Stereotactic radiotherapy for soft tissue and bone sarcomas: real-world evidence

Abstract

Introduction: Selected patients with locally advanced or metastatic soft tissue and bone sarcomas (STBS) may benefit from intensive local treatment, such as stereotactic radiotherapy (SRT). This study aimed to summarize the utilization and outcomes of SRT in STBS and to identify predictive factors for progression and survival. Materials and methods: Consecutive patients with advanced STBS who underwent STBS in a sarcoma tertiary center were identified. We collected tumor- and treatment-related factors. Endpoints comprised time to local progression (TTLP), local progression-free survival (LPFS), time to progression, progression-free survival, and overall survival (OS). The Cox proportional-hazards model was used to identify prognostic factors. Results: We identified 141 patients who underwent 233 SRTs. Median follow-up was 21 months. Local and distant progression occurred after 19 and 163 SRTs, respectively. SRT for lung metastases was predictive for better TTLP and LPFS (hazard ratio, HR = 0.12, p = 0.007 and HR = 0.42, p = 0.002, respectively). Bone sarcoma (HR for TTLP = 3.18, p = 0.043; HR for LPFS = 1.99, p = 0.028) and lower administered dose (HR for TTLP = 0.98, p = 0.007; HR for LPFS = 0.99, p = 0.012) were predictive for worse TTLP and LPFS. SRT for oligometastases (HR = 0.46, p = 0.021) and lung metastases (HR = 0.55, p = 0.046) was predictive for better OS, whereas diagnosis of bone sarcoma (HR = 2.05, p = 0.029) was predictive for worse OS. Conclusion: SRT provides excellent local control in STBS patients without significant toxicity. Patients with oligometastatic disease, lung metastases, and soft tissue sarcomas benefit the most from SRT. The dose escalation moderately enhances local control; however, it does not translate into better survival.

A retrospective case–control study for the comparison of 5-year survival rates: the role of adjuvant and neoadjuvant chemotherapy in craniofacial bone sarcoma in adults

“…8 Proton-based therapies and stereotactic radiosurgery may permit improved multimodal treatment regimens. 29,30 This retrospective study indicated greater survival rates following neoadjuvant chemotherapy in contrast to sole application of adjuvant chemotherapy. Craniofacial osteosarcomas that respond to neoadjuvant chemotherapy may benefit from the additional exposure to postoperative chemotherapy and demonstrate improved 5-year survival rates.…”

“…8 Proton-based therapies and stereotactic radiosurgery may permit improved multimodal treatment regimens. 29,30…”

Toll-Like Receptor 4 Agonist Injection With Concurrent Radiotherapy in Patients With Metastatic Soft Tissue Sarcoma

“…Radiation therapy is an effective tool in the management of symptomatic metastasis for STS . This phase 1 nonrandomized controlled trial suggests that the combination of GLA-SE with radiotherapy for symptomatic, superficial STS tumors is feasible and effective.…”

Treatment outcomes of stereotactic body radiation therapy for pulmonary metastasis from sarcoma: a multicenter, retrospective study

“…They showed that BED 5 > 150 Gy was associated with improved LCpT in the multivariate analysis. Spałek et al [ 15 ] reported a large retrospective data consisted of 233 metastatic lesions from 141 patients. 57.1% of treated lesions were pulmonary metastatic lesions.…”

“…Treated lung tumors were categorized into two groups: a low BED 10 group, defined by BED 10 < 100 Gy, and a high BED 10 group, defined as BED 10 ≥ 100 Gy. Although there were reports with lower α/β ratios for sarcoma [ 13 – 15 ], an α/β ratio of 10 and a BED 10 cutoff value of 100 Gy were chosen based on previous literature for SBRT for primary lung tumors and metastatic lung tumors [ 16 , 17 ]. Comparison of LCpT between the two groups was performed using a log-rank test.…”