Significant reduction of late toxicities in patients with extremity sarcoma treated with image-guided radiation therapy to a reduced target volume

Results of radiation therapy oncology group RTOG-0630 trial

Dian Wang, Qiang Zhang, Burton L. Eisenberg, John M. Kane, X. Allen Li, David Lucas, Ivy A Petersen, Thomas F. DeLaney, Carolyn R. Freeman, Steven E. Finkelstein, Ying J. Hitchcock, Manpreet Bedi, Anurag K. Singh, George Dundas, David G. Kirsch

Research output: Contribution to journalArticle

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Abstract

Purpose We performed a multi-institutional prospective phase II trial to assess late toxicities in patients with extremity soft tissue sarcoma (STS) treated with preoperative image-guided radiation therapy (IGRT) to a reduced target volume. Patients and Methods Patients with extremity STS received IGRT with (cohort A) or without (cohort B) chemotherapy followed by limb-sparing resection. Daily pretreatment images were coregistered with digitally reconstructed radiographs so that the patient position could be adjusted before each treatment. All patients received IGRT to reduced tumor volumes according to strict protocol guidelines. Late toxicities were assessed at 2 years. Results In all, 98 patients were accrued (cohort A, 12; cohort B, 86). Cohort A was closed prematurely because of poor accrual and is not reported. Seventy-nine eligible patients from cohort B form the basis of this report. At a median follow-up of 3.6 years, five patients did not have surgery because of disease progression. There were five local treatment failures, all of which were in field. Of the 57 patients assessed for late toxicities at 2 years, 10.5% experienced at least one grade ≥ 2 toxicity as compared with 37% of patients in the National Cancer Institute of Canada SR2 (CAN-NCIC-SR2: Phase III Randomized Study of Pre- vs Postoperative Radiotherapy in Curable Extremity Soft Tissue Sarcoma) trial receiving preoperative radiation therapy without IGRT (P < .001). Conclusion The significant reduction of late toxicities in patients with extremity STS who were treated with preoperative IGRT and absence of marginal-field recurrences suggest that the target volumes used in the Radiation Therapy Oncology Group RTOG-0630 (A Phase II Trial of Image-Guided Preoperative Radiotherapy for Primary Soft Tissue Sarcomas of the Extremity) study are appropriate for preoperative IGRT for extremity STS.

Original languageEnglish (US)
Pages (from-to)2231-2238
Number of pages8
JournalJournal of Clinical Oncology
Volume33
Issue number20
DOIs
StatePublished - Jul 10 2015

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Image-Guided Radiotherapy
Radiation Oncology
Sarcoma
Radiotherapy
Extremities
National Cancer Institute (U.S.)
Tumor Burden
Treatment Failure
Canada
Disease Progression

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Significant reduction of late toxicities in patients with extremity sarcoma treated with image-guided radiation therapy to a reduced target volume : Results of radiation therapy oncology group RTOG-0630 trial. / Wang, Dian; Zhang, Qiang; Eisenberg, Burton L.; Kane, John M.; Li, X. Allen; Lucas, David; Petersen, Ivy A; DeLaney, Thomas F.; Freeman, Carolyn R.; Finkelstein, Steven E.; Hitchcock, Ying J.; Bedi, Manpreet; Singh, Anurag K.; Dundas, George; Kirsch, David G.

In: Journal of Clinical Oncology, Vol. 33, No. 20, 10.07.2015, p. 2231-2238.

Research output: Contribution to journalArticle

Wang, D, Zhang, Q, Eisenberg, BL, Kane, JM, Li, XA, Lucas, D, Petersen, IA, DeLaney, TF, Freeman, CR, Finkelstein, SE, Hitchcock, YJ, Bedi, M, Singh, AK, Dundas, G & Kirsch, DG 2015, 'Significant reduction of late toxicities in patients with extremity sarcoma treated with image-guided radiation therapy to a reduced target volume: Results of radiation therapy oncology group RTOG-0630 trial', Journal of Clinical Oncology, vol. 33, no. 20, pp. 2231-2238. https://doi.org/10.1200/JCO.2014.58.5828
Wang, Dian ; Zhang, Qiang ; Eisenberg, Burton L. ; Kane, John M. ; Li, X. Allen ; Lucas, David ; Petersen, Ivy A ; DeLaney, Thomas F. ; Freeman, Carolyn R. ; Finkelstein, Steven E. ; Hitchcock, Ying J. ; Bedi, Manpreet ; Singh, Anurag K. ; Dundas, George ; Kirsch, David G. / Significant reduction of late toxicities in patients with extremity sarcoma treated with image-guided radiation therapy to a reduced target volume : Results of radiation therapy oncology group RTOG-0630 trial. In: Journal of Clinical Oncology. 2015 ; Vol. 33, No. 20. pp. 2231-2238.
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title = "Significant reduction of late toxicities in patients with extremity sarcoma treated with image-guided radiation therapy to a reduced target volume: Results of radiation therapy oncology group RTOG-0630 trial",
abstract = "Purpose We performed a multi-institutional prospective phase II trial to assess late toxicities in patients with extremity soft tissue sarcoma (STS) treated with preoperative image-guided radiation therapy (IGRT) to a reduced target volume. Patients and Methods Patients with extremity STS received IGRT with (cohort A) or without (cohort B) chemotherapy followed by limb-sparing resection. Daily pretreatment images were coregistered with digitally reconstructed radiographs so that the patient position could be adjusted before each treatment. All patients received IGRT to reduced tumor volumes according to strict protocol guidelines. Late toxicities were assessed at 2 years. Results In all, 98 patients were accrued (cohort A, 12; cohort B, 86). Cohort A was closed prematurely because of poor accrual and is not reported. Seventy-nine eligible patients from cohort B form the basis of this report. At a median follow-up of 3.6 years, five patients did not have surgery because of disease progression. There were five local treatment failures, all of which were in field. Of the 57 patients assessed for late toxicities at 2 years, 10.5{\%} experienced at least one grade ≥ 2 toxicity as compared with 37{\%} of patients in the National Cancer Institute of Canada SR2 (CAN-NCIC-SR2: Phase III Randomized Study of Pre- vs Postoperative Radiotherapy in Curable Extremity Soft Tissue Sarcoma) trial receiving preoperative radiation therapy without IGRT (P < .001). Conclusion The significant reduction of late toxicities in patients with extremity STS who were treated with preoperative IGRT and absence of marginal-field recurrences suggest that the target volumes used in the Radiation Therapy Oncology Group RTOG-0630 (A Phase II Trial of Image-Guided Preoperative Radiotherapy for Primary Soft Tissue Sarcomas of the Extremity) study are appropriate for preoperative IGRT for extremity STS.",
author = "Dian Wang and Qiang Zhang and Eisenberg, {Burton L.} and Kane, {John M.} and Li, {X. Allen} and David Lucas and Petersen, {Ivy A} and DeLaney, {Thomas F.} and Freeman, {Carolyn R.} and Finkelstein, {Steven E.} and Hitchcock, {Ying J.} and Manpreet Bedi and Singh, {Anurag K.} and George Dundas and Kirsch, {David G.}",
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T1 - Significant reduction of late toxicities in patients with extremity sarcoma treated with image-guided radiation therapy to a reduced target volume

