Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2015

01-09-2015 | Bone and Soft Tissue Sarcomas

Retroperitoneal Sarcoma (RPS) High Risk Gross Tumor Volume Boost (HR GTV Boost) Contour Delineation Agreement Among NRG Sarcoma Radiation and Surgical Oncologists

Authors: Elizabeth H. Baldini, MD, MPH, Walter Bosch, DSc, John M. Kane III, MD, Ross A. Abrams, MD, Kilian E. Salerno, MD, Curtiland Deville, MD, Chandrajit P. Raut, MD, MSc, Ivy A. Petersen, MD, Yen-Lin Chen, MD, John T. Mullen, MD, Keith W. Millikan, MD, Giorgos Karakousis, MD, Michael L. Kendrick, MD, Thomas F. DeLaney, MD, PhD, Dian Wang, MD, PhD

Published in: Annals of Surgical Oncology | Issue 9/2015

Login to get access

Abstract

Purpose

Curative intent management of retroperitoneal sarcoma (RPS) requires gross total resection. Preoperative radiotherapy (RT) often is used as an adjuvant to surgery, but recurrence rates remain high. To enhance RT efficacy with acceptable tolerance, there is interest in delivering “boost doses” of RT to high-risk areas of gross tumor volume (HR GTV) judged to be at risk for positive resection margins. We sought to evaluate variability in HR GTV boost target volume delineation among collaborating sarcoma radiation and surgical oncologist teams.

Methods

Radiation planning CT scans for three cases of RPS were distributed to seven paired radiation and surgical oncologist teams at six institutions. Teams contoured HR GTV boost volumes for each case. Analysis of contour agreement was performed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics.

Results

HRGTV boost volume contour agreement between the seven teams was “substantial” or “moderate” for all cases. Agreement was best on the torso wall posteriorly (abutting posterior chest abdominal wall) and medially (abutting ipsilateral para-vertebral space and great vessels). Contours varied more significantly abutting visceral organs due to differing surgical opinions regarding planned partial organ resection.

