoperative radiation therapy (IORT) in soft-tissue sarcoma

Area of Science:

• Oncology
• Radiation Oncology
• Surgical Oncology

Background:

• Soft-tissue sarcoma (STS) is rare, often treated with surgery and radiation.
• External beam radiation therapy (EBRT) can be limited by adjacent organs at risk.
• Intraoperative radiation therapy (IORT) offers a solution by delivering radiation during surgery.

Purpose of the Study:

• To review the rationale, techniques, and outcomes of IORT for extremity and retroperitoneal STS.
• To evaluate oncological and functional results, including toxicities and pitfalls.
• To compare IORT-containing multimodal approaches with traditional methods.

Main Methods:

• Literature review of published studies on IORT for STS.
• Focus on extremity and retroperitoneal STS cases.
• Analysis of oncological control, functional outcomes, and toxicity profiles.

Main Results:

• IORT combined with surgery and EBRT achieves excellent local control in extremity STS, comparable to EBRT alone, with high limb preservation rates.
• For retroperitoneal STS, preoperative EBRT, surgery, and IORT show superior local control and potentially improved survival compared to surgery alone or with EBRT.
• IORT does not increase wound complication rates; neuropathy is a dose-limiting toxicity, necessitating careful planning.

Conclusions:

• IORT is an effective method for boosting radiation doses in STS treatment, particularly for extremity and retroperitoneal cases.
• IORT-containing multimodal approaches offer significant benefits in local control and functional outcomes.
• Further prospective randomized trials are recommended to solidify IORT's role in STS management.