High-dose pre-operative helical tomotherapy (54 Gy) for retroperitoneal liposarcoma

Abstract

PurposeTo evaluate the feasibility of pre-operative radiotherapy (54 Gy) with Helical Tomotherapy (HT) followed by surgery.Methods and materialsTen patients with non-metastatic resectable retroperitoneal liposarcomas were treated by pre-operative tomotherapy (54 Gy) and surgery. Clinical and biological toxicities were evaluated on the CTCAEV3.0 scale. For nine patients, delivered tomotherapy plans were compared with retrospectively-planned dynamic intensity-modulated radiotherapy (IMRT) dosimetric studies.ResultsNo immediate or late Grade>2 toxicities were observed after radiotherapy. Post-operatively, one patient died and three patients experienced Grade 3 toxicity (two digestive and one metabolic). These toxicities disappeared and only two patients presented persistent Grade 1 paresthesia. R0 resection was obtained for four patients, R1 for four, and R2 resection for two. With a median follow-up of 26 months, no local or metastatic relapse was observed. Dosimetric comparisons between HT and retrospectively-planned IMRT demonstrate adequate target volume coverage for both techniques. Gastrointestinal sparing is higher with HT with a D200cc reduced by 5 Gy. Integral dose (ID) was increased in HT.ConclusionsHigh dose pre-operative radiotherapy (54 Gy) for retroperitoneal liposarcoma is feasible and mostly well tolerated. Cumulative toxicity and tolerance depend mainly on patient’s general status. Image-guided radiation therapy (IGRT) is essential, irrespective of the IMRT technique used. Furthermore, HT offers the possibility of sparing selected areas in such complex volumes.

The effect of neoadjuvant radiation therapy on perioperative outcomes among patients undergoing resection of retroperitoneal sarcomas

“…3D-conformal radiation therapy vs. intensity modulated radiation therapy). This is of particular importance given recent trends towards escalating doses of radiotherapy for higher-grade sarcomas [19–21]. Moreover, we are unable to assess short-term oncologic outcomes such as margin status nor longer-term variables and outcomes such as adjuvant RT, survival, and disease recurrence.…”

Long-term Oncologic Outcomes After Neoadjuvant Radiation Therapy for Retroperitoneal Sarcomas

“…This uncertainty is especially important given the potential for rare—albeit clinically meaningful—radiation toxicities, such as gastrointestinal upset/dehydration, intestinal obstruction, ureteral stricturing, leukopenia, and anemia/ bleeding. 3,15,16 …”

“…10 In the interim, little survival data have surfaced regarding preoperative RT for RPSs. Published reports in that time have included several additional single-institution reviews, 8,13,15,17,18 2 prospective studies evaluating survival only among patients treated with radiation, 16,19 and 2 preliminary trials evaluating the safety and efficacy of concomitant chemoradiation therapy 20,21 (Table 5). Here, we utilize the NCDB to help better define the impact of neoadjuvant RT for this malignancy and to provide more meaningful survival data for patients treated with preoperative RT.…”

“…This lack of granularity may be particularly important given the increasing interest in “aggressive” resections 24,25 and in delivering escalating doses of neoadjuvant radiotherapy to the area of anticipated close or positive margin. 8,15,18,19 Moreover, advances in radiation technology, such as intensity-modulated RT, have improved the ability to focus the high-dose radiation region to the target to minimize treatment toxicity. 16,18 Third, the pathologic diagnosis of sarcomas—including histologic subtyping and grading—may not be uniform across centers.…”

Retro-Peritoneal Liposarcoma: Diagnostic Difficulties and Therapeutic Attitudes

“…However, despite complete resection, most patients developed local recurrence [7,14]. According to different publications, the 5-year local recurrence rates are varying from 35-85% [4,9,12] and in some cases, the primary and recurrent retroperitoneal liposarcoma of the same patient showed different histopathologic subtypes [7]. recurrent retroperitoneal liposarcoma cases than in primary cases.…”