scholarly journals Adjuvant volumetric modulated arc therapy compared to 3D conformal radiation therapy for newly diagnosed soft tissue sarcoma of the extremities: outcome and toxicity evaluation

2019 ◽  
Vol 92 (1102) ◽  
pp. 20190252 ◽  
Author(s):  
Lucia Di Brina ◽  
Antonella Fogliata ◽  
Pierina Navarria ◽  
Giuseppe D'Agostino ◽  
Ciro Franzese ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Total Dose ◽  
Surgical Resection ◽  
Local Control ◽  
Volumetric Modulated Arc Therapy ◽  
Conformal Radiation Therapy ◽  
Arc Therapy ◽  
The Impact

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.

Comparison of dosimetry parameters of three-dimensional conformational radiation therapy and volumetric modulated arc therapy on the example of treatment of a patient with salivary gland adenocarcinoma

2021 ◽  
Vol 59 (1) ◽  
pp. 25-30
Author(s):  
A. Rakhimov ◽  
M. Zekebayev ◽  
A. Kuatbek ◽  
V. Dyachkov
Keyword(s):  
Radiation Therapy ◽  
Salivary Gland ◽  
Volumetric Modulated Arc Therapy ◽  
Three Dimensional ◽  
Optimal Choice ◽  
International Standards ◽  
Salivary Gland Cancer ◽  
Conformal Radiation Therapy ◽  
Dose Load ◽  
Arc Therapy

An optimal choice of radiation therapy method is the main prerequisite for successful completion of treatment. Continuous analysis of radiation therapy methods’ advantages and comparing their parameters and dose load in typical cases will increase the treatment efficacy and reduce the unavoidable load on critical organs. The purpose was to check the plans of treatment by volumetric modulated arc therapy (VMAT) and three-dimensional conformal radiation therapy (3D-CRT) methods, make their comparison and identify the advantages using an example of a treatment design for a patient treated at the Daily Radiotherapy Hospital of the Kazakh Institute of Oncology and Radiology (Almaty, Kazakhstan). Results: The presented illustrations of the process planning and the numerical analysis of the dose load on critical organs show VMAT advantages for radiation therapy of salivary gland cancer: optimal coverage, sparing load on critical organs and healthy tissues, gradient decay at the borders of the neoplasm. Conclusion: The variability of radiation therapy methods ensures the most acceptable coverage that keeps the dose load within international standards’ ranges. Mastering these methods will improve the effectiveness of radiation therapy for various cancer cases

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

2008 ◽  
Vol 26 (20) ◽  
pp. 3440-3444 ◽  
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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