Étude théorique d'une radiothérapie postopératoire avec modulation d'intensité d'un sarcome rétropéritonéal

Musat, E.; Kantor, G.; Caron, J.; Lagarde, P.; Laharie, H.; Stoeckle, Eberhard; Angles, J. M.; Gilbeau, L.; Bui, Binh

doi:10.1016/j.canrad.2004.05.001

Cited by 24 publications

(11 citation statements)

References 10 publications

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“…Furthermore, the improved oxygenation could increase radiosensitivity and lower the required dose as known from extremity sarcomas. Some of these advantages, especially regarding target coverage and reduction of dose to adjacent organs at risk, can be further exploited with the use of modern radiation techniques like IMRT, VMAT or Tomotherapy as shown in several planning studies [4, 21–23], including the opportunity to reduce overall treatment time by an integrated boost concept.…”

Section: Discussionmentioning

confidence: 99%

“…Compared to the postoperative approach, preoperative radiation therapy could offer several benefits, including a more precise target volume definition with smaller safety margins, reduced toxicity to adjacent organs at risk because of their displacement through the tumor itself, a possible devitalisation of tumor cells and the avoidance of treatment delays due to postoperative complications [1]. The use of Intensity-modulated radiation therapy (IMRT) further offers improved target coverage with reduced dose to adjacent organs at risk compared to conventional irradiation [4] and the opportunity to reduce overall treatment time using an integrated boost concept with simultaneously increased dose per fraction to the gross tumor volume. Since little data exists about the combination of these approaches, we initiated this prospective, non-randomised, single center trial [5] to investigate the value of dose-escalated preoperative IMRT followed by surgery with an intraoperative electron boost to reduce the local recurrence rate without a markedly increased toxicity.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Phase I/II trial to Investigate Preoperative Dose-Escalated Intensity-Modulated Radiation Therapy (IMRT) and Intraoperative Radiation Therapy (IORT) in patients with retroperitoneal soft tissue sarcoma: interim analysis

et al. 2014

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BackgroundTo report an unplanned interim analysis of a prospective, one-armed, single center phase I/II trial (NCT01566123).MethodsBetween 2007 and 2013, 27 patients (pts) with primary/recurrent retroperitoneal sarcomas (size > 5 cm, M0, at least marginally resectable) were enrolled. The protocol attempted neoadjuvant IMRT using an integrated boost with doses of 45–50 Gy to PTV and 50–56 Gy to GTV in 25 fractions, followed by surgery and IOERT (10–12 Gy). Primary endpoint was 5-year-LC, secondary endpoints included PFS, OS, resectability, and acute/late toxicity. The majority of patients showed high grade lesions (FNCLCC G1:18%, G2:52%, G3:30%), predominantly liposarcomas (70%). Median tumor size was 15 cm (6–31).ResultsMedian follow-up was 33 months (5–75). Neoadjuvant IMRT was performed as planned (median dose 50 Gy, 26–55) in all except 2 pts (93%). Gross total resection was feasible in all except one patient. Final margin status was R0 in 6 (22%) and R1 in 20 pts (74%). Contiguous-organ resection was needed in all grossly resected patients. IOERT was performed in 23 pts (85%) with a median dose of 12 Gy (10–20 Gy).We observed 7 local recurrences, transferring into estimated 3- and 5-year-LC rates of 72%. Two were located outside the EBRT area and two were observed after more than 5 years. Locally recurrent situation had a significantly negative impact on local control. Distant failure was found in 8 pts, resulting in 3- and 5-year-DC rates of 63%. Patients with leiomyosarcoma had a significantly increased risk of distant failure. Estimated 3- and 5-year-rates were 40% for PFS and 74% for OS. Severe acute toxicity (grade 3) was present in 4 pts (15%). Severe postoperative complications were found in 9 pts (33%), of whom 2 finally died after multiple re-interventions. Severe late toxicity (grade 3) was scored in 6% of surviving patients after 1 year and none after 2 years.ConclusionCombination of neoadjuvant IMRT, surgery and IOERT is feasible with acceptable toxicity and yields good results in terms of LC and OS in patients with high-risk retroperitoneal sarcomas. Long term follow-up seems mandatory given the observation of late recurrences. Accrual of patients will be continued with extended follow-up.Trial registrationNCT01566123.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Phase I/II trial to Investigate Preoperative Dose-Escalated Intensity-Modulated Radiation Therapy (IMRT) and Intraoperative Radiation Therapy (IORT) in patients with retroperitoneal soft tissue sarcoma: interim analysis

et al. 2014

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“…IMRT use has already been investigated for the treatment of retroperitoneal sarcomas [13-15]. Although large fields may be required for those tumors, more particularly in preoperative setting, this does not preclude the employment of IMRT [14], but the dose inhomogeneity within the target can increase considerably, especially in the vicinity of kidneys.…”

Section: Introductionmentioning

confidence: 99%

Feasibility study of volumetric modulated arc therapy for the treatment of retroperitoneal sarcomas

