High-risk soft tissue sarcoma of extremity and trunk wall: A retrospective comparison of local control in patients treated with or without radiation therapy at a single reference center.

Objective: To assess the impact of adjuvant volumetric modulated arc therapy (VMAT) compared with three-dimensional conformal radiation therapy (3DCRT) in terms of toxicity and local control (LC) in patients with soft tissue sarcoma of the extremities. Methods: From 2004 to 2016, 109 patients were treated, initially using 3DCRT and subsequently with VMAT. Clinical outcome was evaluated by contrast-enhanced MRI, thoracic and abdominal CT 3 months after treatments and then every 6 months. Toxicity was evaluated with Common Terminology Criteria for Adverse Events scale v. 4.3. Results: Patients presented Stage III soft tissue sarcoma disease (77%), localized tumor (95%) at the lower extremity (87%), adipocytic histotype (46%). Surgical resection was performed in all patients, followed by adjuvant 3DCRT in 38, and VMAT in 71. The median total dose was 66 Gy/33 fractions (range 60–70 Gy;25–35 fractions). More successful bone sparing was recorded using VMAT (p < 0.001). Median follow-up was 61 months, 93 and 58 months for 3DCRT and VMAT group, respectively. The 2- and 5 year LC were 95.3±2.1%, and 87.4±3.4% for the whole cohort, 92.0±4.5%, 82.9±6.4% for 3DCRT, 97.1±2.0%, 89.6±4.1% for VMAT (p = 0.150). On univariate and multivariate analysis the factors recorded as conditioning LC were the status of the surgical resection margins (p = 0.028) and the total dose delivered (p = 0.013). Conclusion: The availability of modern radiotherapy technique permit a better conformity on the target with maximum sparing of normal tissue and acceptable side-effects. VMAT is a safe and feasible treatment with limited rate of toxicity, compared to 3DCRT. Results on LC of VMAT are encouraging. Advances in knowledge: Soft tissue sarcoma of the extremities can benefit from the use of VMAT, with a reduction of the high dose to bones to avoid radiation osteonecrosis. An adequate total dose of at least 66 Gy and a radical surgical margin allow a good local control.

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Adjuvant Therapy for Soft Tissue Sarcoma

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2005.0013 ◽

2005 ◽

Vol 3 (2) ◽

pp. 207-213 ◽

Cited By ~ 1

Author(s):

Scott M. Schuetze ◽

Michael E. Ray

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

High Risk ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Survival Rates ◽

Wide Resection ◽

High Grade ◽

Postoperative Radiation Therapy ◽

Increased Risk

Wide surgical excision is the backbone of therapy for localized soft tissue sarcoma and often produces excellent results. Patients with a marginal resection of disease and high-grade or large tumors are at an increased risk of recurrence. Radiation therapy (external beam or brachytherapy) has been shown to reduce the risk of local recurrence of disease and should be offered to patients with large (>5 cm) or high-grade sarcomas, especially if a wide resection cannot be performed. Use of preoperative versus postoperative radiation therapy should be planned, in consultation with a radiation oncologist and a surgical oncologist, before resection of the sarcoma if possible. Chemotherapy using an anthracycline- and ifosfamide-based regimen may improve disease-free and overall survival rates. Chemotherapy appears to be most beneficial for patients with very large (≥10 cm), high-grade sarcomas of the extremity who are at a high risk of experiencing distant recurrence of disease. The effect of adjuvant chemotherapy on overall survival remains controversial. Research is greatly needed to identify the patients who are most likely to benefit from conventional chemotherapy, improve the treatment of retroperitoneal sarcomas, and identify novel agents that may impact the natural history of high-risk soft tissue sarcoma.

