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Open Access 01-12-2019 | Edema | Research

Neoadjuvant image-guided helical intensity modulated radiotherapy of extremity sarcomas – a single center experience

Authors: Jan C. Peeken, Christoph Knie, Kerstin A. Kessel, Daniel Habermehl, Severin Kampfer, Hendrik Dapper, Michal Devecka, Rüdiger von Eisenhart-Rothe, Katja Specht, Wilko Weichert, Klaus Wörtler, Carolin Knebel, Jan J. Wilkens, Stephanie E. Combs

Published in: Radiation Oncology | Issue 1/2019

Abstract

Background

Advanced radiotherapy (RT) techniques allow normal tissue to be spared in patients with extremity soft tissue sarcoma (STS). This work aims to evaluate toxicity and outcome after neoadjuvant image-guided radiotherapy (IGRT) as helical intensity modulated radiotherapy (IMRT) with reduced margins based on MRI-based target definition in patients with STS.

Methods

Between 2010 to 2014, 41 patients with extremity STS were treated with IGRT delivered as helical IMRT on a tomotherapy machine. The tumor site was in the upper extremity in 6 patients (15%) and lower extremity in 35 patients (85%). Reduced margins of 2.5 cm in longitudinal direction and 1.0 cm in axial direction were used to expand the MRI-defined gross tumor volume, including peritumoral edema, to the clinical target volume. An additional margin of 5 mm was added to receive the planning target volume. The full total dose of 50 Gy in 2 Gy fractions was sucessfully applied in 40 patients. Two patients received chemotherapy instead of surgery due to systemic progression. All patients were included into a strict follow-up program and were seen interdisciplinarily by the Departments of Orthopaedic Surgery and Radiation Oncology.

Results

Thirty eight patients that received total RT total dose and subsequent resection were analyzed for outcome. After a median follow-up of 38.5 months cumulative OS, local PFS and systemic PFS at 2 years were determined at 78.2, 85.2 and 54.5%, respectively. Two of 6 local recurrences were proximal marginal misses. Negative resection margins were achieved in 84% of patients. The rate of major wound complications was comparable to previous IMRT studies with 36.8%. RT was overall tolerable with low toxicity rates.

Conclusions

IMRT-IGRT offers neoadjuvant treatment for extremity STS with reduced safety margins and thus low toxicity rates. Wound complication rates were comparable to previously reported frequencies. Two reported marginal misses suggest a word of caution for reduction of longitudinal safety margins.

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Title: Neoadjuvant image-guided helical intensity modulated radiotherapy of extremity sarcomas – a single center experience
Authors: Jan C. Peeken
Christoph Knie
Kerstin A. Kessel
Daniel Habermehl
Severin Kampfer
Hendrik Dapper
Michal Devecka
Rüdiger von Eisenhart-Rothe
Katja Specht
Wilko Weichert
Klaus Wörtler
Carolin Knebel
Jan J. Wilkens
Stephanie E. Combs
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Edema
Soft Tissue Sarcoma
Sarcoma
Radiotherapy
Published in: Radiation Oncology / Issue 1/2019
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-019-1207-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Neoadjuvant image-guided helical intensity modulated radiotherapy of extremity sarcomas – a single center experience

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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