ArticleAdvances in radiation oncology2026
Intraoperative Radiation Therapy as a Boost in Soft-Tissue Sarcomas of the Extremity: Long-Term Results of a Retrospective Cohort.
Article in Advances in radiation oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: Intraoperative radiation therapy (IORT) is used as a boost modality for soft-tissue sarcoma (STS). It facilitates the precise delivery of a single tumoricidal dose to areas at high risk for residual microscopic disease while minimizing radiation exposure to adjacent radiosensitive structures. This study reports the long-term outcomes of patients with STS of the extremity at high risk of local recurrence treated with high-dose-rate (HDR)-IORT. Methods and Materials: A cohort of patients with primary STS of the extremities treated between 2013 and 2019 with an intraoperative boost using HDR-IORT as part of their multimodal treatment was retrospectively reviewed. IORT was applied via a flab applicator (flexible silicone-based surface mold) with a dose of 10 Gy prescribed to 0.5 cm depth. Treatment toxicity and recurrence patterns were systematically monitored. Survival was analyzed via the Kaplan-Meier method. Results: Fifty-two patients with a median age of 70 years at diagnosis (range, 22-87) were included. The median tumor size was 10 cm (range, 2-36). Twenty patients (38.5%) had prior unplanned resection, and 14 (26.9%) had resection with close margins (ie, <1 mm) at oncological excision. External beam radiation therapy was delivered either neoadjuvantly (59.6%) or adjuvantly (38.5%). Eight patients (15.4%) received chemotherapy. At a median follow-up of 80 months (range, 33-128), 21 patients (40.4%) experienced recurrence. Isolated local failure occurred in 2 patients (3.8%), isolated metastatic failure in 16 patients (30.8%), and synchronous local and metastatic failure in 3 patients (5.8%). At 5 years, the local control and distant control rates were 80.2% and 57.7%, respectively, and the progression-free survival and overall survival rates were 51.9% and 58.0%, respectively. Conclusions: HDR-IORT boost is a precise and effective technique for dose escalation in primary STS of the extremities, demonstrating favorable local control at long-term follow-up without increasing acute or long-term morbidity in this high-risk patient cohort.
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