Is 5 the New 25? Long-Term Oncologic Outcomes From a Phase II, Prospective, 5-Fraction Preoperative Radiation Therapy Trial in Patients With Localized Soft Tissue Sarcoma

Bedi, Meena; Singh, Ramesh; Charlson, John A.; Kelly, Tracy; Johnstone, Candice; Wooldridge, Adam N.; Hackbarth, Donald A.; Moore, Nicole; Neilson, John C.; King, David M.

doi:10.1016/j.adro.2021.100850

Cited by 16 publications

(10 citation statements)

References 45 publications

(119 reference statements)

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“…5). Accelerated treatment schedules, known as hypofractionation, are being broadly explored [22][23][24] .…”

Section: Radiation Oncologistmentioning

confidence: 99%

Team Approach: Extremity Soft Tissue Sarcoma

Morris,

Banks,

Fitzhugh

et al. 2023

JBJS Reviews

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» Synovial sarcoma is a soft tissue sarcoma that most commonly presents in the extremity in a periarticular location.» As the history and physical examination of patients with synovial sarcoma can overlap considerably with those of patients with non-oncologic orthopedic conditions, it is important that orthopedic surgeons maintain a high level of suspicion when caring for patients with extremity masses.» Soft tissue sarcomas are best treated using a team approach. Early recognition and referral to a multidisciplinary sarcoma team are crucial to ensure the best clinical outcome for the patient.

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“…5). Accelerated treatment schedules, known as hypofractionation, are being broadly explored [22][23][24] .…”

Section: Radiation Oncologistmentioning

confidence: 99%

Team Approach: Extremity Soft Tissue Sarcoma

Morris,

Banks,

Fitzhugh

et al. 2023

JBJS Reviews

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“…Other published studies have used ultrahypofractionated regimens delivering 25–40 Gy in 5 fractions. Of these, 5 Gy × 5 appears to have lower rates of local control, 6 Gy and 7 Gy × 5 appear to have comparable local control, and 8 Gy × 5 resulted in unacceptable rates of complications 15–20 . These published series differ significantly in dose fractionation, target volumes and dose constraints used, RT delivery (either daily or every other day), timing of surgery following RT, and length of follow up.…”

Section: Soft Tissue Sarcoma: Hypofractionated Preoperative Rtmentioning

confidence: 99%

2023 Radiation oncology highlights

Salerno,

Das,

2023

Journal of Surgical Oncology

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Radiation oncology plays an important role in the local treatment of cancers. Understanding recent advances in the application of radiation therapy to solid tumors is important for all disciplines. The radiation oncology section editors for this journal have selected the following articles for their overall significance, relevance to surgical oncologists, and to illustrate important concepts within the practice of radiation oncology.

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“…A recent phase II trial evaluating the use of preoperative radiotherapy to 30 Gy in 5 fractions for patients with high-risk primary soft tissue sarcoma found favorable rates of grade ≥2 radiation-associated toxicity (16%) after median follow-up of 2 years, with a 32% rate of wound healing complications [ 10 ]. Other institutional experiences have similarly reported 15% to 35% rates of late grade ≥2 toxicity and 25% to 40% rate of wound complications associated with preoperative ultra-hypofractionated RT, as shown in Table 1 [ 10 – 13 ].…”

Section: Introductionmentioning

confidence: 95%

Comparing Ultra-hypofractionated Proton versus Photon Therapy in Extremity Soft Tissue Sarcoma

Thomas

Chen

Gogineni

et al. 2023

International Journal of Particle Therapy

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Purpose Recent single institution, phase II evidence has demonstrated the feasibility and efficacy of ultra-hypofractionated, preoperative photon therapy in 5 fractions for the treatment of soft tissue sarcoma (STS). Our purpose was to evaluate the dosimetric benefits of modern scanning beam proton therapy compared with conventional photon radiation therapy (RT) for the neoadjuvant treatment of adult extremity STS. Materials and Methods Existing proton and photon plans for 11 adult patients with STS of the lower extremities previously treated preoperatively with neoadjuvant RT at our center were used to create proton therapy plans using Raystation Treatment Planning System v10.A. Volumes were delineated, and doses reported consistent with International Commission on Radiation Units and Measurements reports 50, 62, and 78. Target volumes were optimized such that 100% clinical target volume (CTV) was covered by 99% of the prescription dose. The prescribed dose was 30 Gy for PT and RT delivered in 5 fractions. For proton therapy, doses are reported in GyRBE = 1.1 Gy. The constraints for adjacent organs at risk (OARs) within 1 cm of the CTV were the following: femur V30Gy ≤ 50%, joint V30Gy < 50%, femoral head V30Gy ≤ 5 cm3, strip V12 ≤ 10%, and skin V12 < 50%. Target coverage goals, OAR constraints, and integral dose were compared by Student t test with P < .05 significance. Results A minimum 99% CTV coverage was achieved for all plans. OAR dose constraints were achieved for all proton and photon plans; however, mean doses to the femur (10.7 ± 8.5 vs 16.1 ± 7.7 GyRBE), femoral head (2.0 ± 4.4 vs 3.6 ± 6.4 GyRBE), and proximal joint (1.8 ± 2.4 vs 3.5 ± 4.4 GyRBE) were all significantly lower with PT vs intensity-modulated radiation therapy (IMRT) (all P < .05). Integral dose was significantly reduced for proton vs photon plans. Conformity and heterogeneity indices were significantly better for proton therapy. Conclusion Proton therapy maintained target coverage while significantly reducing integral and mean doses to the proximal organs at risk compared with RT. Further prospective investigation is warranted to validate these findings and potential benefit in the management of adult STS.

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Is 5 the New 25? Long-Term Oncologic Outcomes From a Phase II, Prospective, 5-Fraction Preoperative Radiation Therapy Trial in Patients With Localized Soft Tissue Sarcoma

Cited by 16 publications

References 45 publications

Team Approach: Extremity Soft Tissue Sarcoma

Team Approach: Extremity Soft Tissue Sarcoma

2023 Radiation oncology highlights

Comparing Ultra-hypofractionated Proton versus Photon Therapy in Extremity Soft Tissue Sarcoma

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