Management of tumor volume changes during preoperative radiotherapy for extremity soft tissue sarcoma: a new strategy of adaptive radiotherapy.
adaptive radiotherapy
image guided radiotherapy
preoperative radiotherapy
soft tissue sarcoma
volumes changes
Journal
Radiology and oncology
ISSN: 1581-3207
Titre abrégé: Radiol Oncol
Pays: Poland
ID NLM: 9317213
Informations de publication
Date de publication:
01 12 2023
01 12 2023
Historique:
received:
13
04
2023
accepted:
25
09
2023
medline:
4
12
2023
pubmed:
1
12
2023
entrez:
1
12
2023
Statut:
epublish
Résumé
Using adaptive radiotherapy (ART), to determine objective clinical criteria that identify extremity soft tissue sarcoma (ESTS) patients requiring adaptation of their preoperative radiotherapy (RT) plan. We included 17 patients with a lower extremity ESTS treated between 2019 and 2021 with preoperative RT, using helicoidal intensity-modulated RT (IMRT) tomotherapy, before surgical resection. We collected clinical, tumor parameters and treatment data. Repositioning was ascertained by daily Megavoltage computed tomography (MVCT) imaging. Using the PreciseART technology we retrospectively manually delineated at least one MVCT for each patient per week and recorded volume and dosimetric parameters. A greater than 5% change between target volume and planned target volume (PTV) dosimetric coverage from the initial planning CT scan to at least one MVCT was defined as clinically significant. All 17 patients experienced significant tumor volume changes during treatment; 7 tumors grew (41%) and 10 shrank (59%). Three patients (18%), all undifferentiated pleomorphic sarcomas (UPS) with increased volume changes, experienced significant reductions in tumor dose coverage. Seven patients required a plan adaptation, as determined by practical criteria applied in our departmental practice. Among these patients, only one ultimately experienced a significant change in PTV coverage. Three patients had a PTV decrease of coverage. Among them, 2 did not receive plan adaptation according our criteria. None of the patients with decreased tumor volumes had reduced target volume coverage. Monitoring volume variations by estimating gross tumor volume (GTV) on MVCT, in addition to axial and sagittal linear tumor dimensions, appeared to be most effective for detecting reductions in PTV coverage throughout treatment. Variations in ESTS volume are evident during preoperative RT, but significant dosimetric variations are rare. Specific attention should be paid to grade 2-3 UPSs during the first 2 weeks of treatment. In the absence of dedicated software in routine clinical practice, monitoring of tumor volume changes by estimating GTV may represent a useful strategy for identifying patients whose treatment needs to be replanned.
Sections du résumé
BACKGROUND
Using adaptive radiotherapy (ART), to determine objective clinical criteria that identify extremity soft tissue sarcoma (ESTS) patients requiring adaptation of their preoperative radiotherapy (RT) plan.
PATIENTS AND METHODS
We included 17 patients with a lower extremity ESTS treated between 2019 and 2021 with preoperative RT, using helicoidal intensity-modulated RT (IMRT) tomotherapy, before surgical resection. We collected clinical, tumor parameters and treatment data. Repositioning was ascertained by daily Megavoltage computed tomography (MVCT) imaging. Using the PreciseART technology we retrospectively manually delineated at least one MVCT for each patient per week and recorded volume and dosimetric parameters. A greater than 5% change between target volume and planned target volume (PTV) dosimetric coverage from the initial planning CT scan to at least one MVCT was defined as clinically significant.
RESULTS
All 17 patients experienced significant tumor volume changes during treatment; 7 tumors grew (41%) and 10 shrank (59%). Three patients (18%), all undifferentiated pleomorphic sarcomas (UPS) with increased volume changes, experienced significant reductions in tumor dose coverage. Seven patients required a plan adaptation, as determined by practical criteria applied in our departmental practice. Among these patients, only one ultimately experienced a significant change in PTV coverage. Three patients had a PTV decrease of coverage. Among them, 2 did not receive plan adaptation according our criteria. None of the patients with decreased tumor volumes had reduced target volume coverage. Monitoring volume variations by estimating gross tumor volume (GTV) on MVCT, in addition to axial and sagittal linear tumor dimensions, appeared to be most effective for detecting reductions in PTV coverage throughout treatment.
CONCLUSIONS
Variations in ESTS volume are evident during preoperative RT, but significant dosimetric variations are rare. Specific attention should be paid to grade 2-3 UPSs during the first 2 weeks of treatment. In the absence of dedicated software in routine clinical practice, monitoring of tumor volume changes by estimating GTV may represent a useful strategy for identifying patients whose treatment needs to be replanned.
Identifiants
pubmed: 38038424
pii: raon-2023-0056
doi: 10.2478/raon-2023-0056
pmc: PMC10690743
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
507-515Informations de copyright
© 2023 Marion Geneau De Lamarliere et al., published by Sciendo.
