Hypofractionated Radiation Therapy for Unresectable or Metastatic Sarcoma Lesions

Boyce-Fappiano, David; Damron, E.P.; Farooqi, Ahsan; Mitra, Devarati; Conley, Anthony P.; Somaiah, Neeta; Araujo, Dejka M.; Livingston, J. Andrew; Ratan, Ravin; Keung, Emily Z.; Roland, Christina L.; Guadagnolo, B. Ashleigh; Bishop, Andrew J.

doi:10.1016/j.adro.2022.100913

Cited by 11 publications

(9 citation statements)

References 54 publications

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“… 31 Many attempts have been made to improve the LC for unresectable STS treated with RT, including concurrent systemic therapy, 32 heavy ion therapy, 33 combined hyperthermia, 34 and hypofractionation. 35 However, our study demonstrated impressive outcomes using our novel HARD photon-based regimen, with no instances of local or regional progression observed in this historically radioresistant cohort.…”

Section: Discussionmentioning

confidence: 71%

“…This can be mitigated by a fractionated approach and the use of hypofractionation with isotoxic dose-painting. HFRT has been explored extensively in the neoadjuvant setting, safety of 5, 37 , 38 , 39 , 40 8, 41 , 42 10, 35 , 43 , 44 and 15 fraction 45 regimens before surgery. However, few studies have explored the role of hypofractionated RT for unresectable disease.…”

Section: Discussionmentioning

confidence: 99%

“… 46 In addition, Boyce-Fappiano et al showed the utility of hypofractionated RT, most commonly 15 fractions to 52.5 Gy/45 Gy (GTV/PTV), which provided a 1-year/2-year LC of 73%/47% with 49% grade 1 to 2 toxicity, and no grade 3 to 5 toxicity. 35 The higher LC with HARD (3-year = 100%) may be due to the higher equivalent dose in 2 Gy per fraction (EQD 2 ) delivered, where prior studies showed improved LC (5-year LC: 60% vs 22%) with dose escalation to ≥ 63 Gy. 11 Assuming an α/β of 4 Gy for STS, prior photon based hypofractionation studies 35 , 46 treated with a lower EQD2(45.5-66 Gy) than our current study (EQD2: 70-77 Gy), and reported LC rates of approximately 70% at 1 year.…”

Section: Discussionmentioning

confidence: 99%

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Novel Definitive Hypofractionated Accelerated Radiation Dose-painting (HARD) for Unresected Soft Tissue Sarcomas

Bryant,

Mills,

Yang

et al. 2024

Advances in Radiation Oncology

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Novel Definitive Hypofractionated Accelerated Radiation Dose-painting (HARD) for Unresected Soft Tissue Sarcomas

Bryant,

Mills,

Yang

et al. 2024

Advances in Radiation Oncology

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“…In light of this, although data on LRT immunomodulatory actions are preliminary and further research is mandatory, this interesting hypothesis may widen LTR from a palliative setting to a curative one, both in bulky localized and widespread disease (18,19).…”

Section: Discussionmentioning

confidence: 99%

How a very large sarcomatoid lung cancer was efficiently managed with lattice radiation therapy: a case report

Iori¹,

Botti²,

Ciammella³

et al. 2022

Ann Palliat Med

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Background: The management of large tumors represent a concerning issue in the palliative setting.Since a surgical approach is excluded and systemic therapy has reported limited efficacy, the patients are commonly referred for radiation therapy as last resort. However, to improve quality of life and to avoid excessive toxicity, low doses of palliative radiotherapy (RT) are delivered. In these cases, with limited and short response. Lattice radiation therapy (LRT) represents an innovative technique aiming to increase tumor response without enhancing adjacent organs at risk (OAR) toxicity, by administering inhomogeneous doses with ablative high dose areas inside the tumor and low doses near the OAR.Case Description: A 69-year-old male patient was admitted to our hospital complaining of sacral pain and mild dyspnea. After a suspicious opacity on X-ray, the chest computed tomography (CT), the positron emission tomography/CT (PET/CT) and the endobronchial ultra sound-guided transbronchial needle aspiration confirmed the diagnosis of a bulky sarcomatoid lung cancer (stage IV: cT4N3M1c). After an effective antalgic RT on the sacral metastasis and three lines of systemic therapy without response, the patient started to have a disabling dyspnea. Thus, we administered LRT on the bulky lesion. The patients experienced no significant toxicity, with a marked lesion response on the 3 month-follow CT and a significant improvement in symptoms and in his daily life.Conclusions: This is the first LRT treatment done in our Center and it provides another evidence in the efficacy of LRT planning. It shows how LRT could represent an innovative technique to provide durable response in large tumors, without increasing treatment-related toxicity.

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“…There has recently been data suggesting that dose escalation up to a total dose of 70.2 Gy may be of benefit in improved local control ( 45 ), although this strategy has not been widely adopted to date. More recent studies show that hypofractionation (5-10 Gy doses over 5-10 fractions) may be as or more effective at treating sarcomas, including Ewing sarcoma ( 46 ).…”

Section: Dna Damage and Ewing Sarcomamentioning

confidence: 99%

Harnessing immunomodulation during DNA damage in Ewing sarcoma

2022

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Ewing sarcoma is a fusion-oncoprotein-driven primary bone tumor most commonly diagnosed in adolescents. Given the continued poor outcomes for patients with metastatic and relapsed Ewing sarcoma, testing innovative therapeutic approaches is essential. Ewing sarcoma has been categorized as a ‘BRCAness’ tumor with emerging data characterizing a spectrum of DNA damage repair defects within individual Ewing tumors, including the presence of EWSR1::FLI1 itself, recurrent somatic mutations, and rare germline-based defects. It is critical to understand the cumulative impact of various DNA damage repair defects on an individual Ewing tumor’s response to therapy. Further, in addition to DNA-damage-directed therapies, subsets of Ewing tumors may be more susceptible to DNA-damage/immunotherapy combinations given the significant cross-talk between DNA damage and inflammatory pathways in the tumor microenvironment. Here we review potential approaches utilizing DNA-damaging agents as modulators of the Ewing tumor immune microenvironment, with a focus on radiation and opportunities during disease metastasis and relapse.

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Hypofractionated Radiation Therapy for Unresectable or Metastatic Sarcoma Lesions

Cited by 11 publications

References 54 publications

Novel Definitive Hypofractionated Accelerated Radiation Dose-painting (HARD) for Unresected Soft Tissue Sarcomas

Novel Definitive Hypofractionated Accelerated Radiation Dose-painting (HARD) for Unresected Soft Tissue Sarcomas

How a very large sarcomatoid lung cancer was efficiently managed with lattice radiation therapy: a case report

Harnessing immunomodulation during DNA damage in Ewing sarcoma

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