Modern Radiotherapy in the Complex Management of Soft Tissue and Bone Sarcomas in Adults – Current Overview and the Author‘s Experience
Authors:
R. Soumarová 1; Z. Lovasová 1; S. Czudek 2; M. Škrovina 2; L. Adamčík 2; M. Straka 2
Authors‘ workplace:
Oddělení radioterapie a onkologie, Komplexní onkologické centrum Nový Jičín
primář: doc. MUDr. Renata Soumarová, Ph. D.
1; Chirurgické oddělení nemocnice Nový Jičín, Komplexní onkologické centrum Nový Jičín
primář: MUDr. Stanislav Czudek, CSc.
2
Published in:
Rozhl. Chir., 2009, roč. 88, č. 7, s. 387-393.
Category:
Monothematic special - Original
Overview
Soft tissue sarcomas and primary bone tumours constitute very heterogenic group. Gold treatment standard is surgery in most of them. Nowadays the combination surgery with radiotherapy is preferred, because thanks new radiotherapeutic technology is possible to apply very high dose of radiation which necessary for local control of these tumours.
The goal of our article is to describe new possibilities of radiotherapy, including neoadjuvant and adjuvant setting, intraoperative radiotherapy, interstitial brachytherapy and the combination with surgery.
But very important is multidisciplinary cooperation to until recently in prognostic bad group of patients, concentration these patients to centers with modern technique and clinical experience with treatment of soft tissue sarcomas and bone tumours.
Key words:
soft tissue sarcomas – primary bone tumours – neoadjuvant radiotherapy – adjuvant radiotherapy – intraoperative radiotherapy – intertitial brachytherapy
Sources
1. Kiel, K. D., Suit, H. D. Radiation therapy in the treatment of aggressive fibromatoses (desmoid tumors). Cancer, 1984; 54: 2051–2055.
2. Micke, O., Seegenschmiedt, M. H. Radiation therapy for aggressive fibromatosis (desmoid tumors): results of a national Patterns of Care Study. Int. J. Radiat. Oncol. Biol. Phys., 2005 Mar 1; 61(3): 882–891.
3. Ballo, M. T., Zagars, G. K., Pollack, A. Radiation therapy in the management of desmoid tumors. Int. J. Radiat. Oncol. Biol. Phys., 1998; 42: 1007–1014.
4. Sugarbaker, P. H. Surgical techniques for extremity soft tissue sarcomas. In: Raaf JH, ed. Soft Tissue Sarcomas: Diagnosis and Treatment. St. Louis, Mo: Mosby; 1993.
5. Heslin, M. J., Woodruff, J., Brennan, M. F. Prognostic significance of a positive microscopic margin in high-risk extremity soft tissue sarcoma: implications for management. J. Clin. Oncol., 1996; 14: 473–478.
6. Grobmyer, S. R., Brennan, M. F. Predictive variables detailing the recurrence rate of soft tissue sarcomas. Curr. Opin. Oncol., 2003; 15: 319–326.
7. O’Sullivan, B., Wylie, J., Catton, C. The local management of soft tissue sarcomas. Semin. Radiat. Oncol., 1999; 9: 328–348.
8. Suit, H. D., Spiro, I. Role of radiation in the management of adult patients with sarcoma of soft tissue. Semin. Surg. Oncol., 1994; 10: 347–356.
9. Yang, J. C., Chang, A. E., Baker, A. R., 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, 6(1), 197–203.
10. Rosenberg, S. A., Temper, 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: 305–315.
11. McKee, M. D., Liu, D. F., Brooks, J. J., et al. The prognostic signifikance of margin width for extremity and trunk sarcoma. J. Surg. Oncol., 2004; 85: 68–76.
12. Yang, J. C., Chang, A. E., Baker, A. R., 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: 197–203.
13. Pisters, P. W., Harrison, L. B., Leung, D. H., et al. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J. Clin. Oncol., 1996; 14: 859–868.
14. O’Sullivan, B., Davis, A. M., Turcotte, R., et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: A randomized trial. Lancet, 2002, 29; 359: 2235–2241
15. Davis, A. M., O’Sullivan, B., Turcotte, R., et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother. Oncol., 2005; 75: 48–53.
16. Zagars, G. K., Ballo, M. T., Pisters, P. W., et al. Surgical margins and reresection in the management of patients with soft tissue sarcoma using conservative surgery and radiation therapy. Cancer, 2003; 97: 2544–2553.
17. Kim, Y. B., Shin, K. H., Seong, J., et al. Clinical significance of margin status in postoperative radiotherapy for extremity and truncal soft-tissue sarcoma. Int. J. Radiat. Oncol. Biol. Phys., 2007, 70(1): 139–144.
