Comparison of Local Recurrence With Conventional and Intensity-Modulated Radiation Therapy for Primary Soft-Tissue Sarcomas of the Extremity

Abstract

Purpose The use of intensity-modulated radiation therapy (IMRT) in the treatment of soft tissue sarcoma (STS) of the extremity is increasing, but no large-scale direct comparison has been reported between conventional external-beam radiation therapy (EBRT) and IMRT. Methods Between January 1996 and December 2010, 319 consecutive adult patients with primary nonmetastatic extremity STS were treated with limb-sparing surgery and adjuvant radiotherapy (RT) at a single institution. Conventional EBRT was used in 154 patients and IMRT in 165 with similar dosing schedules. Median follow-up time for the cohort was 58 months. Results Treatment groups were comparable in terms of tumor location, histology, tumor size, depth, and use of chemotherapy. Patients treated with IMRT were older (P = .08), had more high-grade lesions (P = .05), close (< 1 mm) or positive margins (P = .04), preoperative radiation (P < .001), and nerve manipulation (P = .04). Median follow-up was 90 months for patients treated with conventional EBRT and 42 months for patients treated with IMRT. On multivariable analysis adjusting for patient age and tumor size, IMRT retained significance as an independent predictor of reduced LR (hazard ratio = 0.46; 95% CI, 0.24 to 0.89; P = .02). Conclusion Despite a preponderance of higher-risk features (especially close/positive margin) in the IMRT group, IMRT was associated with significantly reduced local recurrence compared with conventional EBRT for primary STS of the extremity.

Primary high-grade soft-tissue sarcoma of the buttock: a rare but distinct clinical entity

“…Third, the data were collected before our institution adopted intensity-modulated radiotherapy techniques for this entity. In a recent article by Folkert et al, 13 it was suggested that intensity-modulated radiotherapy could improve outcome in the setting of STS. Finally, even expert sarcoma surgeons encounter challenges when dealing with sarcoma of the buttock owing to the proximity of the sciatic nerve and the tendency for prolongations of wound closure in this region.…”

Überlegenheit der IMRT gegenüber der konventionellen 3D-EBRT auch bei der lokalen Kontrolle von Extremitätensarkomen

“…Die mit IMRT behandelten Patienten waren älter (p = 0,08), hatten mehr hochgradige Tumoren (p = 0,05), mehr Resektionen mit "close margins" (< 1 mm) oder positiOriginalbeitrag Folkert MR, Singer S, Brennan MF et al (2014) Comparison of local recurrence with conventional and intensitymodulated radiation therapy for primary soft-tissue sarcomas of the extremity. J Clin Oncol 32:3236-3241…”

“…Während bei Kopf-Hals-Tumoren [5] und der tangentialen Mammabestrahlung [6] die Vorteile einer IMRT gegenüber der konventionellen RT hinsichtlich der Toxizitätsreduktion mittlerweile in randomisierten Studien nachgewiesen wurden und auch erste Registerdaten in diese Richtung deuten [2], fehlen solche prospektiv kontrollierten Vergleiche oder Analysen von großen Patientenzahlen bei vielen anderen Tumorentitäten. Die vorliegende Arbeit [3] beschreibt die erste größere vergleichende Analyse zwischen mittels 3-D-konventioneller RT (3D-CRT) und IMRT prä-oder postoperativ bestrahlter Patienten aus dem MSKCC (Memorial Sloan Kettering Cancer Center), das über eine lange Erfahrung bei der Behandlung von WeichZiel der Arbeit Die Verwendung intensitätsmodulierter Radiotherapie (IMRT) in der Behandlung von Weichteilsarkomen (WTS) der Extremitäten nimmt zu, jedoch ist bisher kein direkter Vergleich zwischen konventioneller externer Strahlentherapie ("external beam radiotherapy", EBRT) und IMRT mit größeren Patientenzahlen veröffentlicht worden. F. Lohr, A. Simeonova teilsarkomen verfügt.…”

Treatment of bone and soft tissue tumors of the limbs with conformal radiotherapy and intensity-modulated radiotherapy (IMRT)

“…It also promoted a decrease of 31% in the maximum and average doses released in the femur, in all patients. 10 12 (B), from the same institution, analyzed 319 patients with end-stage sarcomas treated with conservative limb surgery and adjuvant radiotherapy from 1996 to 2010. Of these, 154 were treated with conformal radiotherapy and 165 with IMRT technique.…”

“…12 (B) All patients after 2002 were treated with IMRT. Their study is the largest existing and compares the conformal and IMRT techniques.…”