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Open Access 01-12-2012 | Research

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

Authors: Paul Sargos, Catherine Dejean, Bénédicte Henriques de Figueiredo, Véronique Brouste, Binh Nguyen Bui, Antoine Italiano, Eberhard Stoeckle, Guy Kantor

Published in: Radiation Oncology | Issue 1/2012

Abstract

Purpose

To evaluate the feasibility of pre-operative radiotherapy (54 Gy) with Helical Tomotherapy (HT) followed by surgery.

Methods and materials

Ten 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.

Results

No 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.

Conclusions

High 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.

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Catton CN, O’Sullivan B, Kotwall C, Cummings B, Hao Y, Fornasier V: Outcome and prognosis in retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys 1994, 29: 1005-1010. 10.1016/0360-3016(94)90395-6CrossRefPubMed

Lewis JJ, Leung D, Woodruff JM, Brennan MF: Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg 1998, 228: 355-365. 10.1097/00000658-199809000-00008PubMedCentralCrossRefPubMed

Bonvalot S, Vanel D, Le Cesne A, Terrier P, Le Pechoux C: Surgery of retroperitoneal sarcomas. Cancer Radiother 2006, 10: 41-49. 10.1016/j.canrad.2005.09.028CrossRefPubMed

Bonvalot S, Rivoire M, Castaing M, Stoeckle E, Le Cesne A, Blay JY, Laplanche A: Primary retroperitoneal sarcomas: a multivariate analysis of surgical factors associated with local control. J Clin Oncol 2009, 27: 31-37. 10.1200/JCO.2008.21.0963CrossRefPubMed

Gronchi A, Lo Vullo S, Fiore M, Mussi C, Stacchiotti S, Collini P, Lozza L, Pennacchioli E, Mariani L, Casali PG: Aggressive surgical policies in a retrospectively reviewed single-institution case series of retroperitoneal soft tissue sarcoma patients. J Clin Oncol 2009, 27: 24-30. 10.1200/JCO.2008.21.0351CrossRefPubMed

Musat E, Kantor G, Caron J, Lagarde P, Laharie H, Stoeckle E, Angles J, Gilbeau L, Bui BN: Comparison of intensity-modulated postoperative radiotherapy with conventional postoperative conformal radiotherapy for retroperitoneal sarcoma. Cancer Radiother 2004, 8: 255-261. 10.1016/j.canrad.2004.05.001CrossRefPubMed

Tzeng CW, Fiveash JB, Popple RA, Arnoletti JP, Russo SM, Urist MM, Bland KI, Heslin MJ: Preoperative radiation therapy with selective dose escalation to the margin at risk for retroperitoneal sarcoma. Cancer 2006, 107: 371-379. 10.1002/cncr.22005CrossRefPubMed

Coindre JM, Trojani M, Contesso G, David M, Rouesse J, Bui NB, Bodaert A, De Mascarel I, De Mascarel A, Goussot JF: Reproducibility of a histopathologic grading system for adult soft tissue sarcoma. Cancer 1986, 58: 306-309. 10.1002/1097-0142(19860715)58:2<306::AID-CNCR2820580216>3.0.CO;2-7CrossRefPubMed

Martin E, Pointreau Y, Roche-Forestier S, Barillot I: Normal tissue tolerance to external beam radiation therapy: small bowel. Cancer Radiother 2010, 14: 350-353. 10.1016/j.canrad.2010.03.013CrossRefPubMed

10.

Kantor G, Mahe MA, Giraud P, Alapetite C, Durdux C, Fourquet A, Gardner M, Le Prise E, Maire JP, Richaud P, et al.: French national evaluation for helicoidal tomotherapy: description of indications, dose constraints and set-up margins. Cancer Radiother 2007, 11: 331-337. 10.1016/j.canrad.2007.09.006CrossRefPubMed

11.

Kantor G, Mahe MA, Giraud P, Lisbona A, Caron J, Mazal A: [Helical tomotherapy: general methodology for clinical and dosimetric evaluation (national French project)]. Cancer Radiother 2006, 10: 488-491. 10.1016/j.canrad.2006.09.037CrossRefPubMed

12.

D’Souza WD, Rosen II: Nontumor integral dose variation in conventional radiotherapy treatment planning. Med Phys 2003, 30: 2065-2071. 10.1118/1.1591991CrossRefPubMed

13.

Youssef E, Fontanesi J, Mott M, Kraut M, Lucas D, Mekhael H, Ben-Josef E: Long-term outcome of combined modality therapy in retroperitoneal and deep-trunk soft-tissue sarcoma: analysis of prognostic factors. Int J Radiat Oncol Biol Phys 2002, 54: 514-519. 10.1016/S0360-3016(02)02942-5CrossRefPubMed

14.

