Neoadjuvant image-guided helical intensity modulated radiotherapy of extremity sarcomas - a single center experience.
Adult
Aged
Aged, 80 and over
Extremities
/ pathology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neoadjuvant Therapy
/ methods
Neoplasm Recurrence, Local
/ pathology
Prognosis
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
/ methods
Radiotherapy, Adjuvant
Radiotherapy, Image-Guided
/ methods
Radiotherapy, Intensity-Modulated
/ methods
Sarcoma
/ pathology
Survival Rate
Young Adult
Extremity
IGRT
IMRT
Image-guidance
Soft tissue sarcoma
Tomotherapy
Journal
Radiation oncology (London, England)
ISSN: 1748-717X
Titre abrégé: Radiat Oncol
Pays: England
ID NLM: 101265111
Informations de publication
Date de publication:
09 Jan 2019
09 Jan 2019
Historique:
received:
13
07
2018
accepted:
02
01
2019
entrez:
11
1
2019
pubmed:
11
1
2019
medline:
2
2
2019
Statut:
epublish
Résumé
Advanced radiotherapy (RT) techniques allow normal tissue to be spared in patients with extremity soft tissue sarcoma (STS). This work aims to evaluate toxicity and outcome after neoadjuvant image-guided radiotherapy (IGRT) as helical intensity modulated radiotherapy (IMRT) with reduced margins based on MRI-based target definition in patients with STS. Between 2010 to 2014, 41 patients with extremity STS were treated with IGRT delivered as helical IMRT on a tomotherapy machine. The tumor site was in the upper extremity in 6 patients (15%) and lower extremity in 35 patients (85%). Reduced margins of 2.5 cm in longitudinal direction and 1.0 cm in axial direction were used to expand the MRI-defined gross tumor volume, including peritumoral edema, to the clinical target volume. An additional margin of 5 mm was added to receive the planning target volume. The full total dose of 50 Gy in 2 Gy fractions was sucessfully applied in 40 patients. Two patients received chemotherapy instead of surgery due to systemic progression. All patients were included into a strict follow-up program and were seen interdisciplinarily by the Departments of Orthopaedic Surgery and Radiation Oncology. Thirty eight patients that received total RT total dose and subsequent resection were analyzed for outcome. After a median follow-up of 38.5 months cumulative OS, local PFS and systemic PFS at 2 years were determined at 78.2, 85.2 and 54.5%, respectively. Two of 6 local recurrences were proximal marginal misses. Negative resection margins were achieved in 84% of patients. The rate of major wound complications was comparable to previous IMRT studies with 36.8%. RT was overall tolerable with low toxicity rates. IMRT-IGRT offers neoadjuvant treatment for extremity STS with reduced safety margins and thus low toxicity rates. Wound complication rates were comparable to previously reported frequencies. Two reported marginal misses suggest a word of caution for reduction of longitudinal safety margins.
Sections du résumé
BACKGROUND
BACKGROUND
Advanced radiotherapy (RT) techniques allow normal tissue to be spared in patients with extremity soft tissue sarcoma (STS). This work aims to evaluate toxicity and outcome after neoadjuvant image-guided radiotherapy (IGRT) as helical intensity modulated radiotherapy (IMRT) with reduced margins based on MRI-based target definition in patients with STS.
METHODS
METHODS
Between 2010 to 2014, 41 patients with extremity STS were treated with IGRT delivered as helical IMRT on a tomotherapy machine. The tumor site was in the upper extremity in 6 patients (15%) and lower extremity in 35 patients (85%). Reduced margins of 2.5 cm in longitudinal direction and 1.0 cm in axial direction were used to expand the MRI-defined gross tumor volume, including peritumoral edema, to the clinical target volume. An additional margin of 5 mm was added to receive the planning target volume. The full total dose of 50 Gy in 2 Gy fractions was sucessfully applied in 40 patients. Two patients received chemotherapy instead of surgery due to systemic progression. All patients were included into a strict follow-up program and were seen interdisciplinarily by the Departments of Orthopaedic Surgery and Radiation Oncology.
RESULTS
RESULTS
Thirty eight patients that received total RT total dose and subsequent resection were analyzed for outcome. After a median follow-up of 38.5 months cumulative OS, local PFS and systemic PFS at 2 years were determined at 78.2, 85.2 and 54.5%, respectively. Two of 6 local recurrences were proximal marginal misses. Negative resection margins were achieved in 84% of patients. The rate of major wound complications was comparable to previous IMRT studies with 36.8%. RT was overall tolerable with low toxicity rates.
CONCLUSIONS
CONCLUSIONS
IMRT-IGRT offers neoadjuvant treatment for extremity STS with reduced safety margins and thus low toxicity rates. Wound complication rates were comparable to previously reported frequencies. Two reported marginal misses suggest a word of caution for reduction of longitudinal safety margins.
Identifiants
pubmed: 30626408
doi: 10.1186/s13014-019-1207-2
pii: 10.1186/s13014-019-1207-2
pmc: PMC6327451
doi:
Types de publication
Clinical Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2Références
Lancet. 2002 Jun 29;359(9325):2235-41
pubmed: 12103287
J Clin Oncol. 2002 Nov 15;20(22):4472-7
pubmed: 12431971
Int J Radiat Oncol Biol Phys. 2004 Jul 1;59(3):752-9
pubmed: 15183478
Radiother Oncol. 2005 Apr;75(1):48-53
pubmed: 15948265
Int J Radiat Oncol Biol Phys. 2007 Mar 1;67(3):847-56
pubmed: 17161553
Int J Radiat Oncol Biol Phys. 2007 Jun 1;68(2):458-64
pubmed: 17363186
BMC Cancer. 2007 Sep 13;7:177
pubmed: 17854490
Cancer. 2009 Mar 15;115(6):1348-55
pubmed: 19156905
Int J Radiat Oncol Biol Phys. 2009 Nov 1;75(3):810-6
pubmed: 19307066
Radiother Oncol. 2009 Oct;93(1):125-30
pubmed: 19604591
Int J Radiat Oncol Biol Phys. 2010 May 1;77(1):203-9
pubmed: 19679403
Ann Surg Oncol. 2010 Jun;17(6):1471-4
pubmed: 20180029
Tumori. 2010 Jul-Aug;96(4):582-8
pubmed: 20968138
ANZ J Surg. 2013 May;83(5):336-41
pubmed: 22943678
Ann Surg Oncol. 2013 May;20(5):1494-9
pubmed: 23242820
Cancer. 2013 May 15;119(10):1878-84
pubmed: 23423841
Am J Clin Oncol. 2016 Dec;39(6):586-592
pubmed: 24879470
Eur J Surg Oncol. 2014 Dec;40(12):1648-54
pubmed: 25130960
J Clin Oncol. 2014 Oct 10;32(29):3236-41
pubmed: 25185087
J Clin Oncol. 2015 Jul 10;33(20):2231-8
pubmed: 25667281
Clin Oncol (R Coll Radiol). 2015 Jun;27(6):369-70
pubmed: 25687174
BMC Cancer. 2015 Nov 16;15:904
pubmed: 26573139
Strahlenther Onkol. 2017 Sep;193(9):700-706
pubmed: 28466155
Strahlenther Onkol. 2018 May;194(5):375-385
pubmed: 29302704
Ann Surg. 1982 Sep;196(3):305-15
pubmed: 7114936
J Clin Oncol. 1998 Jan;16(1):197-203
pubmed: 9440743