The role of radiotherapy in the management of localized soft tissue sarcomas

Tiong, Siaw Sze; Dickie, Colleen; Haas, Rick L.; O’Sullivan, Brian

doi:10.20892/j.issn.2095-3941.2016.0028

Cited by 33 publications

(28 citation statements)

References 58 publications

(63 reference statements)

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“…It was shown that the application of intensity-modulated radiation therapy (IMRT) leads to the reduction of late radiation complications, for example, breast induration and telangiectasia 52,53. IMRT allowed to reduce acute wound healing complication rates in patients with lower extremity sarcomas 54. However, the results may vary depending on treatment site and localization of target volumes, thus preparing a few treatment plans in different techniques and comparing them is recommended.…”

Section: Preventionmentioning

confidence: 99%

Chronic radiation-induced dermatitis: challenges and solutions

Spałek

2016

CCID

106

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Chronic radiation dermatitis is a late side effect of skin irradiation, which may deteriorate patients’ quality of life. There is a lack of precise data about its incidence; however, several risk factors may predispose to the development of this condition. It includes radiotherapy dose, fractionation, technique, concurrent systemic therapy, comorbidities, and personal and genetic factors. Chronic radiation dermatitis is mostly caused by the imbalance of proinflammatory and profibrotic cytokines. Clinical manifestation includes changes in skin appearance, wounds, ulcerations, necrosis, fibrosis, and secondary cancers. The most severe complication of irradiation is extensive radiation-induced fibrosis (RIF). RIF can manifest in many ways, such as skin induration and retraction, lymphedema or restriction of joint motion. Diagnosis of chronic radiation dermatitis is usually made by clinical examination. In case of unclear clinical manifestation, a biopsy and histopathological examination are recommended to exclude secondary malignancy. The most effective prophylaxis of chronic radiation dermatitis is the use of proper radiation therapy techniques to avoid unnecessary irradiation of healthy skin. Treatment of chronic radiation dermatitis is demanding. The majority of the interventions are based only on clinical practice. Telangiectasia may be treated with pulse dye laser therapy. Chronic postirradiation wounds need special dressings. In case of necrosis or severe ulceration, surgical intervention may be considered. Management of RIF should be complex. Available methods are rehabilitative care, pharmacotherapy, hyperbaric oxygen therapy, and laser therapy. Future challenges include the assessment of late skin toxicity in modern irradiation techniques. Special attention should be paid on genomics and radiomics that allow scientists and clinicians to select patients who are at risk of the development of chronic radiation dermatitis. Novel treatment methods and clinical trials are strongly needed to provide more efficacious therapies.

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Section: Preventionmentioning

confidence: 99%

Chronic radiation-induced dermatitis: challenges and solutions

Spałek

2016

CCID

106

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“…The use of adjuvant radiation therapy (RT) was shown in RCTs to reduce the risk of local recurrence in extremity STS, however, with long‐term follow‐up its impact on overall survival was not seen . Retrospective data about the role of RT in RPS is limited, however, its use has been advocated to be limited to the neoadjuvant setting due to both technical considerations and toxicity . The role of preoperative RT in combination with primary surgical resection in RPS is under investigation in a multicenter randomized prospective trial (STRASS) that has been recently closed due to successful patient accrual.…”

Section: Application Of Nomogram‐based Predictions To the Clinical Prmentioning

confidence: 99%

“…Detailed reviews on nomograms construction are published. [38][39][40][41] Once a nomogram is produced, its reliability in terms of discriminative ability, nomogram capability to distinguish between patients who will have an event and those who will not, and calibration, while the majority of patients had extremity/trunk liposarcoma. 23 As such, the ability of the LPS nomogram to prognosticate outcomes in the retroperitoneum is of concern and will not be discussed further for RPS patients in this review.…”

Section: Statistical Backgroundmentioning

confidence: 99%

“…56,57 Retrospective data about the role of RT in RPS is limited, however, its use has been advocated to be limited to the neoadjuvant setting due to both technical considerations and toxicity. 41 What are these numbers useful for? In a situation where the role of perioperative CT and RT is unclear and debated, the estimation of the oncological risk at surgery may help the physician identifying patients that may benefit from systemic or local therapies.…”

Section: Application Of Nomogram-based Predictions To the Clinical mentioning

confidence: 99%

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Prognostic models for RPS patients—Attempting to predict patient outcomes

Callegaro

Miceli

Gladdy

2017

Journal of Surgical Oncology

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Retroperitoneal sarcoma (RPS) patients can have variable of outcomes after surgery. The chance to recur locally or at distant sites varies according to tumor grade, histologic subtype, and other patient- and tumor-related characteristics. The relative contribution of each prognostic variable on the oncological outcome of RPS patients can be weighted by combining them in prognostic tools such as nomograms. With this review, we critically appraise the available nomograms for RPS patients highlighting pros and cons.

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“…Radiotherapy (RT) has become an important component of a multimodality approach to STS 7,9‐11 . Key studies have demonstrated that the addition of RT improves margin‐negative resection rates and local control for this disease 5,7,12 . Although these improvements have not translated to a survival benefit in most studies, the benefit of radiation in the treatment of extremity sarcomas is well‐established 13,14 .…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant radiation improves margin‐negative resection rates in extremity sarcoma but not survival

Shelby

Suarez‐Kelly

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: Radiation improves limb salvage in extremity sarcomas.Timing of radiation therapy remains under investigation. We sought to evaluate the effects of neoadjuvant radiation (NAR) on surgery and survival of patients with extremity sarcomas. Materials and Methods:A multi-institutional database was used to identify patients with extremity sarcomas undergoing surgical resection from 2000-2016. Patients were categorized by treatment strategy: surgery alone, adjuvant radiation (AR), or NAR. Survival, recurrence, limb salvage, and surgical margin status was analyzed.Results: A total of 1483 patients were identified. Most patients receiving radiotherapy had high-grade tumors (82% NAR vs 81% AR vs 60% surgery; P < .001). The radiotherapy groups had more limb-sparing operations (98% AR vs 94% NAR vs 87% surgery; P < .001). NAR resulted in negative margin resections (90% NAR vs 79% surgery vs 75% AR; P < .0001). There were fewer local recurrences in the radiation groups (14% NAR vs 17% AR vs 27% surgery; P = .001). There was no difference in overall or recurrence-free survival between the three groups (OS, P = .132; RFS, P = .227). Conclusion:In this large study, radiotherapy improved limb salvage rates and decreased local recurrences. Receipt of NAR achieves more margin-negative resections however this did not improve local recurrence or survival rates over. K E Y W O R D S extremity, margins, radiation therapy, sarcoma, survival 1250 | SHELBY ET AL.

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The role of radiotherapy in the management of localized soft tissue sarcomas

Cited by 33 publications

References 58 publications

Chronic radiation-induced dermatitis: challenges and solutions

Chronic radiation-induced dermatitis: challenges and solutions

Prognostic models for RPS patients—Attempting to predict patient outcomes

Neoadjuvant radiation improves margin‐negative resection rates in extremity sarcoma but not survival

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