SARCOMA RADIATION MANAGEMENT

RADIATION ALONE

  • overall survival at 5-years is 52% (Kepka et al. IJROBP 05)
    • patient who receive < 63 Gy did worse than those that received 63 Gy or more.
  • dose should be at least 70 Gy in 35 fractions
Tumor Size Local Control at 5-years
< 5 cm 51%
5-10 cm 45%
> 10 cm 9%

INDICATION FOR RADIATION

Image1.jpg

COMPARISON OF PRE- VS POST-OPERATIVE EBRT

Image2.jpg

SEQUELAE OF TREATMENT

General

  • < 10% moderate-severe complications

Edema

  • at least 1 cm of skin/soft-tissue should be spared

Bone fracture

  • limit circumference of uninvolved bone
  • no sports

Joint Fibrosis

  • limit joint spaces to 45 Gy

Fertility in Young Men

  • Testicular shield to decrease testicular dose
  • Sperm banking

OUTCOMES

Local Failure base on Size

Size (mm) Postop# 60-66Gy LC% Preop# 50Gy LC%
25 20 100 11 80
26-49 45 95 16 100
50-100 64 83 63 93
101-150 12 91 34 100
151-200 6 50 25 79
200 3 67 11 100
Tota 150 87 with 73% DFS 160 92 with 65% DFS

Distant Failure

  • DM ranged from 40% in tumors 10cm to 80% if >20cm

Margin Status

  • If margins negative after preop 95% LC vs 80% if positive

By Tumor Location

  • UF Brant 1990 58pts received 50.4Gy
  • Extremity 92% Trunk 83%

By Grade

  • 5-OS low grade 100%
  • high grade
    • <10cm 68%
    • >10cm 39%

Limb Salvage

  • 85% maintained functional limb

BRACHYTHERAPY as SOLE THERAPY

Contra-indications

  • poor implant geometry
  • resection margins are postive
  • skin involvement
  • low-grade tumors (lack of efficacy)

Advantages

  • Requires less time
  • Smaller irradiated volume
  • Directly applied to tumor bed
  • Cheaper
  • Can be used in previously treated patients
  • Improved functionality
  • Patients completes treatment in 10-14 days vs. 7-8 weeks

Dose

  • 45-50 Gy @ ~ 0.45 Gy/hr dosed at 1 cm (4-6 days)
    • skin dose not to exceed 20 to 25 Gy

LDR BRACHYTHERAPY

LDR Technique

  • Use either I-125 (children) or Ir-192 seeds (adults)
  • Load catheter placement horizontally into surgical bed placed at 1cm interval
  • Volume covers tumor + 2cm margin
  • Wound closed over catheters
  • Load hot sources postop day no sooner than 6th post-operative day

LDR DOSE

  • As mono therapy 45-50 Gy @ ~ 0.45 Gy/hr dosed at 1 cm (4-6 days)
    • skin dose not to exceed 20 to 25 Gy
  • Boost after pre-operative EBRT
    • positive or close margin 20 Gy @ ~ 0.45 Gy/hr dosed at 1 cm (2-3 days)
  • Boost after post-operative EBRT
    • positive margin 20 Gy @ ~ 0.45 Gy/hr dosed at 1 cm (2-3 days)
    • close margin 10-16 Gy @ ~ 0.45 Gy/hr dosed at 1 cm (2-3 days)

Complication Rates

  • Administering 15 Gy to 20 Gy as a boost with brachytherapy, the perioperative complication rate was
    • 5% with postoperative versus
    • 25% with preoperative radiation
Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-Share Alike 2.5 License.