바로가기  >

[Abstract]

PURPOSE:

We performed a multi-institutional prospective phase II trial to assess late toxicities in patients with extremity soft tissue sarcoma (STS) treated with preoperative image-guided radiation therapy (IGRT) to a reduced target volume.

PATIENTS AND METHODS:

Patients with extremity STS received IGRT with (cohort A) or without (cohort B) chemotherapy followed by limb-sparing resection. Daily pretreatment images were coregistered with digitally reconstructed radiographs so that the patient position could be adjusted before each treatment. All patients received IGRT to reduced tumor volumes according to strict protocol guidelines. Late toxicities were assessed at 2 years.

RESULTS:

In all, 98 patients were accrued (cohort A, 12; cohort B, 86). Cohort A was closed prematurely because of poor accrual and is not reported. Seventy-nine eligible patients from cohort B form the basis of this report. At a median follow-up of 3.6 years, five patients did not have surgery because of disease progression. There were five local treatment failures, all of which were in field. Of the 57 patients assessed for late toxicities at 2 years, 10.5% experienced at least one grade ≥ 2 toxicity as compared with 37% of patients in the National Cancer Institute of Canada SR2 (CAN-NCIC-SR2: Phase III Randomized Study of Pre- vs Postoperative Radiotherapy in Curable Extremity Soft Tissue Sarcoma) trial receiving preoperative radiation therapy without IGRT (P < .001).

CONCLUSION:

The significant reduction of late toxicities in patients with extremity STS who were treated with preoperative IGRT and absence of marginal-field recurrences suggest that the target volumes used in the Radiation Therapy Oncology Group RTOG-0630 (A Phase II Trial of Image-Guided Preoperative Radiotherapy for Primary Soft Tissue Sarcomas of the Extremity) study are appropriate for preoperative IGRT for extremity STS. 

[Author information]

Wang D1, Zhang Q2, Eisenberg BL2, Kane JM2, Li XA2, Lucas D2, Petersen IA2, DeLaney TF2, Freeman CR2, Finkelstein SE2, Hitchcock YJ2, Bedi M2, Singh AK2, Dundas G2, Kirsch DG2.

1Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC. Dian_Wang@Rush.edu.

2Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.