Llacer-Moscardo

Quénet²,

Azria

et al. 2010

Radiat Oncol

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BackgroundRadiotherapy for retroperitoneal sarcomas remains controversial and a technical challenge considering the threshold of contiguous critical organs tolerance. We performed consecutive RapidArc dosimetric plans in preoperative or postoperative setting.MethodsA dosimetric study was carried out from six preoperative (group A) and four postoperative (group B) CT-scans, performed in 7 patients.Prescribed dose was 45 and 50 Gy for groups A and B, respectively. The planning target volume (PTV) was defined as the clinical target volume (CTV) plus 5 mm. The CTV encompassed the gross tumor volume (GTV) plus 10 mm or the tumoral bed. The dosimetric plans were optimized on a RapidArc Eclipse console using the progressive resolution algorithm, PRO version 8.8. Normalization method allowed the coverage of 99% of the PTV by 95% of the dose.ResultsMean PTV were 2318.5 ± 2223.9 cc [range 348-6198 cc] and 698.3 ± 216.6 cc [range 463 -933 cc] for groups A and B, respectively. Plans were optimized for single arcs in group B and for single or two arcs in group A. The contralateral kidney volume receiving 5 Gy (V5Gy) was 21.5 ± 23.3% [range 0-55%] and 3.1 ± 2.6% [range 0-7.3%] for groups A and B, respectively. The mean dose received by 1% of the kidney (D1%) was 5.6 ± 2.4 Gy [range 3.6 -7.6 Gy] for group A and 5.4 ± 0.7 Gy [range 4.3-6 Gy] for group B. The volume of small bowel excluding the PTV (small bowel-PTV) that received 40 Gy and 30 Gy (V40Gy and V30Gy) in group A were 7.5 ± 4.4% [range 5.4-14.1%] and 18.5 ± 7.1% [range 10-30.4%], respectively.In group B, small bowel-PTV V40Gy and V30Gy were 4.7 ± 3.3% [range 3.3-8%] and 21.6 ± 7.5% [range 9.4-30%] respectively. In a second step, we treated two patients in the postoperative group. Treatment time delivery with one arc was 74 seconds. No severe acute toxicity was observed.ConclusionRapidArc technology for retroperitoneal sarcomas showed acceptable dosimetric results in preoperative or postoperative clinical situation. From the first treated patients, acute tolerability was good to excellent.

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“…Compared to the postoperative approach, preoperative radiation therapy and the use of improved irradiation techniques seem favourable for the following reasons : Preoperative radiation therapy allows for a more precise target volume definition and delineation with smaller safety margins, reduces toxicity to adjacent organs at risk because of their displacement through the tumor itself, may lead to a devitalisation of tumor cells including a down-sizing effect, and may avoid a treatment delay due to postoperative complications. Considering improved irradiation techniques, intensity-modulated radiation therapy (IMRT) has been shown to result in improved target coverage and reduced dose to adjacent organs at risk compared to conventional irradiation, as shown in several diseases including retroperitoneal sarcoma [17,18], especially if complex shaped target volumes have to be treated [19]. Further on, IMRT offers the opportunity to reduce overall treatment time using an integrated boost concept with simultaneously increased dose per fraction in parts of the target volume which are at increased risk for incomplete resection during planned surgery.…”

Section: Introductionmentioning

confidence: 99%

A Clinical phase I/II trial to investigate preoperative dose-escalated intensity-modulated radiation therapy (IMRT) and intraoperative radiation therapy (IORT) in patients with retroperitoneal soft tissue sarcoma

et al. 2012

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BackgroundLocal control rates in patients with retroperitoneal soft tissue sarcoma (RSTS) remain disappointing even after gross total resection, mainly because wide margins are not achievable in the majority of patients. In contrast to extremity sarcoma, postoperative radiation therapy (RT) has shown limited efficacy due to its limitations in achievable dose and coverage. Although Intraoperative Radiation Therapy (IORT) has been introduced in some centers to overcome the dose limitations and resulted in increased outcome, local failure rates are still high even if considerable treatment related toxicity is accepted. As postoperative administration of RT has some general disadvantages, neoadjuvant approaches could offer benefits in terms of dose escalation, target coverage and reduction of toxicity, especially if highly conformal techniques like intensity-modulated radiation therapy (IMRT) are considered.Methods/designThe trial is a prospective, one armed, single center phase I/II study investigating a combination of neoadjuvant dose-escalated IMRT (50–56 Gy) followed by surgery and IORT (10–12 Gy) in patients with at least marginally resectable RSTS. The primary objective is the local control rate after five years. Secondary endpoints are progression-free and overall survival, acute and late toxicity, surgical resectability and patterns of failure. The aim of accrual is 37 patients in the per-protocol population.DiscussionThe present study evaluates combined neoadjuvant dose-escalated IMRT followed by surgery and IORT concerning its value for improved local control without markedly increased toxicity.Trial registrationNCT01566123

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Étude théorique d'une radiothérapie postopératoire avec modulation d'intensité d'un sarcome rétropéritonéal

Cited by 24 publications

References 10 publications

Clinical Phase I/II trial to Investigate Preoperative Dose-Escalated Intensity-Modulated Radiation Therapy (IMRT) and Intraoperative Radiation Therapy (IORT) in patients with retroperitoneal soft tissue sarcoma: interim analysis

Clinical Phase I/II trial to Investigate Preoperative Dose-Escalated Intensity-Modulated Radiation Therapy (IMRT) and Intraoperative Radiation Therapy (IORT) in patients with retroperitoneal soft tissue sarcoma: interim analysis

Feasibility study of volumetric modulated arc therapy for the treatment of retroperitoneal sarcomas

A Clinical phase I/II trial to investigate preoperative dose-escalated intensity-modulated radiation therapy (IMRT) and intraoperative radiation therapy (IORT) in patients with retroperitoneal soft tissue sarcoma

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