This study revealed significant variation in the perception of negative and close margins among radiation oncologists in NA and Europe. Given these findings, a universal definition of negative margins and consistent recommendations for reexcision are needed.

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Purpose The benefit of radiation therapy in extremity soft tissue sarcomas remains controversial. The purpose of this study was determine the effect of radiation therapy on overall survival among patients with primary soft tissue sarcomas of the extremity who underwent limb sparing surgery. Patients and Methods A retrospective study from the Surveillance, Epidemiology, and End Results (SEER) database that included data from January 1, 1988, to December 31st, 2005. A total of 6,960 patients comprised the study population. Overall survival curves were constructed using Kaplan-Meir Method and for patients with low and high grade tumors. Hazard ratios were calculated based on multivariable Cox proportional hazards models. Results Of the cohort, 47% received radiation therapy. There was no significant difference in overall survival among patients with low grade tumors by radiation therapy. In high grade tumors, the 3 year overall survival was 73% in patients who received radiation therapy vs. 63% for those who did not receive radiation therapy (p < 0.001). On multivariate analysis, patients with high grade tumors who received radiation therapy had an improved overall survival (HR 0.67, 95% CI 0.57-0.79). In patients receiving radiation therapy, 13.5% received it in a neo-adjuvant setting. The incidence of patients receiving neo-adjuvant radiation did not change significantly between 1988 and 2005. Conclusions This is the largest population based study reported in patients undergoing limb sparing surgery for soft tissue sarcomas of the extremities and reports that radiation was associated with improved survival in patients with high grade tumors.

While the workshop was co-sponsored by the NCI and RSS, the comments in this report are strictly the opinions of the co-authors and does not constitute endorsement of these results and/or treatments by the NCI and RSS or consensus of all the co-authors on each of the points. This report is designed to stimulate further formal research and development to explore the future clinical application of these novel therapies and not for implementation into routine clinical practice.

The results of radiotherapy alone for patients with locally advanced (stage III or IV) nasopharyngeal cancer (NPC) are poor in spite of the initial complete clearance. Twenty-seven patients (26 stage IV) were treated with concurrent standard radiotherapy and cisplatin 100 mg/m2 intravenously on day 1 and every 3 weeks for three courses. In 24 (89%) patients, complete response (CR) was achieved. The CR rate was higher for poorly undifferentiated cancer (100%). The major side effects were leukopenia (97%), anemia (54%), nausea and vomiting (81%), stomatitis (92%), and renal impairment (52%). Most of these side effects were either mild or moderate and reversible. All patients finished the radiotherapy dose (greater than 6,450 cGy), 19 (70%) had three courses of cisplatin, and eight had only two courses, six due to drug toxicity. Twenty-six patients with stage IV disease were compared with 78 patients treated with radiotherapy alone by the Radiation Therapy Oncology Group (RTOG). The disease-free survival (DFS), overall survival, and the incidence of distant organ metastasis appear to be better in the combined group. It was concluded that the combination of chemo-radiotherapy in patients with locally advanced NPC needs to be evaluated in a phase III randomized trial.

Purpose-A dosimetric comparison between multiple static-field intensity-modulated radiation therapy (IMRT), multi-arc intensity-modulated arc therapy (IMAT) and single-arc arc-modulated radiation therapy (AMRT) is performed to evaluate their clinical advantages and shortcomings.Methods and Materials-Twelve cases were selected for this study, including 3 head-and-neck (HN), 3 brain (CNS), 3 lung, and 3 prostate cases. An IMRT, IMAT, and AMRT plan was generated for each of the patient cases with clinically-relevant planning constraints. For fair comparison, the same parameters were used for the IMRT, IMAT, and AMRT planning for each patient.Results-Multi-arc IMAT provided the best plan quality while single-arc AMRT achieved comparable dose distributions to IMRT, especially in the complicated HN and brain cases. Both AMRT and IMAT showed effective normal tissue sparing without compromising target coverage and delivered a lower total dose to the surrounding normal tissues in some cases.Conclusions-IMAT provides the most uniform and conformal dose distributions especially for the cases with large and complex targets with a similar delivery time to IMRT. AMRT achieves results comparable to IMRT with significantly faster treatment delivery.

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