Neoadjuvant image-guided helical intensity modulated radiotherapy of extremity sarcomas - A single center experience
Peeken JC, Knie C, Kessel KA, Habermehl D, Kampfer S, Dapper H, Devecka M, Von Eisenhart-Rothe R, Specht K, Weichert W, Woertler K, Knebel C, Wilkens JJ, Combs SE (2019)
Publication Type: Journal article
Publication year: 2019
Journal
Book Volume: 14
Article Number: 2
Journal Issue: 1
DOI: 10.1186/s13014-019-1207-2
Abstract
Background: Advanced radiotherapy (RT) techniques allow normal tissue to be spared in patients with extremity soft tissue sarcoma (STS). This work aims to evaluate toxicity and outcome after neoadjuvant image-guided radiotherapy (IGRT) as helical intensity modulated radiotherapy (IMRT) with reduced margins based on MRI-based target definition in patients with STS. Methods: Between 2010 to 2014, 41 patients with extremity STS were treated with IGRT delivered as helical IMRT on a tomotherapy machine. The tumor site was in the upper extremity in 6 patients (15%) and lower extremity in 35 patients (85%). Reduced margins of 2.5 cm in longitudinal direction and 1.0 cm in axial direction were used to expand the MRI-defined gross tumor volume, including peritumoral edema, to the clinical target volume. An additional margin of 5 mm was added to receive the planning target volume. The full total dose of 50 Gy in 2 Gy fractions was sucessfully applied in 40 patients. Two patients received chemotherapy instead of surgery due to systemic progression. All patients were included into a strict follow-up program and were seen interdisciplinarily by the Departments of Orthopaedic Surgery and Radiation Oncology. Results: Thirty eight patients that received total RT total dose and subsequent resection were analyzed for outcome. After a median follow-up of 38.5 months cumulative OS, local PFS and systemic PFS at 2 years were determined at 78.2, 85.2 and 54.5%, respectively. Two of 6 local recurrences were proximal marginal misses. Negative resection margins were achieved in 84% of patients. The rate of major wound complications was comparable to previous IMRT studies with 36.8%. RT was overall tolerable with low toxicity rates. Conclusions: IMRT-IGRT offers neoadjuvant treatment for extremity STS with reduced safety margins and thus low toxicity rates. Wound complication rates were comparable to previously reported frequencies. Two reported marginal misses suggest a word of caution for reduction of longitudinal safety margins.
Involved external institutions
Germany (DE)How to cite
APA:
Peeken, J.C., Knie, C., Kessel, K.A., Habermehl, D., Kampfer, S., Dapper, H.,... Combs, S.E. (2019). Neoadjuvant image-guided helical intensity modulated radiotherapy of extremity sarcomas - A single center experience. Radiation Oncology, 14(1). https://doi.org/10.1186/s13014-019-1207-2
MLA:
Peeken, Jan C., et al. "Neoadjuvant image-guided helical intensity modulated radiotherapy of extremity sarcomas - A single center experience." Radiation Oncology 14.1 (2019).
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