Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel

Baldini, Elizabeth H.; Wang, Dian; Haas, Rick L.; Catton, Charles; Indelicato, Daniel J.; Kirsch, David G.; Roberge, David; Salerno, Kilian E.; Deville, Curtiland; Guadagnolo, B. Ashleigh; O’Sullivan, Brian; Petersen, Ivy A.; Péchoux, C. Le; Abrams, Ross A.; DeLaney, Thomas F.

doi:10.1016/j.ijrobp.2015.02.013

Cited by 106 publications

(106 citation statements)

References 74 publications

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“…However, available data does support preoperative RT as a reasonable, and perhaps, preferred treatment strategy for patients with high-grade RPS and expert consensus-based guidelines for its use have been established. 40 Dose escalation may be important in enhancing any survival benefit. A study from the University of Alabama at Birmingham showed that in using intensity-modulated RT, a preoperative dose of 57.5 Gy was delivered to the anatomic region considered to be at highest risk for tumor infiltration without increased toxicity, and the authors postulated that doses of 80 Gy might be possible without compromise of adjacent tissue.…”

Section: Discussionmentioning

confidence: 99%

The Benefit of Adjuvant Radiotherapy in High-grade Nonmetastatic Retroperitoneal Soft Tissue Sarcoma

Bates

Dhakal

Mazloom

et al. 2018

American Journal of Clinical Oncology

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Section: Discussionmentioning

confidence: 99%

The Benefit of Adjuvant Radiotherapy in High-grade Nonmetastatic Retroperitoneal Soft Tissue Sarcoma

Bates

Dhakal

Mazloom

et al. 2018

American Journal of Clinical Oncology

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“…If 4-dimensional CT scans showed GTV motion, an iGTV was defined to capture motion. The average risk for CTV1 was an anatomically constrained 1 to 1.5 cm expansion on the GTV or iGTV with an edited reduction at bone, renal and hepatic interfaces (0 mm), bowel and air cavity (5 mm), and skin (3 mm) 15 . CTV1 expanded fully into the retroperitoneal muscles but not beyond the peritoneal compartment or intact fascia.…”

Section: Methodsmentioning

confidence: 99%

“…Many groups do not administer postoperative EBRT after R1 resection because they are concerned about the potential toxicity to fixed bowel in the tumor bed 14, 15. In a small trial conducted by the U.S. National Cancer Institute, 35 patients were randomized to receive either postoperative EBRT of 50 to 55 Gy (35-40 Gy to extended field + 15 Gy to boost field) or misonidazole plus electron intraoperative radiation therapy (IORT) and postoperative EBRT (35-40 Gy) 16 .…”

Section: Introductionmentioning

confidence: 99%

Phase 1 trial of preoperative image guided intensity modulated proton radiation therapy with simultaneously integrated boost to the high risk margin for retroperitoneal sarcomas

DeLaney

Chen

Baldini

et al. 2017

Advances in Radiation Oncology

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PurposeTo conduct phase 1 and 2 trials with photon intensity modulated radiation therapy and intensity modulated proton therapy (IMPT) arms to selectively escalate the retroperitoneal sarcoma preoperative radiation dose to tumor volume (clinical target volume [CTV] 2) that is judged to be at a high risk for positive margins and aim to reduce local recurrence. We report on the IMPT study arm in phase 1.Methods and materialsPatients aged ≥18 years with primary or locally recurrent retroperitoneal sarcoma were treated with preoperative IMPT, 50.4 GyRBE in 28 fractions, to CTV1 (gross tumor volume and adjacent tissues at risk of subclinical disease) with a simultaneous integrated boost to CTV2 to doses of 60.2, 61.6, and 63.0 GyRBE in 28 fractions of 2.15, 2.20, and 2.25 GyRBE, respectively. The primary objective of the phase 1 study was to determine the maximum tolerated dose to CTV2, which will be further tested in the phase 2 study.ResultsEleven patients showed increasing IMPT dose levels without acute dose limiting toxicities that prevented dose escalation to maximum tolerated dose. Acute toxicity was generally mild with no radiation interruptions. No unexpected perioperative morbidity was noted. Eight months postoperatively, one patient developed hydronephrosis that was treated by stent with ureter dissected off tumor and received 57.5 GyRBE. Retained ureter(s) was (were) subsequently constrained to 50.4 GyRBE without further problem. With an 18-month median follow-up, there were no local recurrences.ConclusionsIMPT dose escalation to CTV2 to 63 GyRBE was achieved without acute dose limiting toxicities. The phase 2 study of IMPT will accrue patients to that dose. Parallel intensity modulated radiation therapy phase 1 arm is currently accruing at the initial dose level. Ureters that undergo a high dose radiation and/or surgery are at risk for late hydro-ureter. Future studies will constrain retained ureters to 50.4 GyRBE to avoid ureteral stricture.

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“…In addition, radiation therapy may be delivered with acceptable toxicity, particularly with intensity-modulated radiation therapy and pre-operative therapy 40, 43, 44 . Pre-operative radiation therapy is the preferred method of adjuvant radiation therapy for retroperitoneal sarcoma for the benefits of 1) displacement of bowel out of the radiation therapy field by the in situ tumor, 2) defining a more accurate volume, 3) theoretically reducing intra-operative tumor seeding, and 4) delivering an overall smaller radiation dose 45 .…”

Section: Radiation Therapymentioning

confidence: 99%

Recent advances in the management of liposarcoma

Nassif

Tseng

Borges³

et al. 2016

F1000Res

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Liposarcoma is the most common soft tissue sarcoma. With its various subtypes, the natural history of this disease can vary significantly from a locally recurrent tumor to a highly malignant one carrying a poor prognosis. Progress in the understanding of the specific molecular abnormalities in liposarcoma provides greater opportunity for new treatment modalities. Although surgical resection and radiation therapy remain the keystones for the management of primary liposarcoma, the inclusion of novel agents that target known abnormalities in advanced liposarcoma enhances the potential for improved outcomes.

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Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel

Cited by 106 publications

References 74 publications

The Benefit of Adjuvant Radiotherapy in High-grade Nonmetastatic Retroperitoneal Soft Tissue Sarcoma

The Benefit of Adjuvant Radiotherapy in High-grade Nonmetastatic Retroperitoneal Soft Tissue Sarcoma

Phase 1 trial of preoperative image guided intensity modulated proton radiation therapy with simultaneously integrated boost to the high risk margin for retroperitoneal sarcomas

Recent advances in the management of liposarcoma

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