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Adequate 3D Treatment Volume in Preoperative Radiotherapy in Extremity Soft Tissue Sarcoma

Adequate 3D Treatment Volume in Preoperative Radiotherapy in Extremity Soft Tissue Sarcoma. Kim BK, Chen YL, Kirsch DG, Kobayashi W, Goldberg S, Wolfgang J, Kung JH, Doppke K, Raskin KA, Springfield DS, Schwab JH, Yoon SS, Hornicek FJ, Nielson GP, DeLaney TF

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Adequate 3D Treatment Volume in Preoperative Radiotherapy in Extremity Soft Tissue Sarcoma

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  1. Adequate 3D Treatment Volume in Preoperative Radiotherapy in Extremity Soft Tissue Sarcoma Kim BK, Chen YL, Kirsch DG, Kobayashi W, Goldberg S, Wolfgang J, Kung JH, Doppke K, Raskin KA, Springfield DS, Schwab JH, Yoon SS, Hornicek FJ, Nielson GP, DeLaney TF Department of Radiation Oncology, Orthopedic Oncology, Surgical Oncology, Pathology, Massachusetts General Hospital, Boston, MA, USA

  2. Background • Radiotherapy in Extremity Soft Tissue Sarcoma (STS ) • Preoperative • Postoperative • Potential Advantages of Preoperative RT • More precise definition of tumor – accurate/small field • Increase R0 resection/ possible limb preservation • Decrease the risk of tumor seeding • Complications • Increased wound complications vs. • Decreased late morbidities • Adequate 3D Treatment Volume for Preoperative RT?

  3. Target Volume of Preoperative RT

  4. Objectives • Retrospective Study • Analyze the pattern of local failure (LF). • Patients with extremity STS • Curative preoperative irradiation (XRT) • Treated with 3D XRT using CT simulation • Elucidate optimal 3D radiation field design. • Evaluate other results and prognostic factors.

  5. Materials and Methods

  6. Materials and Methods

  7. Materials and Methods

  8. Treatment

  9. Radiotherapy (Preoperative RT Volume) Gross Tumor Volume (GTV) : T1 Gd CE (+) area on MRI Clinical Target Volume (CTV) : GTV + 1-1.5 cm radial margin : GTV + 3.5 cm proximal/distal margin Planning Target Volume (PTV) : CTV + 0.5- 0.8 cm margin Dose Prescription : PTV covered by > 95 % isodoseline GTV

  10. Treatment

  11. Results (Treatment Responses)

  12. Survival & Local Control 93.2 % (31) 93.2% (12) 91.5% (31) 88.5% (12) Local Recurrence as First Failure (3) Local Recurrence as Cumulative Failure (5)

  13. Patterns of Failure

  14. Prognostic Factors (Univariate)

  15. Margin Status & Local Failures RM Positive vs. Negative RM < 1 mm vs. > 1 mm RM < 1 mm vs. > 1 mm p = 0.0364 p = < 0.0001 p = 0.0016

  16. Prognostic Factors (Multivariate)

  17. Complications

  18. Conclusions

  19. Thankyou for your attention!

  20. Acute Skin Toxicity RT

  21. Infield Failure All infield failures were located in GTV or CTV.

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