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
COMPARISON OF PRE- VS POST-OPERATIVE EBRT
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
page revision: 44, last edited: 04 May 2009 19:14