Large Malignant Fibrous Histiocytoma Treated with Hypofractionated Proton Beam Therapy and Local Hyperthermia

Abstract

Purpose: Malignant fibrous histiocytoma (MFH) is one of the most common soft tissue sarcomas. The standard treatment is adequate surgical resection; in addition, radiation therapy plays a major role in perioperative treatment in most cases. Herein, we report the case of a patient with a large MFH who was successfully treated with combined proton beam therapy (PBT) and local hyperthermia (LH). Case Presentation: A 60-year-old man presented with a 6×4-cm mass on his left thigh. Histopathology and immunohistochemistry indicated MFH, and he refused limb amputation. He received treatment with PBT at a dose at 72 GyE in 18 fractions. To cover the entire large target lesion, we used a patch-field protocol. He also concurrently received 7 courses of LH. The combination therapy achieved long-term local control without severe acute or late toxicity during the 7-year follow-up period. Conclusions: This case suggests that the combination of PBT and LH may be an option as a limb-preserving treatment for large inoperable MFH in the extremities.

Nomogram for predicting cancer-specific survival in undifferentiated pleomorphic sarcoma: A Surveillance, Epidemiology, and End Results -based study

“…The SEER database contains data from more than 20 regions and covers 28% of the US population. 6 It collects sociodemographic, clinicopathological, treatment, follow-up, and other information on cancer patients. 30 This can provide high-quality, multicenter, large-sample data for the study of rare cancers.…”

“…[1][2][3][4] Undifferentiated pleomorphic sarcoma occurs most frequently in the soft tissues of extremities (50% in lower limbs, 20% in upper limbs), and occasionally in bone and viscera. [5][6][7][8] It peaks around the age of 60 years and is more common in males. 6 As one of the most common subtypes, it accounts for about 5-10% of the adult soft-tissue sarcoma (STS).…”

“…[5][6][7][8] It peaks around the age of 60 years and is more common in males. 6 As one of the most common subtypes, it accounts for about 5-10% of the adult soft-tissue sarcoma (STS). [1][2][3] The present study focused on UPS occurring in soft tissues.…”

The Role of Hypofractionation in Proton Therapy

“…A number single case studies of hypofractionated PBT have been reported since 2017 [58][59][60]. Seidensaal et al published a study protocol to compare the outcomes of hypofractionated PBT vs carbon ion therapy for neoadjuvant irradiation of retroperitoneal soft tissue sarcoma [61].…”

Recent Advances in Metal-Based NanoEnhancers for Particle Therapy

“…Although particle therapy has significant advantages over conventional RT for treating cancer by reducing the radiation damage to surrounding normal tissues, the radiation dose deposited by the particle beam in normal tissues which locates in the path before the tumor is unavoidable, which may cause normal tissue damage [ 10 ]. Many strategies have been suggested to balance treatment outcome of conventional RT with side effects, such as increasing radiation resistance in healthy tissues by using a very high-dose-rate (>40 Gy/s) RT (known as FLASH RT) [ 11 , 12 ], reversing tumor tissue radiation resistance using synergistic therapeutics [ 13 , 14 , 15 , 16 ], increasing radiation sensitization, and limiting radiation dose deposition in the tumor using nanosensitizing agents [ 17 , 18 , 19 ]. Of these, metal-based nanomaterials or “nano-radioenhancers” (NREs) have attracted significant attention in radiation oncology because of their strong photoelectric absorption coefficients for high atomic number (Z) metallic elements [ 20 ].…”