Low-Dose Neoadjuvant External Beam Radiation Therapy for Soft Tissue Sarcoma

Journal Article · Fri Jul 01 04:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2010.02.067· OSTI ID:21587566

Devisetty, Kiran ^[1]; Kobayashi, Wendy; Suit, Herman D; Goldberg, Saveli I; Niemierko, Andrzej; Chen, Yen-Lin E ^[2]; Raskin, Kevin A; Schwab, Joseph H; Springfield, Dempsey S ^[3]; Yoon, Sam S ^[4]; Hornicek, Francis J ^[3]

---

1. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States)
2. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)
3. Department of Orthopedics, Massachusetts General Hospital, Boston, MA (United States)
4. Department of Surgery, Massachusetts General Hospital, Boston, MA (United States)

Purpose: For soft tissue sarcoma, neoadjuvant external beam radiation therapy (EBRT) to 50 Gy has the same local control (LC) and overall survival as postoperative radiation therapy (PORT) to 60 Gy, but with increased wound complications. We examined whether low-dose neoadjuvant EBRT would decrease acute toxicity while maintaining LC. Methods and Materials: From 1971 to 2008, 1,765 patients with nonmetastatic soft tissue sarcoma were treated with radiation therapy at Massachusetts General Hospital. We identified 42 patients treated with low-dose neoadjuvant EBRT (median, 20 Gy; range, 16-26) followed by surgical resection and PORT. PORT included EBRT (25 patients; median, 40 Gy; range, 20-56.2), brachytherapy (13 patients; median, 42 Gy; range, 26-50), and intraoperative radiation therapy (IORT) (4 patients; median, 12.5 Gy; range, 8-20). The median total dose was 63.3 Gy (range, 28-78.4). Results: Median follow-up was 36 months (range, 4-318). Severe acute wound complications were reported in 15 patients (36%) and correlated to PORT technique (16% EBRT, 69% brachytherapy, 50% IORT, p = 0.004). The 5-year LC was 73% and correlated to PORT technique (68% EBRT, 100% brachytherapy, 50% IORT, p = 0.03) and histology (p = 0.05), with a trend to improvement if >60 Gy (p = 0.10). The 5-year overall survival was 65% and correlated to extent of resection (p < 0.001) and margin status (p < 0.001). Conclusions: Despite using low-dose neoadjuvant EBRT, we report a high rate of severe acute wound complications that was strongly associated with brachytherapy. Modification of the brachytherapy technique may decrease acute toxicity while maintaining excellent local control. Further study must be conducted before recommending broader application.

• OSTI ID: 21587566
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 3 Vol. 80; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BRACHYTHERAPY
DISEASES
DOSES
HISTOLOGY
MEDICINE
NEOPLASMS
NUCLEAR MEDICINE
RADIATION DOSES
RADIOLOGY
RADIOTHERAPY
SARCOMAS
SURGERY
THERAPY