A prospective study of proton reirradiation for recurrent and secondary soft tissue sarcoma

Guttmann, David; Frick, Melissa A.; Carmona, Ruben; Deville, Curtiland; Levin, William P.; Berman, Abigail T.; Chinniah, C.; Hahn, Stephen M.; Plastaras, John P.; Simone, Charles B.

doi:10.1016/j.radonc.2017.06.024

Cited by 34 publications

(20 citation statements)

References 22 publications

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“…Seven studies examining re-irradiation for recurrent disease were identified across five different subsites, [51][52][53][54][55][56][57] including a recent systematic review 58 of 16 studies across broad indications. The level and quality of evidence was low as the majority of studies are retrospective, with small sample size, limited follow-up duration and do not directly compare results to photon-based re-irradiation.…”

Section: Other Tumour Sitesmentioning

confidence: 99%

Particle therapy tumour outcomes: An updated systematic review

Hwang

Gorayski

et al. 2020

J Med Imag Rad Onc

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Particle therapy (PT) offers the potential for reduced normal tissue damage as well as escalation of target dose, thereby enhancing the therapeutic ratio in radiation therapy. Reflecting the building momentum of PT use worldwide, construction has recently commenced for The Australian Bragg Centre for Proton Therapy and Research in Adelaidethe first PT centre in Australia. This systematic review aims to update the clinical evidence base for PT, both proton beam and carbon ion therapy. The purpose is to inform clinical decision-making for referral of patients to PT centres in Australia as they become operational and overseas in the interim. Three major databases were searched by two independent researchers, and evidence quality was classified according to the National Health and Medical Research Council evidence hierarchy. One hundred and thirty-six studies were included, two-thirds related to proton beam therapy alone. PT at the very least provides equivalent tumour outcomes compared to photon controls with the possibility of improved control in the case of carbon ion therapy. There is suggestion of reduced morbidities in a range of tumour sites, supporting the predictions from dosimetric modelling and the wide international acceptance of PT for specific indications based on this. Though promising, this needs to be counterbalanced by the overall low quality of evidence found, with 90% of studies of level IV (case series) evidence. Prospective comparative clinical trials, supplemented by database-derived outcome information, preferably conducted within international and national networks, are strongly recommended as PT is introduced into Australasia.

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Section: Other Tumour Sitesmentioning

confidence: 99%

Particle therapy tumour outcomes: An updated systematic review

Hwang

Gorayski

et al. 2020

J Med Imag Rad Onc

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“…Finally, particle therapy should be considered because of its general ability to limit dose to surrounding tissues. Guttman et al [112] reported a prospective series of 23 patients (mainly non-extremity lesions) treated with perioperative or definitive re-irradiation with protons (50-74 Gy) and observed a 3-year local failure rate of 41% with only 15% grade 3+ late toxicities.…”

Section: Reirradiation Of Non-metastatic Locally Recurrent Primariesmentioning

confidence: 99%

Radiation Therapy in Adult Soft Tissue Sarcoma—Current Knowledge and Future Directions: A Review and Expert Opinion

Roeder

2020

Cancers

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Radiation therapy (RT) is an integral part of the treatment of adult soft-tissue sarcomas (STS). Although mainly used as perioperative therapy to increase local control in resectable STS with high risk features, it also plays an increasing role in the treatment of non-resectable primary tumors, oligometastatic situations, or for palliation. Modern radiation techniques, like intensity-modulated, image-guided, or stereotactic body RT, as well as special applications like intraoperative RT, brachytherapy, or particle therapy, have widened the therapeutic window allowing either dose escalation with improved efficacy or reduction of side effects with improved functional outcome. This review summarizes the current evidence for RT in adult STS including typical indications, outcomes, side effects, dose and fractionation regimens, and target volume definitions based on tumor localization and risk factors. It covers the different overall treatment approaches including RT either as part of a multimodal treatment strategy or as a sole treatment, namely its use as an adjunct to surgery in resectable STS (perioperative RT), as a primary treatment in non-resectable tumors (definitive RT), as a local treatment modality in oligometastatic disease or as palliative therapy. Due to the known differences in clinical course, general treatment options and, consequently, outcome depending on lesion localization, the main part of perioperative RT is divided into three sections according to body site (extremity/trunk wall, retroperitoneal, and head and neck STS) including the discussion of special applications of radiation techniques specifically amenable to this region. The review of the current evidence is accompanied by a summary on ongoing clinical research pointing at future directions of RT in STS.

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“…To date, there is relatively limited data regarding outcomes following PT for STS, especially in the extremity subset. The University of Pennsylvania has recently presented results with PT for sarcomas arising in previously irradiated fields in 23 patients [ 7 ]. High-grade toxicity was limited with only a 15% rate of significant wound complications.…”

Section: Discussionmentioning

confidence: 99%

“…Small series and dosimetric studies have suggested the utility of PT in this setting [ 6 - 7 ]. However, there remains some lack of clarity on the relative biological effectiveness (RBE) of PT across the spread-out Bragg peak (SOBP), especially at the end of the range of the beam, as employed in both passive scattering and pencil beam scanning (PBS) techniques [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Excellent Pathologic Response and Atypical Clinical Course of High-Grade Extremity Sarcoma to Neoadjuvant Pencil Beam Scanning Proton Therapy

Remick

Regine

Malyapa

et al. 2017

Cureus

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Neoadjuvant radiation therapy, followed by definitive surgical resection, remains the standard of care for resectable high-grade and unresectable soft tissue sarcomas. Proton therapy offers the promise of highly conformal dose distributions with improved sparing of neighboring normal tissues as compared with conformal and intensity modulated photon techniques. It is unclear whether proton therapy may offer an improved tumoral response, especially with dose escalation, in this relatively radio-insensitive tumor type. We, herein, present a patient with an excellent pathologic response to preoperative pencil beam scanning proton therapy despite a complex treatment course.

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A prospective study of proton reirradiation for recurrent and secondary soft tissue sarcoma

Cited by 34 publications

References 22 publications

Particle therapy tumour outcomes: An updated systematic review

Particle therapy tumour outcomes: An updated systematic review

Radiation Therapy in Adult Soft Tissue Sarcoma—Current Knowledge and Future Directions: A Review and Expert Opinion

Excellent Pathologic Response and Atypical Clinical Course of High-Grade Extremity Sarcoma to Neoadjuvant Pencil Beam Scanning Proton Therapy

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