scholarly journals Intraoperative Radiotherapy in the Management of Locally Recurrent Extremity Soft Tissue Sarcoma

Sarcoma ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Christopher L. Tinkle ◽  
Vivian Weinberg ◽  
Steve E. Braunstein ◽  
Rosanna Wustrack ◽  
Andrew Horvai ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Disease Control ◽  
Local Control ◽  
Intraoperative Radiotherapy ◽  
Disease Free Survival ◽  
Median Dose ◽  
Extremity Soft Tissue Sarcoma ◽  
Locally Recurrent ◽  
Grade 3

Purpose. To investigate the efficacy and morbidity of limb-sparing surgery with intraoperative radiotherapy (IORT) for patients with locally recurrent extremity soft tissue sarcoma (ESTS).Methods and Materials. Twenty-six consecutively treated patients were identified in a single institution retrospective analysis of patients with locally recurrent ESTS treated with IORT following salvage limb-sparing resection from May 2000 to July 2011. Fifteen (58%) patients received external beam radiotherapy (EBRT) prior to recurrence (median dose 63 Gy), while 11 (42%) patients received EBRT following IORT (median dose 52 Gy). The Kaplan-Meier product limit method was used to estimate disease control and survival and subsets were compared using a log rank statistic, Cox’s regression model was used to determine independent predictors of disease outcome, and toxicity was reported according to CTCAE v4.0 guidelines.Results. With a median duration of follow-up from surgery and IORT of 34.9 months (range: 4 to 139 mos.), 10 patients developed a local recurrence with 4 subsequently undergoing amputation. The 5-year estimate for local control (LC) was 58% (95% CI: 36–75%), for amputation-free was 81% (95% CI: 57–93%), for metastasis-free control (MFC) was 56% (95% CI: 31–75%), for disease-free survival (DFS) was 35% (95% CI: 17–54%), and for overall survival (OS) was 50% (95% CI: 24–71%). Prior EBRT did not appear to influence disease control (LC,p=0.74; MFC,p=0.66) or survival (DFS,p=0.16; OS,p=0.58). Grade 3 or higher acute and late toxicities were reported for 6 (23%) and 8 (31%) patients, respectively. The frequency of both acute and late grade 3 or higher toxicities occurred equally between patients who received EBRT prior to or after IORT.Conclusions. IORT in combination with oncologic resection of recurrent ESTS yields good rates of local control and limb-salvage with acceptable morbidity. Within the limitations of small subsets, these data suggest that prior EBRT does not significantly influence disease control or toxicity.

CT-guided Interstitial Brachytherapy Followed by External Bean Radiotherapy for a Patient With Relapsed Extremity Soft Tissue Sarcoma

2021 ◽  
Author(s):  
Zhongshan Liu ◽  
Yangzhi Zhao ◽  
Yunfeng Li ◽  
Xia Lin ◽  
Dongzhou Wang ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Lower Extremity ◽  
Local Control ◽  
Conservative Surgery ◽  
Local Control Rate ◽  
Left Thigh ◽  
Ct Guided ◽  
Extremity Soft Tissue Sarcoma ◽  
Locally Recurrent

Abstract Purpose: Locally recurrent extremity soft tissue sarcoma remains a therapeutic challenge; conservative surgery alone results in an inferior local control rate. This study demonstrates a new interstitial (IS) brachytherapy (BT) technique in a patient with recurrent extremity soft tissue sarcoma. Patients and methods: A 53-year-old man with recurrent left thigh malignant fibrous histiocytoma underwent conservative surgery and adjuvant intensity-modulated radiotherapy (IMRT) after two surgical excisions. A magnetic resonance imaging (MRI) of the lower extremity after the conservative surgery and IMRT revealed a left thigh mass measuring 12 cm × 8 cm × 7 cm. An IS BT with 3 fractions of 8 Gy each and guided with three-dimensional (3D) computed tomography (CT) was administered. For this procedure, IS metal needles were inserted at a depth of 1 cm into the tumor as a preliminary implantation, and their direction and depth were adjusted repeatedly until a satisfactory distribution was achieved through multiple CT scans. Results: The course of the IS BT procedure was uneventful. No severe bleeding, infection, or other complications were observed. At 3, 12, and 24 months after the IS BT, lower extremity MRI scans showed a left thigh mass measuring 10 cm × 5 cm × 4, 8 cm × 3 cm × 2 cm, and 6 cm × 2 cm × 2 cm, respectively. Minimal fibrosis, local numbness, and edema in the treatment area were noted. The patient had an excellent quality of life. Conclusion: Favorable oncologic outcomes for locally recurrent extremity soft tissue sarcoma were achieved using 3D CT-guided IS BT. This BT technique may contribute to an excellent local control rate and offer an effective and safe therapeutic option in selected cases.

