Phase 2 study of preoperative image-guided intensity-modulated radiation therapy to reduce wound and combined modality morbidities in lower extremity soft tissue sarcoma

Authors

  • Brian O'Sullivan MD,

    1. Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
    2. University of Toronto, Toronto, Ontario, Canada
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  • Anthony M. Griffin MSc,

    Corresponding author
    1. Division of Orthopaedic Surgery, University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
    • Suite 476H, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5

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    • Fax: (416) 586-8397

  • Colleen I. Dickie MSc,

    1. Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
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  • Michael B. Sharpe PhD,

    1. Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
    2. University of Toronto, Toronto, Ontario, Canada
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  • Peter W. M. Chung MD,

    1. Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
    2. University of Toronto, Toronto, Ontario, Canada
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  • Charles N. Catton MD,

    1. Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
    2. University of Toronto, Toronto, Ontario, Canada
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  • Peter C. Ferguson MD,

    1. University of Toronto, Toronto, Ontario, Canada
    2. Division of Orthopaedic Surgery, University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Jay S. Wunder MD,

    1. University of Toronto, Toronto, Ontario, Canada
    2. Division of Orthopaedic Surgery, University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Benjamin M. Deheshi MD,

    1. University of Toronto, Toronto, Ontario, Canada
    2. Division of Orthopaedic Surgery, University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Lawrence M. White MD,

    1. University of Toronto, Toronto, Ontario, Canada
    2. Joint Department of Medical Imaging, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
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  • Rita A. Kandel MD,

    1. University of Toronto, Toronto, Ontario, Canada
    2. Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • David A. Jaffray PhD,

    1. Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
    2. University of Toronto, Toronto, Ontario, Canada
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  • Robert S. Bell MD

    1. University of Toronto, Toronto, Ontario, Canada
    2. Division of Orthopaedic Surgery, University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Presented at the 52nd Annual American Society for Radiation Oncology (ASTRO) Meeting, November 2010, San Diego, California.

Abstract

BACKGROUND:

This study sought to determine if preoperative image-guided intensity-modulated radiotherapy (IG-IMRT) can reduce morbidity, including wound complications, by minimizing dose to uninvolved tissues in adults with lower extremity soft tissue sarcoma.

METHODS:

The primary endpoint was the development of an acute wound complication (WC). IG-IMRT was used to conform volumes to avoid normal tissues (skin flaps for wound closure, bone, or other uninvolved soft tissues). From July 2005 to June 2009, 70 adults were enrolled; 59 were evaluable for the primary endpoint. Median tumor size was 9.5 cm; 55 tumors (93%) were high-grade and 58 (98%) were deep to fascia.

RESULTS:

Eighteen (30.5%) patients developed WCs. This was not statistically significantly different from the result of the National Cancer Institute of Canada SR2 trial (P = .2); however, primary closure technique was possible more often (55 of 59 patients [93.2%] versus 50 of 70 patients [71.4%]; P = .002), and secondary operations for WCs were somewhat reduced (6 of 18 patients [33%] versus 13 of 30 patients [43%]; P = .55). Moderate edema, skin, subcutaneous, and joint toxicity was present in 6 (11.1%), 1 (1.9%), 5 (9.3%), and 3 (5.6%) patients, respectively, but there were no bone fractures. Four local recurrences (6.8%, none near the flaps) occurred with median follow-up of 49 months.

CONCLUSIONS:

The 30.5% incidence of WCs was numerically lower than the 43% risk derived from the National Cancer Institute of Canada SR2 trial, but did not reach statistical significance. Preoperative IG-IMRT significantly diminished the need for tissue transfer. RT chronic morbidities and the need for subsequent secondary operations for WCs were lowered, although not significantly, whereas good limb function was maintained. Cancer 2013. © 2013 American Cancer Society.

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