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Impact of Intensity-Modulated Radiation Therapy on Local Control in Primary Soft-Tissue Sarcoma of the Extremity

Journal of Clinical Oncology ◽

10.1200/jco.2008.16.6249 ◽

2008 ◽

Vol 26 (20) ◽

pp. 3440-3444 ◽

Cited By ~ 87

Author(s):

Kaled M. Alektiar ◽

Murray F. Brennan ◽

John H. Healey ◽

Samuel Singer

Keyword(s):

Radiation Therapy ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Local Control ◽

Intensity Modulated Radiation Therapy ◽

Local Control Rate ◽

Bone Resection ◽

Close Margin ◽

Intensity Modulated

Purpose One of the concerns about intensity-modulated radiation therapy (IMRT) is that its tight dose distribution, an advantage in reducing RT morbidity to surrounding normal structures, might compromise tumor coverage. The purpose of this study is to determine if such concern is warranted in soft-tissue sarcoma (STS) of the extremity. Methods Between 02/02 and 05/05, 41 adult patients with primary STS of the extremity were treated with limb-sparing surgery and adjuvant IMRT. The margins were positive/within 1 mm in 21. Tumor size was more than 10 cm in 68% of patients and grade was high in 83%. Preoperative IMRT was given to 7 patients (50 Gy) and postoperative IMRT (median dose, 63 Gy) was given to 34 patients. Complete gross resection including periosteal stripping/bone resection was required in 11, and neurolysis/nerve resection in 24. Results With a median follow-up time of 35 months, two (4.8%) of 41 patients developed local recurrence. The 5-year actuarial local control rate was 94% (95% CI, 86% to 100%). The local control rate was also 94% for patients with negative or positive/close margin. Other prognostic factors such as age, size, and grade did not impact local control either. The 5-year distant control rate was 61% (95% CI, 45% to 76%) and the overall survival rate was 64% (95% CI, 45% to 84%). Conclusion IMRT in STS of the extremity provides excellent local control in a group of patients with high risk features. This suggests that the precision with which IMRT dose is distributed has a beneficiary effect in sparing normal tissue and improving local control.

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At the Confluence of Radiation Therapy and Immunotherapy: External Beam Radiation (EBRT) with Intratumoral Injection of Dendritic Cells as Neoadjuvant Treatment of High-risk Soft Tissue Sarcoma Patients

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2009.07.166 ◽

2009 ◽

Vol 75 (3) ◽

pp. S65 ◽

Cited By ~ 3

Author(s):

S.E. Finkelstein ◽

D.I. Gabrilovich ◽

M.M. Bui ◽

M. Cotter ◽

D. Cheong ◽

...

Keyword(s):

Dendritic Cells ◽

Radiation Therapy ◽

High Risk ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Neoadjuvant Treatment ◽

Intratumoral Injection ◽

External Beam Radiation ◽

External Beam ◽

Beam Radiation

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Intraoperative radiation therapy for high risk soft tissue sarcoma resection margins

Journal of Solid Tumors ◽

10.5430/jst.v4n4p25 ◽

2014 ◽

Vol 4 (4) ◽

Author(s):

Jacqueline Oxenberg ◽

Harish K. Malhotra ◽

Kristopher Attwood ◽

John M. Kane III ◽

Kilian Salerno

Keyword(s):

Radiation Therapy ◽

High Risk ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Intraoperative Radiation Therapy ◽

Resection Margins ◽

Intraoperative Radiation

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Radiation Therapy in Metastatic Soft Tissue Sarcoma: From Palliation to Ablation

Cancers ◽

10.3390/cancers13194775 ◽

2021 ◽

Vol 13 (19) ◽

pp. 4775

Author(s):

Nishant K. Shah ◽

Nikhil Yegya-Raman ◽

Joshua A. Jones ◽

Jacob E. Shabason

Keyword(s):

Radiation Therapy ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Metastatic Disease ◽

