Reduced Toxicity With Intensity Modulated Radiation Therapy (IMRT) for Desmoplastic Small Round Cell Tumor (DSRCT): An Update on the Whole Abdominopelvic Radiation Therapy (WAP-RT) Experience

Desai, Neil B.; Stein, Nicholas F.; LaQuaglia, Michael P.; Alektiar, Kaled M.; Kushner, Brian H.; Modak, Shakeel; Magnan, Heather; Goodman, Karyn A.; Wolden, Suzanne L.

doi:10.1016/j.ijrobp.2012.09.005

Cited by 63 publications

(55 citation statements)

References 13 publications

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“…4,5,[7][8][9] We also found that EPM are highly predictive of a poor prognosis. 5,24 The median OS after peritoneal CRS in patients with synchronous liver metastases was only 14.8 months, which is comparable to the results obtained with systemic chemotherapy alone. 2 Therefore, we believe that surgery is inappropriate for this group of patients, who should instead be treated with systemic chemotherapy alone.…”

Section: Discussionsupporting

confidence: 54%

Abdominal Desmoplastic Small Round Cell Tumor: Multimodal Treatment Combining Chemotherapy, Surgery, and Radiotherapy is the Best Option

et al. 2014

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Section: Discussionsupporting

confidence: 54%

Abdominal Desmoplastic Small Round Cell Tumor: Multimodal Treatment Combining Chemotherapy, Surgery, and Radiotherapy is the Best Option

et al. 2014

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“…For pelvic malignancies, BM-sparing IMRT/ intensity-modulated proton therapy using specific dose constraints of the BM had theoretic benefit through dosimetric analysis. [19][20][21][22] Desai et al 23 demonstrated that BM-sparing IMRT reduced acute HT in patients with pelvic malignancies. For current IMRT treatment of thoracic malignancies, specific dose constraints of the BM were not followed, as none have been set.…”

Section: (Continued)mentioning

confidence: 99%

Dosimetric predictors of acute haematological toxicity in oesophageal cancer patients treated with neoadjuvant chemoradiotherapy

Lee¹,

Lin²,

Sun³

et al. 2016

BJR

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Objective: Haematological toxicity (HT) is common in patients with oesophageal cancer (EC) treated with chemoradiotherapy (CRT). The Quantitative Analysis of Normal Tissue Effects in the Clinic guidelines provide no dose constraints for the bone marrow (BM) to avoid HT. We aimed to determine dosimetric factors associated with HT during CRT for EC. Methods: 41 patients with EC treated with neoadjuvant cisplatin and 5-fluorouracil-based CRT were retrospectively reviewed. Associations between the dose-volume histogram parameters of thoracic bones and blood cell count changes during CRT were assessed using logistic regression analyses. Receiver-operating characteristic curves were used to derive optimal dosimetric planning constraints. V x indicates the total organ volume percentage exceeding a radiation dose of x (Gy). Results: Greater thoracic vertebrae and rib irradiation doses, including mean vertebral dose (MVD), thoracic vertebrae V 5-30 (TVV 5-30 ), mean rib dose and rib V 5-20 , were associated with increased leukopenia (grade $ 3) risk. Additional BM sites (sternum, scapulae and clavicles) did not influence HT. White blood cell and absolute neutrophil count nadirs were associated with increased irradiation doses to the thoracic vertebrae, ribs and sternum. Chemotherapy cycle number was not significantly associated with severe neutropenia or leukopenia. Cut-off values with the highest likelihood of avoiding leukopenia were MVD , 25.9 Gy, TVV 20 , 70% and TVV 10 , 77%. Conclusion: Thoracic bone irradiation dose was significantly associated with HT after adjusting for chemotherapy effects. Efforts to maintain MVD , 25.9 Gy, TVV 10 , 77% and TVV 20 , 70% could reduce HT. Advances in knowledge: This is the first study addressing issues concerning HT in patients with neoadjuvant CRTtreated EC.

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“…Chemo n = 234 No chemo n = 851 (15) 109 (15) 34 (14) 131 (15) 38 000-47 999 243 (22) 75 (20) 168 (24) 58 (25) 185 (22) 48 000-62 999 283 (26) 101 (27) 182 (26) 63 (27) (27) 104 (27) 190 (27) 55 (23) 239 (27) 7-12.9% 346 (32) 120 (32) 226 (32) 69 (29) 277 (33) 13-20.9% 244 (22) 90 (24) 154 (22) 61 (26) (15) 59 (16) 99 (14) 25 (11) 133 (16) R 2 297 (27) 89 (23) 208 (29) 88 (37) 209 (24) Chemotherapy 0.42 -Yes 234 (22) 87 (23) 147 (21) The univariate analysis identified male gender, age older than 50 years, comorbidity, tumor larger than 8 cm, positive surgical margins, absence of perioperative radiotherapy and/or radiotherapy dose <60…”

Section: Resultsmentioning

confidence: 99%

Utilization pattern and survival outcomes of adjuvant therapies in high‐grade nonretroperitoneal abdominal soft tissue sarcoma: A population‐based study

Green

Jabbour

DeLaney

et al. 2017

Asia-Pac J Clncl Oncology

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Summary: Nonretroperitoneal abdominal soft tissue sarcoma (NRA-STS) is a rare disease characterized by poor outcomes with limited data supporting its management. Our study indicates that adjuvant radiotherapy was associated with improved survival in high-grade NRA-STS, and higher radiotherapy doses may accentuate this benefit. AbstractBackground: Nonretroperitoneal abdominal soft tissue sarcoma (NRA-STS) is a rare disease with limited data supporting its management. Our study aimed to reveal the utilization patterns of adjuvant therapy and its potential survival benefits using the National Cancer Data Base. Materials:The analysis included patients with resected high-grade NRA-STS. Chi-square analysis was used to evaluate distribution of patient and tumor-related factors within treatment groups.The Kaplan-Meier and Cox proportional hazards model were utilized to evaluate overall survival according to treatment approach. Multivariate analysis was used to determine the impact of these factors on patients' outcome. Matched propensity score analysis was implemented to control for imbalance of confounding variables. Results:At median follow-up of 49 months, 5-year overall survival improved from 46% without adjuvant radiation therapy to 52% (P = 0.009) with radiotherapy delivery with a 30% reduction in hazard of death (95% confidence interval = 0.58-0.84). On multivariate analysis, age <50, tumor <8 cm, negative margins and radiotherapy delivery were significant predictors of improved survival. Chemotherapy was not associated with significant survival improvement (Hazard Ratios[HR]: 0.89, P = 0.28). Conclusion:Adjuvant radiotherapy was associated with improved survival in high-grade NRA-STS. Chemotherapy was not associated with a survival improvement; however, further studies are needed to refine treatment strategies.

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Reduced Toxicity With Intensity Modulated Radiation Therapy (IMRT) for Desmoplastic Small Round Cell Tumor (DSRCT): An Update on the Whole Abdominopelvic Radiation Therapy (WAP-RT) Experience

Cited by 63 publications

References 13 publications

Abdominal Desmoplastic Small Round Cell Tumor: Multimodal Treatment Combining Chemotherapy, Surgery, and Radiotherapy is the Best Option

Abdominal Desmoplastic Small Round Cell Tumor: Multimodal Treatment Combining Chemotherapy, Surgery, and Radiotherapy is the Best Option

Dosimetric predictors of acute haematological toxicity in oesophageal cancer patients treated with neoadjuvant chemoradiotherapy

Utilization pattern and survival outcomes of adjuvant therapies in high‐grade nonretroperitoneal abdominal soft tissue sarcoma: A population‐based study

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