Références
Beane JD, Yang JC, White D, Steinberg SM, Rosenberg SA, Rudloff U. Efficacy of adjuvant radiation therapy in the treatment of STS of the extremity: 20-year follow-up of a randomized prospective trial. Ann Surg Oncol 2014; 21: 2484–9. doi: 10.1245/s10434-014-3732-4
doi: 10.1245/s10434-014-3732-4
O’Sullivan B, Davis AM, Turcotte R, Bell R, Catton C, Chabot P, et al. Preoperative versus postoperative radiotherapy in STS of the limbs: a randomised trial. Lancet 2002; 359: 2235–41. doi: 10.1016/S0140-6736(02)09292-9
doi: 10.1016/S0140-6736(02)09292-9
Davis AM, O’Sullivan B, Turcotte R, Bell R, Catton C, Chabot P, et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol 2005; 75: 48–53. doi: 10.1016/j.radonc.2004.12.020
doi: 10.1016/j.radonc.2004.12.020
Le Péchoux C, Moureau-Zabotto L, Llacer C, Ducassou A, Sargos P, Sunyach MP, et al. RECORAD 2016: Radiothérapie des sarcomes des tissus mous de l’adulte. Cancer Radiother 2016; 20S: S235–43. doi: 10.1016/j.canrad.2016.07.028
doi: 10.1016/j.canrad.2016.07.028
Wang D, Bosch W, Roberge D, Finkelstein SE, Petersen I, Haddock M, et al. RTOG Sarcoma Working Group Consensus on the GTV and CTV for preoperative RT. Int J Radiation Oncology Biol Phys 2011; 81: e525–e528. doi: 10.1016/j.ijrobp.2011.04.038
doi: 10.1016/j.ijrobp.2011.04.038
Haas RL, van Beek S, Betgen A, Ali S, Schneider CJ, Diddens FH, et al. Substantial volume changes and plan adaptations during preoperative radiotherapy in extremity soft tissue sarcoma patients. Practical Radiat Oncol 2019; 9: 115–122. doi: 10.1016/j.prro.2018.11.001
doi: 10.1016/j.prro.2018.11.001
Mc Nair H, Buijs M. Image guided radiotherapy moving towards real time adaptive radiotherapy; global positioning system for radiotherapy? Tech Innov Patient Support Radiat Oncol 2019; 12: 1–2. doi: 10.1016/j.tipsro.2019.10.006
doi: 10.1016/j.tipsro.2019.10.006
Stankiewicz M, Li W, Rosewall T, Tadic T, Dickie C, Velec M. Patterns of practice of adaptive re-planning for anatomic variances during cone-beam CT guided radiotherapy. Tech Innov Patient Support Radiat Oncol 2019; 12: 50–5. doi: 10.1016/j.tipsro.2019.10.003
doi: 10.1016/j.tipsro.2019.10.003
Abu-Hijlih R, Mheid S, Abuhijla F, Asha W, Mohamad I, Alrashdan A, et al. Adaptive radiotherapy in patients receiving neoadjuvant radiation for soft tissue sarcoma. Rep Pract Oncol Radiother 2019; 24: 263–8. doi: 10.1016/j.rpor.2019.02.007
doi: 10.1016/j.rpor.2019.02.007
Dickie C, Parent A, GriffinAM, Wunder J, Ferguson P, Chung PW, et al. The value of adaptive preoperative radiotherapy in management of soft tissue sarcoma. Radiother Oncol 2017; 122: 458–63. doi: 10.1016/j.radonc.2016.12.028
doi: 10.1016/j.radonc.2016.12.028
Betgen A, Haas RLM, Sonke JJ. Volume changes in soft tissue sarcomas during preoperative radiotherapy of extremities evaluated using cone-beam CT. J Radiat Oncol 2013; 2: 55–62. doi: 10.1007/s13566-012-0085-0
doi: 10.1007/s13566-012-0085-0
Pitson G, Robinson P, Wilke D, Kandel RA, White L, Griffin AM, et al. Radiation response: an additional unique signature of myxoide liposarcoma. Int J Radiat Oncol Biol Phys 2004; 60: 522–6. doi: 10.1016/j.ijrobp.2004.03.009
doi: 10.1016/j.ijrobp.2004.03.009
Magierowski K, Moseley J, Lockwood G, Parent A, Euler C, Sharpe M, et al. Retrospective study of volume changes in two pathological subtypes of sarcomas using deformation image registration. Int J Radiat Oncol Biol Phys 2008; 72: S504. doi: https://doi.org/10.1016/j.ijrobp.2008.06.1471
O’Sullivan B, Griffin AM, Dickie CI, Sharpe MB, Chung PWM, Catton CN, et al. Phase 2 study of preoperative image-guided intensity-modulated radiation therapy to reduce wound and combined modality morbidities in lower extremity soft tissue sarcoma. Cancer 2013; 119: 1878–84. doi: 10.1002/cncr.27951
doi: 10.1002/cncr.27951
Thorwarth D, Low DA. Technical challenges of real-time adaptive MR-guided radiotherapy. Front Oncol 2021; 11: 634507. doi: 10.3389/fonc.2021.634507
doi: 10.3389/fonc.2021.634507
Chen X, Men K, Li Y, Yi J, Dai J. A feasibility study on an automated method to generate patient-specific dose distributions for radiotherapy using deep learning. Med Phys 2019; 46: 56–64. doi: 10.1002/mp.13262
doi: 10.1002/mp.13262
Bertholet J, Anastasi G, Noble D, Bel A, van Leeuven R, Roggen T, et al. Patterns of practice for adaptive and real-time radiation therapy (POP-ART RT) part II: Offline and online plan adaption for interfractional changes. Radiother Oncol 2020; 153: 88–96. doi: 10.1016/j.radonc.2020.06.017
doi: 10.1016/j.radonc.2020.06.017