Local Control ◽

Metastatic Cancer ◽

Local Therapy ◽

Primary Site ◽

Metastatic Soft Tissue Sarcoma ◽

Low Volume

The management of patients with metastatic cancer is rapidly changing. Historically, radiotherapy was utilized for the treatment of localized disease or for palliation. While systemic therapy remains the mainstay of management for patients with metastatic cancer, radiotherapy is becoming increasingly important not only to palliate symptoms, but also to ablate oligometastatic or oligoprogressive disease and improve local control in the primary site. There is emerging evidence in multiple solid malignancies that patients with low volume metastatic disease that undergo local ablative therapy to metastatic sites may have improved progression free survival and potentially overall survival. In addition, there is increasing evidence that select patients with metastatic disease may benefit from aggressive treatment of the primary site. Patients with metastatic soft tissue sarcoma have a poor overall prognosis. However, there may be opportunities in patients with low volume metastatic soft tissue sarcoma to improve outcomes with local therapy including surgery, ablation, embolization, and radiation therapy. Stereotactic body radiation therapy (SBRT) offers a safe, convenient, precise, and non-invasive option for ablation of sites of metastases. In this review article, we explore the limited yet evolving role of radiotherapy to metastatic and primary sites for local control and palliation, particularly in the oligometastatic setting.

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Preoperative accelerated radiotherapy combined with chemotherapy in a defined cohort of patients with high risk soft tissue sarcoma: a Scandinavian Sarcoma Group study

Clinical Sarcoma Research ◽

10.1186/s13569-020-00145-5 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Kirsten Sundby Hall ◽

Øyvind S. Bruland ◽

Bodil Bjerkehagen ◽

Elisabet Lidbrink ◽

Nina Jebsen ◽

...

Keyword(s):

High Risk ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Local Control ◽

Survival Data ◽

Locally Advanced ◽

Resection Margins ◽

Accelerated Radiotherapy ◽

Group B

Abstract Background We recently reported outcomes from a Scandinavian Sarcoma Group adjuvant study (SSG XX group A) conducted on localized and operable high risk soft tissue sarcoma (STS) of the extremities and trunk wall. SSG XX, group B, comprised of patients in a defined cohort with locally advanced STS considered at high risk for intralesional surgery. These patients received preoperative accelerated radiotherapy, together with neoadjuvant and adjuvant chemotherapy. Herein we report the results of this group B. Methods Twenty patients with high-grade, locally advanced and deep STS located in lower extremities (n = 12), upper extremities (5) or trunk wall (3) were included. The median age was 59 years and 14 patients were males. The treatment regimen consisted of 6 cycles of doxorubicin (60 mg/m2) and ifosfamide (6 g/m2), with three cycles given neoadjuvantly, and preoperative radiotherapy (1, 8 Gyx2/daily to 36 Gy) between cycles 2 and 3. After a repeated MRI surgery was then conducted, and the remaining 3 chemotherapy cycles were given postoperatively at 3 weeks intervals. Survival data, local control, toxicity of chemotherapy and postoperative complications are presented. Results Median follow-up time for metastasis-free survival (MFS) was 2.8 years (range 0.3–10.4). The 5-year MFS was 49.5% (95% confidence interval [CI] 31.7–77.4). The median follow-up time was 5.4 years (range 0.3–10.4) for overall survival (OS). The 5-year OS was 64.0% (95% CI 45.8–89.4). The median tumour size was 13 cm, with undifferentiated pleomorphic sarcoma (n = 10) and synovial sarcoma (n = 6) diagnosed most frequently. All patients completed surgery. Resection margins were R0 in 19 patients and R1 in 1 patient. No patients had evidence of disease progression preoperatively. Three patients experienced a local recurrence, in 2 after lung metastases had already been diagnosed. Eleven patients (55%) had postoperative wound problems (temporary in 8 and persistent in 3). Conclusions Preoperative chemotherapy and radiotherapy were associated with temporary wound-healing problems. Survival outcomes, local control and toxicities were deemed satisfactory when considering the locally advanced sarcoma disease status at primary diagnosis. Trial registration This study was registered at ClinicalTrials.gov Identifier NCT00790244 and with European Union Drug Regulating Authorities Clinical Trials No. EUDRACT 2007-001152-39

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