Stoeckle E, Coindre JM, Bonvalot S, Kantor G, Terrier P, Bonichon F, Nguyen Bui B: Prognostic factors in retroperitoneal sarcoma: a multivariate analysis of a series of 165 patients of the French Cancer Center Federation Sarcoma Group. Cancer 2001, 92: 359-368. 10.1002/1097-0142(20010715)92:2<359::AID-CNCR1331>3.0.CO;2-YCrossRefPubMed

15.

Pawlik TM, Pisters PW, Mikula L, Feig BW, Hunt KK, Cormier JN, Ballo MT, Catton CN, Jones JJ, O’Sullivan B, et al.: Long-term results of two prospective trials of preoperative external beam radiotherapy for localized intermediate- or high-grade retroperitoneal soft tissue sarcoma. Ann Surg Oncol 2006, 13: 508-517. 10.1245/ASO.2006.05.035CrossRefPubMed

16.

Zlotecki RA, Katz TS, Morris CG, Lind DS, Hochwald SN: Adjuvant radiation therapy for resectable retroperitoneal soft tissue sarcoma: the University of Florida experience. Am J Clin Oncol 2005, 28: 310-316. 10.1097/01.coc.0000158441.96455.31CrossRefPubMed

17.

Bossi A, De Wever I, Van Limbergen E, Vanstraelen B: Intensity modulated radiation-therapy for preoperative posterior abdominal wall irradiation of retroperitoneal liposarcomas. Int J Radiat Oncol Biol Phys 2007, 67: 164-170. 10.1016/j.ijrobp.2006.08.023CrossRefPubMed

18.

Gilbeau L, Kantor G, Stoeckle E, Lagarde P, Thomas L, Kind M, Richaud P, Coindre JM, Bonichon F, Bui BN: Surgical resection and radiotherapy for primary retroperitoneal soft tissue sarcoma. Radiother Oncol 2002, 65: 137-143. 10.1016/S0167-8140(02)00283-9CrossRefPubMed

19.

Tepper JE, Suit HD, Wood WC, Proppe KH, Harmon D, McNulty P: Radiation therapy of retroperitoneal soft tissue sarcomas. Int J Radiat Oncol Biol Phys 1984, 10: 825-830. 10.1016/0360-3016(84)90383-3CrossRefPubMed

20.

Koshy M, Landry JC, Lawson JD, Staley CA, Esiashvili N, Howell R, Ghavidel S, Davis LW: Intensity modulated radiation therapy for retroperitoneal sarcoma: a case for dose escalation and organ at risk toxicity reduction. Sarcoma 2003, 7: 137-148. 10.1080/13577140310001644751PubMedCentralCrossRefPubMed

21.

Paumier A, Le Pechoux C, Beaudre A, Negretti L, Ferreira I, Roberti E, Brahim J, Lefkopoulos D, Daly-Schweitzer N, Bourhis J, Bonvalot S: IMRT or conformal radiotherapy for adjuvant treatment of retroperitoneal sarcoma? Radiother Oncol 2011, 99: 73-78. 10.1016/j.radonc.2011.02.002CrossRefPubMed

22.

Wiezorek T, Schwahofer A, Schubert K: The Influence of Different IMRT Techniques on the Peripheral Dose. Strahlenther Onkol 2009, 185: 696-702. 10.1007/s00066-009-2005-9CrossRefPubMed

23.

Hall EJ, Wuu CS: Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys 2003, 56: 83-88. 10.1016/S0360-3016(03)00073-7CrossRefPubMed

24.

Boda-Heggemann J, Lohr F, Wenz F, Flentje M, Guckenberger M: kV Cone-Beam CT-Based IGRT. Strahlenther Onkol 2011, 187: 284-291. 10.1007/s00066-011-2236-4CrossRefPubMed

25.

Lisbona A, Averbeck D, Supiot S, Delpon G, Ali D, Vinas F, Diana C, Murariu C, Lagrange JL: IMRT combined to IGRT: increase of the irradiated volume. Consequences? Cancer Radiother 2010, 14: 563-570. 10.1016/j.canrad.2010.07.227CrossRefPubMed

Title: High-dose pre-operative helical tomotherapy (54 Gy) for retroperitoneal liposarcoma
Authors: Paul Sargos
Catherine Dejean
Bénédicte Henriques de Figueiredo
Véronique Brouste
Binh Nguyen Bui
Antoine Italiano
Eberhard Stoeckle
Guy Kantor
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2012
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-7-214

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods and materials

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods and materials

Results

Conclusions

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