T2 - Results of radiation therapy oncology group RTOG-0630 trial

AU - Wang, Dian

AU - Zhang, Qiang

AU - Eisenberg, Burton L.

AU - Kane, John M.

AU - Li, X. Allen

AU - Lucas, David

AU - Petersen, Ivy A

AU - DeLaney, Thomas F.

AU - Freeman, Carolyn R.

AU - Finkelstein, Steven E.

AU - Hitchcock, Ying J.

AU - Bedi, Manpreet

AU - Singh, Anurag K.

AU - Dundas, George

AU - Kirsch, David G.

PY - 2015/7/10

Y1 - 2015/7/10

N2 - Purpose We performed a multi-institutional prospective phase II trial to assess late toxicities in patients with extremity soft tissue sarcoma (STS) treated with preoperative image-guided radiation therapy (IGRT) to a reduced target volume. Patients and Methods Patients with extremity STS received IGRT with (cohort A) or without (cohort B) chemotherapy followed by limb-sparing resection. Daily pretreatment images were coregistered with digitally reconstructed radiographs so that the patient position could be adjusted before each treatment. All patients received IGRT to reduced tumor volumes according to strict protocol guidelines. Late toxicities were assessed at 2 years. Results In all, 98 patients were accrued (cohort A, 12; cohort B, 86). Cohort A was closed prematurely because of poor accrual and is not reported. Seventy-nine eligible patients from cohort B form the basis of this report. At a median follow-up of 3.6 years, five patients did not have surgery because of disease progression. There were five local treatment failures, all of which were in field. Of the 57 patients assessed for late toxicities at 2 years, 10.5% experienced at least one grade ≥ 2 toxicity as compared with 37% of patients in the National Cancer Institute of Canada SR2 (CAN-NCIC-SR2: Phase III Randomized Study of Pre- vs Postoperative Radiotherapy in Curable Extremity Soft Tissue Sarcoma) trial receiving preoperative radiation therapy without IGRT (P < .001). Conclusion The significant reduction of late toxicities in patients with extremity STS who were treated with preoperative IGRT and absence of marginal-field recurrences suggest that the target volumes used in the Radiation Therapy Oncology Group RTOG-0630 (A Phase II Trial of Image-Guided Preoperative Radiotherapy for Primary Soft Tissue Sarcomas of the Extremity) study are appropriate for preoperative IGRT for extremity STS.

AB - Purpose We performed a multi-institutional prospective phase II trial to assess late toxicities in patients with extremity soft tissue sarcoma (STS) treated with preoperative image-guided radiation therapy (IGRT) to a reduced target volume. Patients and Methods Patients with extremity STS received IGRT with (cohort A) or without (cohort B) chemotherapy followed by limb-sparing resection. Daily pretreatment images were coregistered with digitally reconstructed radiographs so that the patient position could be adjusted before each treatment. All patients received IGRT to reduced tumor volumes according to strict protocol guidelines. Late toxicities were assessed at 2 years. Results In all, 98 patients were accrued (cohort A, 12; cohort B, 86). Cohort A was closed prematurely because of poor accrual and is not reported. Seventy-nine eligible patients from cohort B form the basis of this report. At a median follow-up of 3.6 years, five patients did not have surgery because of disease progression. There were five local treatment failures, all of which were in field. Of the 57 patients assessed for late toxicities at 2 years, 10.5% experienced at least one grade ≥ 2 toxicity as compared with 37% of patients in the National Cancer Institute of Canada SR2 (CAN-NCIC-SR2: Phase III Randomized Study of Pre- vs Postoperative Radiotherapy in Curable Extremity Soft Tissue Sarcoma) trial receiving preoperative radiation therapy without IGRT (P < .001). Conclusion The significant reduction of late toxicities in patients with extremity STS who were treated with preoperative IGRT and absence of marginal-field recurrences suggest that the target volumes used in the Radiation Therapy Oncology Group RTOG-0630 (A Phase II Trial of Image-Guided Preoperative Radiotherapy for Primary Soft Tissue Sarcomas of the Extremity) study are appropriate for preoperative IGRT for extremity STS.

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