Complication rate, functional outcomes, and risk factors associated with carbon ion radiotherapy for patients with unresectable pelvic bone sarcoma

Takenaka, Satoshi; Araki, Nobuhito; Outani, Hidetatsu; Hamada, Kenichiro; Yoshikawa, Hideki; Kamada, Tadashi; Imai, Reiko

doi:10.1002/cncr.33082

Cited by 14 publications

(12 citation statements)

References 47 publications

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“…Pelvic location has been described as a risk factor for worse postoperative outcomes and higher recurrence rates, and therefore its management remains challenging 5,6 . Unlike appendicular tumors, which are often detected early due to their mass effect, pelvic bone, and ST sarcomas can remain hidden until symptomatic and present as a more aggressive tumor 4,5,7 …”

Section: Introductionmentioning

confidence: 99%

Risk factors for 30‐day soft tissue complications after pelvic sarcoma surgery: A National Surgical Quality Improvement Program study

Gonzalez

Karczewski

Bedi

et al. 2023

Journal of Surgical Oncology

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Introduction Soft tissue (ST) complications after resection of bone and ST sarcomas of the pelvis occur more frequently than in appendicular tumors. We sought to identify risk factors for complications within 30 days of surgery. Methods The National Surgical Quality Improvement Program database was used for this study. Patients with sarcomas of bone and ST of the pelvis were retrieved using Current Procedural Terminology and International Classification of Diseases codes. Outcomes assessed were ST complications, overall complication rates, 30‐day reoperation, and mortality. Results A total of 770 patients with pelvic bone and ST sarcoma were included. The ST complication rate was 12.6%, including 4.9% superficial and 4.7% deep surgical site infections. Higher ST complication rates were seen in patients >30 years, with partially dependent health status, hematocrit <30%, bone tumors, tumor >5 cm, amputation procedures, and longer operative times. ST complication rates were 1.5 and 3 times higher in pelvic sarcoma surgeries than in the lower and upper extremities, respectively. Age >30 years (odds ratio [OR] = 5.07), hematocrit <30% (OR = 1.84), operative time 1–3 h (OR = 2.97), and >3 h (OR = 4.89) were risk factors for ST complications. Conclusion One in nine patients with pelvic sarcoma surgery will develop ST complications within 30 days. Risk factors for ST complications were age >30, hematocrit <30%, and longer operative time.

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Section: Introductionmentioning

confidence: 99%

Risk factors for 30‐day soft tissue complications after pelvic sarcoma surgery: A National Surgical Quality Improvement Program study

Gonzalez

Karczewski

Bedi

et al. 2023

Journal of Surgical Oncology

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“…To date, there have been a few reports on the effectiveness and safety of spacer placement [ 6–8 ]. However, there is a risk of infection due to leaving the Gore-Tex sheets spacer after the C-ion RT [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Rectal dose-sparing effect with bioabsorbable spacer placement in carbon ion radiotherapy for sacral chordoma: dosimetric comparison of a simulation study

Shiba

Okamoto

Tashiro

et al. 2021

Journal of Radiation Research

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It is difficult to treat patients with an inoperable sarcoma adjacent to the gastrointestinal (GI) tract using carbon ion radiotherapy (C-ion RT), owing to the possible development of serious GI toxicities. In such cases, spacer placement may be useful in physically separating the tumor and the GI tract. We aimed to evaluate the usefulness of spacer placement by conducting a simulation study of dosimetric comparison in a patient with sacral chordoma adjacent to the rectum treated with C-ion RT. The sacral chordoma was located in the third to fourth sacral spinal segments, in extensive contact with and compressing the rectum. Conventional C-ion RT was not indicated because the rectal dose would exceed the tolerance dose. Because we chose spacer placement surgery to physically separate the tumor and the rectum before C-ion RT, bioabsorbable spacer sheets were inserted by open surgery. After spacer placement, 67.2 Gy [relative biological effectiveness (RBE)] of C-ion RT was administered. The thickness of the spacer was stable at 13–14 mm during C-ion RT. Comparing the dose–volume histogram (DVH) parameters, Dmax for the rectum was reduced from 67 Gy (RBE) in the no spacer plan (simulation plan) to 45 Gy (RBE) in the spacer placement plan (actual plan) when a prescribed dose was administered to the tumor. Spacer placement was advantageous for irradiating the tumor and the rectum, demonstrated using the DVH parameter analysis.

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“…The LEM-I prescription doses and dose constraints were adapted with respect to corresponding mMKM prescription doses as per the translation schema provided by Fossati et al [28]. The median overall treatment time was 26 days (range of [22][23][24][25][26][27][28][29][30][31][32]. During the course of treatment, at least two re-evaluation CT scans were performed to evaluate the robustness of target and OAR dose constraints.…”

Section: Treatment Simulation and Planning: Clinicalmentioning

confidence: 99%

Sacral-Nerve-Sparing Planning Strategy in Pelvic Sarcomas/Chordomas Treated with Carbon-Ion Radiotherapy

Nachankar,

Schafasand,

Hug

et al. 2024

Cancers

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To minimize radiation-induced lumbosacral neuropathy (RILSN), we employed sacral-nerve-sparing optimized carbon-ion therapy strategy (SNSo-CIRT) in treating 35 patients with pelvic sarcomas/chordomas. Plans were optimized using Local Effect Model-I (LEM-I), prescribed DRBE|LEM-I|D50% (median dose to HD-PTV) = 73.6 (70.4–76.8) Gy (RBE)/16 fractions. Sacral nerves were contoured between L5-S3 levels. DRBE|LEM-I to 5% of sacral nerves-to-spare (outside HD-CTV) (DRBE|LEM-I|D5%) were restricted to <69 Gy (RBE). The median follow-up was 25 months (range of 2–53). Three patients (9%) developed late RILSN (≥G3) after an average period of 8 months post-CIRT. The RILSN-free survival at 2 years was 91% (CI, 81–100). With SNSo-CIRT, DRBE|LEM-I|D5% for sacral nerves-to-spare = 66.9 ± 1.9 Gy (RBE), maintaining DRBE|LEM-I to 98% of HD-CTV (DRBE|LEM-I|D98%) = 70 ± 3.6 Gy (RBE). Two-year OS and LC were 100% and 93% (CI, 84–100), respectively. LETd and DRBE with modified-microdosimetric kinetic model (mMKM) were recomputed retrospectively. DRBE|LEM-I and DRBE|mMKM were similar, but DRBE-filtered-LETd was higher in sacral nerves-to-spare in patients with RILSN than those without. At DRBE|LEM-I cutoff = 64 Gy (RBE), 2-year RILSN-free survival was 100% in patients with <12% of sacral nerves-to-spare voxels receiving LETd > 55 keV/µm than 75% (CI, 54–100) in those with ≥12% of voxels (p < 0.05). DRBE-filtered-LETd holds promise for the SNSo-CIRT strategy but requires longer follow-up for validation.

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Complication rate, functional outcomes, and risk factors associated with carbon ion radiotherapy for patients with unresectable pelvic bone sarcoma

Cited by 14 publications

References 47 publications

Risk factors for 30‐day soft tissue complications after pelvic sarcoma surgery: A National Surgical Quality Improvement Program study

Risk factors for 30‐day soft tissue complications after pelvic sarcoma surgery: A National Surgical Quality Improvement Program study

Rectal dose-sparing effect with bioabsorbable spacer placement in carbon ion radiotherapy for sacral chordoma: dosimetric comparison of a simulation study

Sacral-Nerve-Sparing Planning Strategy in Pelvic Sarcomas/Chordomas Treated with Carbon-Ion Radiotherapy

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