18. Jebsen, N. L., Trovik, C. S., Bauer, H. C., et al. Radiotherapy to improve local control regardless of surgical margin and malignancy grade in extremity and trunk wall soft tissue sarcoma: a Scandinavian sarcoma group study. Int. J. Radiat. Oncol. Biol. Phys., 2008 Jul 15; 71(4): 1196–203.
19. Guadagnolo, B. A., Zagars, G. K., Ballo, M. T., et al. Long-term outcomes for synovial sarcoma treated with conservation surgery and radiotherapy. Int. J. Radiat. Oncol. Biol. Phys., 2007; 69(4): 1173–1180.
20. Park, L., DeLaney, T. F., Liebsch, N. J., et al. Sacral chordomas: Impact of high-dose proton/photon-beam radiation therapy combined with or without surgery for primary versus recurrent tumor. Int. J. Radiat. Oncol. Biol. Phys., 2006; 65: 1514–1521.
21. Hug, E. B., Fitzek, M. M., Liebsch, et al. Locally challenging osteo and chondrogenic tumors of the axial skeleton: Results of combined proton and photon radiation therapy using threedimensional treatment planning. Int. J. Radiat. Oncol. Biol. Phys., 1995; 31: 467–476.
22. DeLaney, T. F., Park, L., Goldberg, S. I., et al. Radiotherapy for local control of osteosarcoma. Int. J. Radiat. Oncol. Biol. Phys., 2005; 61: 492–498.
23. Indelicato, D. J., Keole, S. R., Shahlaee, A. H., et al. Impact of local management on long-term outcomes in Ewing tumors of the pelvis and sacral bones: the University of Florida experience. Int. J. Radiat. Oncol. Biol. Phys., 2008 Sep l; 72(l): 41–48.
24. Dincbas, F. O., Koca, S., Mandel, N. M., et al. The role of preoperative radiotherapy in nonmetastatic high-grade osteosarcoma of the extremities for limb-sparing surgery. Int. J. Radiat. Oncol. Biol. Phys., 2005 Jul l; 62(3): 820–828.
25. Wagner, T. D., Kobayashi, W., Dean, S., et al. Combination Short-Course Preoperative Irradiation, Surgical Resection, and Reduced-Field High-Dose Postoperative Irradiation in the Treatment of Tumors Involving the Bone. Int. J. Radiat. Oncol. Biol. Phys., 2009, 73(l): 259–266.
26. Sailer, S. L. The role of radiation therapy in localized Ewing‘s sarcoma. Semin. Radiat. Oncol., 1997, 7: 225–235.
27. Hug, E. B., Fitzek, M. M., Liebsch, N. J., et al. Locally challenging osteo- and chondrogenic tumor soft the axial skeleton: results of combined proton and photon radiation therapy using three-dimensional treatment planning. Int. J. Radiat. Oncol. Biol. Phys., 1995, 31: 467–476.
28. Munzenrider, J. E., Liebsch, N. J. Proton therapy for tumors of the skuli base. Sthranlenther Onkol., 1999, 175(suppl 2): 57–63.
29. Krasin, M. J., Rodriguez-Galindo, C., Billups, C. A., et al. Definitive irradiation in multidisciplinary management of localized Ewing sarcina family of tumors in pediatrie patiens: outcome and prognostic factors. Int. J. Radiat. Oncol. Biol. Phys., 2004, 60(3): 830–838.
30. Pitson, G., Robinson, P., Wilke, D., et al. Radiation response: An additional unique signature of myxoid liposarcoma. Int. J. Radiat. Oncol. Biol. Phys., 2004; 60: 522–526.
31. 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 Jan l; 67(l): 164–170.
32. Guadagnolo, B. A., Zagars, G. K., Ballo, M. T., et al. Excellent local kontrol rates and distinctive patterns of failure in myxoid liposarcoma treated with conservation surgery and radiotherapy. Int. J. Radiat. Oncol. Biol. Phys., 2008 Mar l; 70(3): 760–765.
33. Kepka, L., DeLaney, T. F., Suit, H. D., Goldberg, S. I. Results of radiation therapy for unresected soft-tissue sarcomas. Int. J. Radiat. Oncol. Biol. Phys., 2005, 63, 3, 852–859.
34. Alektiar, K. M., Hong, L., Brennan, M. F., et al. Intensity modulated radiation therapy for primary soft tissue sarcoma of the extremity: preliminary results. Int. J. Radiat. Oncol. Biol. Phys., 2007; 68: 458–464.
35. Munzenrider, J. E., Liebsch, N. J. Proton therapy for tumors of the skuli base. Strahlenther Onkol., 1999; 174(suppl 2): 57–63.
36. Lindberg, R. D., Martin, R. G., Romsdhal, M. M., et al. Conservative surgery and postoperative radiotherapy is the treatment of soft tissue sarcoma in adults. AJR, 1975, 123: 123–129.
