Intraoperative radiation therapy (IORT) for soft tissue sarcoma - ESTRO IORT Task Force/ACROP recommendations.

Area of Science:

• Oncology
• Radiation Oncology
• Surgical Oncology

Background:

• Soft-tissue sarcomas (STS) are a diverse group of malignancies requiring multimodal treatment approaches.
• Intraoperative radiation therapy (IORT) is an established technique in managing various cancers, including STS.
• Optimizing IORT application in STS necessitates clear guidelines based on current evidence.

Purpose of the Study:

• To establish evidence-based guidelines for the application of intraoperative radiation therapy (IORT) in the management of soft-tissue sarcomas (STS).
• To provide recommendations on patient selection, treatment integration, and procedural aspects of IORT for STS.

Main Methods:

• A systematic literature review was conducted by a panel of experts in the field.
• Clinical experience of the expert panel supplemented the literature review findings.
• Recommendations were developed based on synthesized evidence and expert consensus.

Main Results:

• IORT-containing treatment approaches demonstrate very high local control rates for extremity STS with low acute and late toxicity.
• For retroperitoneal sarcomas, IORT combined with external-beam radiation therapy (EBRT) shows superior local control compared to EBRT alone.
• Evidence suggests that combinations of preoperative EBRT and IORT are particularly effective for retroperitoneal STS, achieving high local control with acceptable toxicity.

Conclusions:

• IORT-based strategies are effective in achieving high local control rates for soft-tissue sarcomas.
• The established guidelines aim to standardize IORT use in STS, promoting consistent and effective patient care.
• These recommendations encourage the adoption of IORT in clinical practice and its consideration in future clinical trial designs for STS.