Conclusions

Agreement of RPS HRGTV boost volumes between sarcoma radiation and surgical oncologist teams was substantial to moderate. Differences were most striking in regions abutting visceral organs, highlighting the importance of collaboration between the radiation and surgical oncologist for “individualized” target delineation on the basis of areas deemed at risk and planned resection.
Literature
1.
Swallow CJ, Catton CN. Improving outcomes for retroperitoneal sarcomas: a work in progress. Surg Oncol Clin N Am. 2012;21(2):317–31.PubMedCrossRef
2.
Rosenberg SA, Tepper J, Glatstein E, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. 1982;196(3):305–15.PubMedCentralPubMedCrossRef
3.
Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16(1):197–203.PubMed
4.
Pisters PW, Harrison LB, Leung DH, Woodruff JM, Casper ES, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol. 1996;14(3):859–68.PubMed
5.
Stoeckle E, Coindre JM, Bonvalot S, et al. 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(2):359–68.PubMedCrossRef
6.
Heslin MJ, Lewis JJ, Nadler E, et al. Prognostic factors associated with long-term survival for retroperitoneal sarcoma: implications for management. J Clin Oncol. 1997;15(8):2832–9.PubMed
7.
Gronchi A, Miceli R, Colombo C, et al. Frontline extended surgery is associated with improved survival in retroperitoneal low- to intermediate-grade soft tissue sarcomas. Ann Oncol. 2012;23(4):1067–73.PubMedCrossRef
8.
Sampath S, Hitchcock YJ, Shrieve DC, Randall RL, Schultheiss TE, Wong JY. Radiotherapy and extent of surgical resection in retroperitoneal soft-tissue sarcoma: multi-institutional analysis of 261 patients. J Surg Oncol. 2010;101(5):345–50.PubMed
9.
Singer S, Corson JM, Demetri GD, Healey EA, Marcus K, Eberlein TJ. Prognostic factors predictive of survival for truncal and retroperitoneal soft-tissue sarcoma. Ann Surg. 1995;221(2):185–95.PubMedCentralPubMedCrossRef
10.
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(5):1005–10.PubMedCrossRef
11.
Le Pechoux C, Musat E, Baey C, et al. Should adjuvant radiotherapy be administered in addition to front-line aggressive surgery (FAS) in patients with primary retroperitoneal sarcoma? Ann Oncol. 2013;24(3):832–7.PubMedCrossRef
12.
Hassan I, Park SZ, Donohue JH, et al. Operative management of primary retroperitoneal sarcomas: a reappraisal of an institutional experience. Ann Surg. 2004;239(2):244–50.PubMedCentralPubMedCrossRef
13.
14.
Tzeng CW, Fiveash JB, Popple RA, et al. Preoperative radiation therapy with selective dose escalation to the margin at risk for retroperitoneal sarcoma. Cancer. 2006;107(2):371–9.PubMedCrossRef
15.
Baldini EH, Wang D, Haas RLM, et al. Treatment guidelines for preoperative radiation therapy (RT) for retroperitoneal sarcoma (RPS): preliminary consensus of an international expert panel. Int J Radiat Oncol Biol Phys. 2015 (in press).
16.
Baldini EH, Bosch W, Abrams RA, et al. Retroperitoneal sarcoma (RPS) target volume and organ at risk (OAR) contour delineation agreement among RTOG sarcoma radiation oncologists. Int J Radiat Oncol Biol Phys. 2015 (in press).
17.
Deasy JO, Blanco AI, Clark VH. CERR: a computational environment for radiotherapy research. Med Phys. 2003;30(5):979–85.PubMedCrossRef
18.
Warfield SK, Zou KH, Wells WM. Simultaneous truth and performance level estimation (STAPLE): an algorithm for the validation of image segmentation. IEEE Trans Med Imaging. 2004;23(7):903–21.PubMedCentralPubMedCrossRef
19.
Allozi R, Li XA, White J, et al. Tools for consensus analysis of experts’ contours for radiotherapy structure definitions. Radiother Oncol. 2010;97(3):572–8.PubMedCentralPubMedCrossRef
20.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.PubMedCrossRef
21.
Bonvalot S, Miceli R, Berselli M, et al. Aggressive surgery in retroperitoneal soft tissue sarcoma carried out at high-volume centers is safe and is associated with improved local control. Ann Surg Oncol. 2010;17(6):1507–14.PubMedCrossRef
22.
Bonvalot S, Raut CP, Pollock RE, et al. Technical considerations in surgery for retroperitoneal sarcomas: position paper from E-Surge, a master class in sarcoma surgery, and EORTC-STBSG. Ann Surg Oncol. 2012;19(9):2981–91.PubMedCrossRef
23.
Pisters PW. Resection of some—but not all—clinically uninvolved adjacent viscera as part of surgery for retroperitoneal soft tissue sarcomas. J Clin Oncol. 2009;27(1):6–8.PubMedCrossRef
24.
Raut CP, Swallow CJ. Are radical compartmental resections for retroperitoneal sarcomas justified? Ann Surg Oncol. 2010;17(6):1481–4.PubMedCrossRef
25.
Tseng WW, Madewell JE, Wei W, et al. Locoregional disease patterns in well-differentiated and dedifferentiated retroperitoneal liposarcoma: implications for the extent of resection? Ann Surg Oncol. 2014;21(7):2136–43.PubMedCrossRef
26.
27.
Gronchi A, Lo Vullo S, Fiore M, et al. Aggressive surgical policies in a retrospectively reviewed single-institution case series of retroperitoneal soft tissue sarcoma patients. J Clin Oncol. 2009;27(1):24–30.PubMedCrossRef
28.
Bonvalot S, Rivoire M, Castaing M, et al. Primary retroperitoneal sarcomas: a multivariate analysis of surgical factors associated with local control. J Clin Oncol. 2009;27(1):31–7.PubMedCrossRef
29.
Trans-Atlantic RPSWG. Management of primary retroperitoneal sarcoma (RPS) in the adult: a consensus approach from the Trans-Atlantic RPS Working Group. Ann Surg Oncol. 2014. doi:10.​1245/​s10434-014-3965-2.
30.
Zagars GK, Ballo MT, Pisters PW, et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 1225 patients. Cancer. 2003;97(10):2530–43.PubMedCrossRef
31.
Trovik CS, Bauer HC, Alvegard TA, et al. Surgical margins, local recurrence and metastasis in soft tissue sarcomas: 559 surgically-treated patients from the Scandinavian Sarcoma Group Register. Eur J Cancer. 2000;36(6):710–6.PubMedCrossRef
32.
Gronchi A, Casali PG, Mariani L, et al. Status of surgical margins and prognosis in adult soft tissue sarcomas of the extremities: a series of patients treated at a single institution. J Clin Oncol. 2005;23(1):96–104.PubMedCrossRef
33.
Gerrand CH, Wunder JS, Kandel RA, et al. Classification of positive margins after resection of soft-tissue sarcoma of the limb predicts the risk of local recurrence. J Bone Joint Surg Br. 2001;83(8):1149–55.PubMedCrossRef
34.
Singer S, Corson JM, Gonin R, Labow B, Eberlein TJ. Prognostic factors predictive of survival and local recurrence for extremity soft tissue sarcoma. Ann Surg. 1994;219(2):165–73.PubMedCentralPubMedCrossRef
35.
Delaney TF, Kepka L, Goldberg SI, et al. Radiation therapy for control of soft-tissue sarcomas resected with positive margins. Int J Radiat Oncol Biol Phys. 2007;67(5):1460–9.PubMedCrossRef
Metadata
Title
Retroperitoneal Sarcoma (RPS) High Risk Gross Tumor Volume Boost (HR GTV Boost) Contour Delineation Agreement Among NRG Sarcoma Radiation and Surgical Oncologists
Authors
Elizabeth H. Baldini, MD, MPH
Walter Bosch, DSc
John M. Kane III, MD
Ross A. Abrams, MD
Kilian E. Salerno, MD
Curtiland Deville, MD
Chandrajit P. Raut, MD, MSc
Ivy A. Petersen, MD
Yen-Lin Chen, MD
John T. Mullen, MD
Keith W. Millikan, MD
Giorgos Karakousis, MD
Michael L. Kendrick, MD
Thomas F. DeLaney, MD, PhD
Dian Wang, MD, PhD
Publication date
01-09-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 9/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4633-x

Other articles of this Issue 9/2015

Annals of Surgical Oncology 9/2015 Go to the issue

Endocrine Tumors

Clinical Presentation of Patients with a Thyroid Follicular Neoplasm: Are there Preoperative Predictors of Malignancy?

Colorectal Cancer

Standard Versus Extralevator Abdominoperineal Low Rectal Cancer Excision Outcomes: A Systematic Review and Meta-analysis

Hepatobiliary Tumors

TREM-1, an Inflammatory Modulator, is Expressed in Hepatocellular Carcinoma Cells and Significantly Promotes Tumor Progression

Breast Oncology

Preoperative Carboplatin–Paclitaxel–Bevacizumab in Triple-Negative Breast Cancer: Final Results of the Phase II Ca.Pa.Be Study

Reconstructive Oncology

An Algorithmic Approach to Simultaneous Vascularized Lymph Node Transfer with Microvascular Breast Reconstruction

Head and Neck Oncology

Targeting HIF1α Peri-operatively Increased Post-surgery Survival in a Tongue Cancer Animal Model