Management of extremity soft tissue sarcomas with limbsparing surgery and postoperative irradiation: Do total dose, overall treatment time, and the surgery-radiotherapy interval impact on local control?

The authors review the main contributions of international literature to show the current status in clinical trials on unconventional fractionations of the dose in radiotherapy of head and neck cancers. Several clinical (but only a few randomized) trials have been conducted over the last 15 years using hyperfractionated (HF), accelerated (AF) or mixed (HF-AF) schedules. HF schedules have obtained promising results in terms of local control in comparison with conventional fractionation (CF) of the dose. Improvement in survival was also obtained by the random trials of Pinto and Sanchiz, whereas in EORTC trial no. 22791, the improvement in survival rate was only marginal. A significant increase in local control and, less frequently, in survival has been claimed in several studies using HF-AF. Such data still need to be confirmed by a random study, since EORTC trial 22811 showed superimposable results in comparison with CF. Selection of the most suitable cases for altered fractionation schemes is also being studied in ongoing trials of the EORTC (22851) and RTOG (90-03). As regards acute reactions during and after altered fractionation, they are more severe than after CF. Only pure HF with a dose intensity approximately comparable to CF seems to produce similar acute reactions. Several factors have been found to influence the severity of acute mucosal reactions: interfraction interval, overall treatment time, total dose, and field size. As regards late damage, genuine HF schemes seem to cause roughly equivalent late damage in comparison to CF, whereas high-dose intensity schedules have a higher rate of complications. Interfraction interval, overall treatment time, total dose, fraction size and field size can influence the risk of late sequelae. Before altered fractionations can be considered standard therapy, more data are needed, which should be provided by multicentric randomized trials, some of which are already in progress.

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Efficacy and Safety of Carbon Ion Radiotherapy in Bone and Soft Tissue Sarcomas

Journal of Clinical Oncology ◽

10.1200/jco.2002.10.050 ◽

2002 ◽

Vol 20 (22) ◽

pp. 4466-4471 ◽

Cited By ~ 198

Author(s):

Tadashi Kamada ◽

Hirohiko Tsujii ◽

Hiroshi Tsuji ◽

Tsuyoshi Yanagi ◽

Jun-etsu Mizoe ◽

...

Keyword(s):

Soft Tissue ◽

Total Dose ◽

Local Control ◽

Dose Escalation ◽

Soft Tissue Sarcomas ◽

Carbon Ion Radiotherapy ◽

Skin Reactions ◽

Carbon Ion ◽

Acute Skin Reactions

PURPOSE: To evaluate the tolerance for and effectiveness of carbon ion radiotherapy in patients with unresectable bone and soft tissue sarcomas. PATIENTS AND METHODS: We conducted a phase I/II dose escalation study of carbon ion radiotherapy. Fifty-seven patients with 64 sites of bone and soft tissue sarcomas not suited for resection received carbon ion radiotherapy. Tumors involved the spine or paraspinous soft tissues in 19 patients, pelvis in 32 patients, and extremities in six patients. The total dose ranged from 52.8 to 73.6 gray equivalent (GyE) and was administered in 16 fixed fractions over 4 weeks (3.3 to 4.6 GyE/fraction). The median tumor size was 559 cm3 (range, 20 to 2,290 cm3). The minimum follow-up was 18 months. RESULTS: Seven of 17 patients treated with the highest total dose of 73.6 GyE experienced Radiation Therapy Oncology Group grade 3 acute skin reactions. Dose escalation was then halted at this level. No other severe acute reactions (grade > 3) were observed in this series. The overall local control rates were 88% and 73% at 1 year and 3 years of follow-up, respectively. The median survival time was 31 months (range, 2 to 60 months), and the 1- and 3-year overall survival rates were 82% and 46%, respectively. CONCLUSION: Carbon ion radiotherapy seems to be a safe and effective modality in the management of bone and soft tissue sarcomas not eligible for surgical resection, providing good local control and offering a survival advantage without unacceptable morbidity.

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Postoperative radiotherapy in the management of adult soft tissue sarcoma of the extremities: results with two different total dose, fractionation, and overall treatment time schedules

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/s0360-3016(99)00077-2 ◽

1999 ◽

Vol 44 (4) ◽

pp. 879-886 ◽

Cited By ~ 28

Author(s):

Cécile Le Péchoux ◽

Marie-Cécile Le Deley ◽

Suzette Delaloge ◽

Eric Lartigau ◽

Christine Levy-Piedbois ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Total Dose ◽

Treatment Time ◽

Postoperative Radiotherapy ◽

Dose Fractionation ◽

Overall Treatment Time

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The effect of delayed postoperative irradiation on local control of soft tissue sarcomas of the extremity and torso

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/s0360-3016(01)02807-3 ◽

2002 ◽

Vol 52 (5) ◽

pp. 1352-1359 ◽

Cited By ~ 27

Author(s):

David L Schwartz ◽

John Einck ◽

Karen Hunt ◽

James Bruckner ◽

Ernest Conrad ◽

...

Keyword(s):

Soft Tissue ◽

Local Control ◽

Soft Tissue Sarcomas ◽

Postoperative Irradiation

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Radiological progression of extremity soft tissue sarcoma following preoperative radiotherapy predicts for poor survival

British Journal of Radiology ◽

10.1259/bjr.20210936 ◽

2021 ◽

Author(s):

Christian Isaac ◽

John Kavanagh ◽

Anthony Michael Griffin ◽

Colleen I Dickie ◽

Rakesh Mohankumar ◽

...

Keyword(s):

Soft Tissue ◽

Local Control ◽

Preoperative Radiotherapy ◽

Multivariable Analysis ◽

Group Versus ◽

Soft Tissue Sarcomas ◽

Preoperative Radiation ◽

Radiological Response ◽

Post Radiation ◽

Response Groups

Objectives: To determine if radiological response to preoperative radiotherapy is related to oncologic outcome in patients with extremity soft tissue sarcomas (STS). Methods: 309 patients with extremity STS who underwent preoperative radiation and wide resection were identified from a prospective database. Pre-and post-radiation MRI scans were retrospectively reviewed. Radiological response was defined by the modified Response Evaluation Criteria in Solid Tumours (RECIST).Local recurrence-free (LRFS), metastasis-free (MFS) and overall survival (OS) were compared across response groups. Results: Tumour volume decreased in 106 patients (34.3%; PR- Partial Responders), remained stable in 97 (31.4%; SD- Stable Disease), increased in 106 (34.3%; PD- Progressive Disease). The PD group were older (p = 0.007), had more upper extremity (p = 0.03) and high grade tumours (p < 0.001). 81% of myxoid liposarcomas showed substantial decrease in size. There was no difference in initial tumour diameter (p = 0.5), type of surgery (p = 0.5), margin status (p = 0.4), or complications (p = 0.8) between the three groups. There were ten (3.2%) local recurrences with no differences between the three response groups (p = 0.06). Five-year MFS was 52.1% for the PD group versus 73.8 and 78.5% for the PR and SD groups respectively (p < 0.001). OS was similar (p < 0.001). Following multivariable analysis, worse MFS and OS were associated with higher grade, larger tumour size at diagnosis and tumour growth following preoperative radiation. Older age was also associated with worse OS. Conclusion: STS that enlarge according to RECIST criteria following preoperative radiotherapy identify a high risk group of patients with worse systemic outcomes but equivalent local control. Advances in knowledge: Post radiation therapy, STS enlargement may identify patients with potential for worse systemic outcomes but equivalent local control. Therefore, adjunct therapeutic approaches could be considered in these patients.

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