Anatomic Tumor Location Influences the Success of Contemporary Limb-sparing Surgery and Radiation among Adults with Soft Tissue Sarcomas of the Extremities

Abstract

Purpose/Objective(s): To determine the recommended irradiation dose of carbon ion radiotherapy and to evaluate the safety and effects of high-dose carbon ion radiotherapy for unresectable bone and soft tissue sarcoma in the adult head and neck. Materials/Methods: Adult patients with unresectable bone and soft tissue sarcoma in the head and neck were eligible for this phase I/II study. First, the patients were enrolled in a study on dose escalation from 70.4 GyE/16 fr. to determine the appropriate irradiation dose with carbon ion radiotherapy. Then a phase II study was performed using that irradiation dose. Results: A total of 27 evaluable patients were enrolled. The median follow-up period of survival patients was 29.0 months. As acute adverse effects, Grade 3 mucositis was observed in only 1 patient, and no patient had Grade 4 toxicity. As late adverse effects, Grade 4 optic nerve injury was observed in 1 patient and Grade 3 osteonecrosis was observed in 4 patients. Since the local control rate with the initial dose during the phase I study was approximately 100% and since results of another dose-escalation study with carbon ion for sarcomas of the trunk performed in our institution showed that a dose of more than 70.4 GyE has many unacceptable adverse effects, we considered 70.4 GyE/16 fr. to be an appropriate irradiation dose for unresectable bone and soft tissue sarcoma in the adult head and neck. We therefore used that irradiation dose in a phase II study. Overall response rate was 29.6%, with complete response in 3 patients and partial response in 5 patients. The 1-year and 3-year local control rates were 96.0% and 91.6%, respectively, the 1-year and 3-year overall survival rates were 92.6% and 72.6%, respectively. The local control rate was significantly better than that of our past results with carbon ion radiotherapy at a dose of 57.6 or 64.0 GyE/16 fr. for sarcomas in the head and neck (log-rank test: p\0.001); however, there was not significant difference of overall survival rate between 70.4 GyE and 57.6 or 64.0 GyE (log-rank test: p = 0.165). Conclusions: The recommended irradiation dose of carbon ion radiotherapy for bone and soft tissue sarcoma in the adult head and neck is 70.4 GyE/16 fr., and that dose is considered to be safe and relative effective.Purpose/Objective(s): Acral myxoinflammatory fibroblastic sarcoma (AMFS) represents a rare, low-grade sarcoma that commonly affects the distal extremities. The lesion often presents as a painless mass in the hands or feet. From the published cases, S524I.

Predictors for Major Wound Complications Following Preoperative Radiotherapy and Surgery for Soft-Tissue Sarcoma of the Extremities and Trunk: Importance of Tumor Proximity to Skin Surface

“…Large tumor size has been reported as a significant predictor for MWC by many groups. Various sizes have been found to be predictive, including[10 cm (current study and the NCI Canada study), [8 cm (Korah et al) 15 and [5 cm (Cannon et al). 12,15,16 This is the first report to identify proximity of tumor \3 mm from skin surface as a predictor for MWC.…”

“…Various sizes have been found to be predictive, including[10 cm (current study and the NCI Canada study), [8 cm (Korah et al) 15 and [5 cm (Cannon et al). 12,15,16 This is the first report to identify proximity of tumor \3 mm from skin surface as a predictor for MWC. It is reasonable to assume that for tumors very close to the skin surface, the overlying and adjacent skin and subcutaneous tissues received the full dose of RT.…”

“…[11][12][13][14][15][16][17][18][19][20][21][22][23][24] The most robust of the published data come from the prospective study conducted by O'Sullivan et al 12 in which MWC were the primary endpoint. To facilitate comparison of our results with those of the NCI Canada trial, we purposely used the same definitions of MWC as reported therein.…”

“…On the other hand, patients treated with preoperative RT experience higher rates of wound complications. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] The National Cancer Institute of Canada (NCI Canada) conducted a landmark randomized trial of preoperative versus postoperative RT for STS of the extremity and reported major wound complication (MWC) rates of 35 % for the preoperative RT group compared to 17 % for the postoperative RT group. 12 Most MWC are treatable with resultant good functional status and thus are not considered ''permanent.''…”

Complications after thigh sarcoma resection

“…STS of the lower extremity are known to be associated with more complications than those in the upper extremity 6–19 . Lower extremity tumors tend to be larger, resulting in more disruption of local structures 7.…”