Stereotactic Radiosurgical Salvage Treatment for Locally Recurrent Esthesioneuroblastoma

Neurosurgery ◽  
2012 ◽  
Vol 72 (3) ◽  
pp. 332-340 ◽  
Author(s):  
Jamie J. Van Gompel ◽  
Matthew L. Carlson ◽  
Bruce E. Pollock ◽  
Eric J. Moore ◽  
Robert L. Foote ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Local Control ◽  
Additional Patient ◽  
Median Dose ◽  
Single Institution ◽  
Treatment Volume ◽  
Locally Recurrent ◽  
Assess Treatment Response ◽  
Grade 3

Abstract BACKGROUND: Esthesioneuroblastoma (ENB) is a rare malignant neuroendocrine tumor considered to be radiation sensitive. Local recurrence may be treated in a variety of ways, including stereotactic radiosurgery (SRS); however, little information on its effectiveness is available. OBJECTIVE: To determine whether SRS is effective in providing local control for recurrent ENB. METHODS: This was a retrospective single-institution experience including 109 patients with ENB treated at the Mayo Clinic (1962–2009). Sixty-three patients presented with Kadish stage C disease, and 21 patients developed local recurrence. Of these 21 patients, 7 patients underwent SRS at our institution and an additional patient underwent SRS after transnasal biopsy. Therefore, a total of 8 patients are reported. RESULTS: The median age at time of local recurrence was 50 years. All patients had Kadish C disease at initial diagnosis. Six of 8 patients were found to have Hyams grade 3 disease; the remaining 2 patients had grade 2 disease. The median treatment volume was 8.4 cm3 (mean, 18.9 cm3; range, 1.4-76.3 cm3), and the median dose to the tumor margin was 15 Gy (mean, 14.4 ± 2.2 Gy; range, 10-18 Gy). Of the 16 treatments, 13 had adequate follow-up to assess treatment response, with 92% achieving local control over a median follow-up of 42 months from the time of SRS. Five lesions decreased in size, 7 lesions stabilized, and only 1 lesion had in-field progression. There were no documented complications secondary to SRS. CONCLUSION: SRS appears to be a reasonable and safe option for treatment of intracranial recurrence of ENB.

Primary and locally recurrent retroperitoneal soft-tissue sarcoma: Local control and survival

2009 ◽  
Vol 35 (9) ◽  
pp. 986-993 ◽  
Author(s):  
T. Lehnert ◽  
S. Cardona ◽  
U. Hinz ◽  
F. Willeke ◽  
G. Mechtersheimer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Local Control ◽  
Locally Recurrent ◽  
Retroperitoneal Soft Tissue Sarcoma

Randomized Phase II Evaluation of 6 g/m2 of Ifosfamide Plus Doxorubicin and Granulocyte Colony-Stimulating Factor (G-CSF) Compared With 12 g/m2 of Ifosfamide Plus Doxorubicin and G-CSF in the Treatment of Poor-Prognosis Soft Tissue Sarcoma

2005 ◽  
Vol 23 (1) ◽  
pp. 105-112 ◽  
Author(s):  
Francis P. Worden ◽  
Jeremy M.G. Taylor ◽  
Janet S. Biermann ◽  
Vernon K. Sondak ◽  
Kirstin M. Leu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Standard Dose ◽  
Disease Free Survival ◽  
High Dose ◽  
First Line Therapy ◽  
Significant Difference ◽  
Outcome Differences ◽  
Grade 3 ◽  
Combination Regimens

Purpose The relative value of increasing ifosfamide dose in combination chemotherapy for patients with soft tissue sarcoma (STS) is unclear. The purpose of this study was to compare the efficacy and toxicity of doxorubicin with high-dose (HD) ifosfamide or standard-dose (SD) ifosfamide in patients with STS. Patients and Methods Chemotherapy-naive patients with STS were randomly assigned to receive doxorubicin 60 mg/m2 and either SD ifosfamide (1.5 g/m2/d, days 1 through 4) or HD ifosfamide (3.0 g/m2, days 1 through 4) every 21 days. Patients were stratified by the presence or absence of metastatic disease. End points were overall survival (OS), 1-year disease-free survival (DFS), and toxicity. Results The study group consisted of 79 patients (52 patients with localized disease and 27 patients with metastases). Both groups were well-balanced with respect to known prognostic factors. There was no significant difference in 1-year DFS comparing SD ifosfamide with HD ifosfamide (55% v 52%; P = .81). For SD ifosfamide, 2- and 3-year OS were 73% and 52% versus 57% and 49% for HD ifosfamide (P = .34). The incidence of grade 3/4 neutropenia, anemia, and thrombocytopenia were 49%, 23%, and 10%, respectively, on the SD ifosfamide arm, compared with 88%, 58%, and 63%, respectively, on the HD ifosfamide arm. There were five early deaths, all on the HD ifosfamide arm. Conclusion When combined with doxorubicin, HD ifosfamide did not improve 1-year DFS and OS. Toxicity was clearly greater with the HD ifosfamide arm, and lack of outcome differences might be explained by toxicities with HD ifosfamide. These results suggest that HD ifosfamide combination regimens should not be used as first-line therapy for patients with STS.

Amputations for extremity soft tissue sarcoma in an era of limb salvage treatment: Local control and survival

2017 ◽  
Vol 117 (3) ◽  
pp. 434-442 ◽  
Author(s):  
Marc G. Stevenson ◽  
Annelie H. Musters ◽  
Jan H.B. Geertzen ◽  
Barbara L. van Leeuwen ◽  
Harald J. Hoekstra ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Limb Salvage ◽  
Local Control ◽  
Salvage Treatment ◽  
Extremity Soft Tissue Sarcoma
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