37. Chaudhary, A. J., Laskar, S., Badhwar, R. Interstitial brachy-therapy in soft tissue sarcomas. Strahlenther Onkol., 1998, 174: 522–528.
38. Calais, G. Role of radiotherapy in soft tissue sarcoma. Cancer Radiother., 1(5): 457–461, 1997.
39. Nori, D., Shupak, K., Shiu, M. H., Brennan, M. F. Role of brachytherapy in recurrent extremity sarcoma in patients treated with prior surgery and irradiation. Int. J. Radiat. Oncol. Biol. Phys., 1991; 20: 1229–1233.
40. Moureau-Zabotto, L., Thomas, L., Bui, B. N., et al. Management of soft tissue sarcomas (STS) in first isolated local recurrence: a retrospective study of 83 cases. Radiother. Oncol., 2004 Dec; 73(3): 313–319.
41. Oya, N., Kokubo, M., Mizowaki, T., et al. Definitive intraoperative very high-dose radiotherapy for localized osteosarcoma in the extremities. Int. J. Radiat. Oncol. Biol. Phys., 2001 Sep l; 51(l): 87–93.
42. Petersen, I. A., Haddock, M. G., Donohue, J. H., et al. Use of intraoperative electron beam radiotherapy in the management of retroperitoneal soft tissue sarcoma. Int. J. Radiat. Oncol. Biol. Phys., 2002; 52(2): 469–475.
43. Heslin, M. J., Lewis, J. J., Nadler, E., et al. Prognostic factors associated with long-term survival for retroperitoneal sarcoma: Implications for management. J. Clin. Oncol., 1998; 15: 2832–2839.
44. Dalton, R. R., Donohue, J. H., Mucha, P., et al. Management of retroperitoneal sarcomas. Surgery, 1989; 106: 725–733.
45. Zlotecki, R. A., Katz, T. S., Morris, C. G., Lind, D. S., Hochwald, S. N. Adjuvant radiation therapy for resectable retroperitoneal soft tissue sarcoma: the University of Florida experience. Am. J. Clin. Oncol., 2005 Jun; 28(3): 310–316.
46. Sindelar, W. F., Kinsella, T. J., Chen, P. W., et al. Intraoperative radiotherapy in retroperitoneal sarcomas. Arch. Surg., 1993; 128: 402–410.
47. Gieschen, H. L., Spiro, I. J., Suit, H. D., et al. Long-term results of intraoperative electron beam radiotherapy for primary and recurrent retroperitoneal soft tissue sarcoma. Int. J. Radiat. Oncol. Biol. Phys., 2001 May l; 50(l): 127–131.
48. Krempien, R., Roeder, F., Oertel, S., et al. Intraoperative electron-beam therapy for primary and recurrent retroperitoneal soft-tissue sarcoma. Int. J. Radiat. Oncol. Biol. Phys., 2006 Jul l; 65(3): 773–779.
49. Petersen, I. A., Haddock, M. G., Donohue, J. H., et al. Use of intraoperative electron beam radiotherapy in the management of retroperitoneal soft tissue sarcomas. Int. J. Radiat. Oncol. Biol. Phys., 2002 Feb l; 52(2): 469–475.
50. Bobin, J. Y., Al-Lawati, T., Granero, L. E., et al. Surgical management of retroperitoneal sarcomas associated with external and intraoperative electron beam radiotherapy. Eur. J. Surg. Oncol., 2003 Oct; 29(8): 676–681.
51. Gunderson, L. L., Nagorney, D. M., McIlrath, D. C., et al. External beam and intraoperative electron irradiation for locally advanced soft tissue sarcomas. Int. J. Radiat. Oncol. Biol. Phys., 1993 Mar 15; 25(4): 647–656.
52. Imai, R., Kamada, T., Tsuji, H., et al. Carbon ion radiotherapy for unresectable sacral chordomas. Clin. Cancer Res., 2004 Sep l; 10(17): 5741–5746.
53. Breteau, N., Demasure, M., Favre, A., et al. Fast neutron therapy for inoperable or recurrent sacrococcygeal chordomas. Bull Cancer Radiother., 1996; 83 Suppl: 142 s.
54. Gelderblom, H., Hogendoorn, P. C., Dijkstra, S. D., et al. The clinical approach towards chondrosarcoma. Oncologist., 2008 Mar; 13(3): 320–329.
55. Anacak, Y., Sabah, D., Demirci, S., Kamer, S. Intraoperative extracorporeal irradiation and re-implantation of involved bone for the treatment of musculoskeletal tumors. J. Exp. Clin. Cancer. Res., 2007 Dec; 26(4): 571–574.
56. Davidson, A. W., Hong, A., McCarthy, S. W., Stalley, P. D. En-bloc resection, extracorporeal irradiation, and re-implantation in limb salvage for bony malignancies. J. Bone Joint Surg. Br., 2005 Jun; 87(6): 851–857.
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