1 / 27

LA Mikula, PF Ridgway, CN Catton, JJ Jones, B O’Sullivan, MA Ko, CJ Swallow University of Toronto

Long-term follow-up of a prospective trial of pre-operative external-beam radiation and post-operative brachytherapy for retroperitoneal sarcoma. LA Mikula, PF Ridgway, CN Catton, JJ Jones, B O’Sullivan, MA Ko, CJ Swallow University of Toronto

nicole-morton
Download Presentation

LA Mikula, PF Ridgway, CN Catton, JJ Jones, B O’Sullivan, MA Ko, CJ Swallow University of Toronto

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Long-term follow-up of a prospective trial of pre-operativeexternal-beam radiationand post-operative brachytherapyfor retroperitoneal sarcoma LA Mikula, PF Ridgway, CN Catton, JJ Jones, B O’Sullivan, MA Ko, CJ Swallow University of Toronto Mount Sinai Hospital & Princess Margaret Hospital Toronto, Canada

  2. Retroperitoneal Sarcoma:the Challenge

  3. Retroperitoneal SarcomaPrincess Margaret Hospitaln=45 resected patients, 1975-1988 OS Local Relapse-Free Survival Distant relapse-Free Survival Catton, O’Sullivan et al, Int J Rad Oncol Biol Phys 1994; 29:1005.

  4. Adjuvant Radiation

  5. Treatment Schema • Patients with RPS referred to Princess Margaret Hospital, Toronto, June 1996-April 2003 • Inclusion criteria: resectable disease & no mestastases; signed informed consent Pre-operative XRT: 45 Gy/5 weeks 4-6 weeks Surgery Post-operative brachytherapy (BT): 25 Gy (0.5Gy/hr, depth 0.5cm)

  6. RPS n=83 incurable n=12 refused therapy n=2 trial recent resection n=14 n=55 mets n=5 resection pre-op death n=4 n=46 BT n=2 pre-op XRT n=40 no RT n=2 BT and post-op XRT n=2 + BT n=19 - BT n=21 XRT = external beam radiation therapy BT = post-operative brachytherapy Jones et al, Ann Surg Onc 2002,9,346

  7. Pre-operative External Beam Radiation • Conformal planning using 3D techniques • Shielding of contralateral kidney; liver

  8. Post-operative Brachytherapy • Single plane of 3-8 afterloading BT catheters placed on the surgical bed with 1cm spacing • Planar implant dose of 0.5 Gy/hr, depth 0.5cm • Afterloading iridium-192 pulsed dose rate BT unit • BT initiated once GI function returned (7-14 days post-op)

  9. Outcomes & Follow-up • Follow-up: clinic visit + CT scan every 6 months x5 years, then anually • Minimum follow-up 48 months • Outcomes: • Survival • Disease recurrence • Toxicity: Radiation Therapy Oncology Group scores • Pre-operative toxicity • Acute post-operative toxicity (within 3 months) • Late toxicity (3 months to 1 year post-op) Jones et al, Ann Surg Onc 2002,9,346

  10. Results: Toxicity

  11. Pre-Operative Toxicity:40 patients treated with pre-op XRT • All patients had a maximum RTOG score of ≤ 2 • Acute toxicity scores related to upper and lower GI symptoms … • … except for one patient who developed cystitis Jones et al, Ann Surg Onc 2002,9,346

  12. Acute Post-operative Toxicity:46 resected patients 4 life- threatening 0 none 1 mild 2 medical therapy 3 hospital admission 5 death n= 15 8 5 11 6 1 4/6 had BT Hepatic failure Jones et al, Ann Surg Onc 2002,9,346

  13. Modified Late Toxicity(3-12 months post-op) 0 none 1 mild 2 medical therapy 5 death 3 hospital admission 4 life- threatening 36 1 1 1 1 2 n= 2 late complications of duodenal perforation 6/6 had BT Jones et al, Ann Surg Onc 2002,9,346

  14. Results:Long-term Follow-up

  15. Clinicopathologic Features:Pre-op XRT + Surgery • N=40 • Male 15, female 25 • Median age 58 yrs (range 41-75) • Primary presentation of RPS = 29 (72%) • Referred with recurrent disease = 11 (28%) • Tumour characteristics: • Median size 19cm (range 4-40cm) • 55% high grade • 70% liposarcoma

  16. Treatment Characteristics • Patients who completed pre-op XRT & surgery: • Median pre-op XRT dose = 45 Gy (range 45-57 Gy) • Median BT dose = 23 Gy (range 7.5-25 Gy) • All resections were grossly complete • 97% had resection of contiguous structures • No patients received adjunctive chemotherapy

  17. Status at Last Follow-Up • Median follow-up 89 months (7.4 years) • No patients lost to follow-up • 4 patients recurred and were re-resected • At last follow-up: • 25 alive and disease-free (62.5%) • 3 alive with recurrent disease (7.5%) • 9 dead of disease (22.5%) • 3 dead of other causes (7.5%)

  18. Overall Survival (n=40) 5yr OS 10yr OS 75% 63% median OS not reached at median 89 mos. f/u (months)

  19. Recurrence-Free Survival (n=40) 5yr RFS 10yr RFS 69% 52% median RFS ≈ 120 mos. median 89 mnths f/u

  20. OS BT (n=19) vs no BT (n=21) 5yr OS 10yr OS 80% 80% Log Rank: p=0.27 5yr OS 10yr OS 68% 54% Median not reached median OS not reached

  21. RFS BT (n=19) vs no BT (n=21) 5yr RFS: 75% 10yr RFS:-- 5yr RFS 10yr RFS 61% 47% Log Rank: p=0.58 No BT: median RFS not reached BT: median RFS ≈ 106 mnths

  22. OS in High-Grade Tumours (n=22) 5yr RFS 10yr RFS 68% --- Log Rank: p=0.68 No BT, n=10 BT, n=12 5yr RFS 10yr RFS 58% 47% No BT: median OS not reached BT: median OS ≈ 116 mnths

  23. Prospective Trials of Combined Radiation + Resection for RPS

  24. Historical vs. Current Data OS Local Relapse-Free Survival Catton, O’Sullivan et al, Int J Rad Oncol Biol Phys 1994; 29:1005.

  25. Conclusions • Pre-operative XRT was well tolerated • Brachytherapy to the upper abdomen was associated with significant toxicity • Pre-operative XRT and aggressive surgical resection shows promise in improving local control and long-term survival in RPS

  26. Intent-to-treat Analysis • For all 55 patients entered into the trial: 2-year OS 73% • For 46 patients resected with curative intent: 2-year OS 88%

More Related