Stereotactic Body Radiotherapy for Pulmonary Metastases from Soft Tissue Sarcomas: Excellent Local...
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2916 Radiotherapy for Angiosarcoma: The 35-Year University of Florida Experience M. Scott, L. Portnow, R. B. Marcus, N. P. Mendenhall, W. M. Mendenhall, D. J. Indelicato University of Florida, Gainesville, FL Purpose/Objective(s): Angiosarcoma is a rare but aggressive malignant vascular tumor often associated with prior radiotherapy. This study aimed to define prognostic factors and to identify successful therapeutic approaches in the treatment of angiosarcoma with radiation therapy (RT). Materials/Methods: Between 1964 and 2009, 41 patients with nonmetastatic, histologically proven angiosarcoma were treated with RT at the University of Florida. The median age of the patients was 67 years (range, 21 to 87 years). Sixteen of the 41 angio- sarcomas were considered radiation-induced. Twenty-two patients had angiosarcomas of the head and neck, including 9 of the scalp. Fourteen angiosarcomas were located on the breast or chest wall while 5 were located on the extremities, retroperitoneum, or deep soft tissues. Thirty-one patients were treated with both surgery and RT (12 with preoperative RT and 19 with postoperative RT), whereas 10 patients were treated with RT alone. The median RT dose was 60 Gy (range, 37.5 to 76 Gy). Sixteen patients were treated with RT once daily, 7 patients were treated twice daily, and 18 patients were treated three times daily. Two patients received adjuvant chemotherapy. The median follow-up was 44 months (range, 2 to 343 months). Results: The 5-year local control and overall survival rates were 64% and 54%, respectively. Of 23 patients who relapsed, 15 had a component of local failure: 11 had an isolated local recurrence and 4 occurred in conjunction with metastatic disease. The median time to a local failure was 1.5 years from RT and the longest time interval to a local failure was 10.2 years. Predictors of 5-year local control were non-scalp primary location (92% breast vs. 80% other vs. 60% non-scalp head and neck vs. 18% scalp; p \ 0.05), tumor size # 5 cm (76% vs. 26%; p \0.01), radiation-induced tumors versus de novo angiosarcoma (92% vs. 47%; p \ 0.01), and combined-modality local therapy (78% surgery + RT vs. 30% RT alone; p \0.01). Predictors of 5-year overall survival were non-scalp primary location (79% breast vs. 69% non-scalp head and neck vs. 20% other vs. 9% scalp; p \ 0.05) and tumor size # 5 cm (69% vs. 17%; p \ 0.05). With regard to both local control and overall survival, the most favorable cohort was com- prised of patients who were treated with radiotherapy three times daily combined with surgery for angiosarcoma of the breast. Conclusions: For angiosarcomas treated with radiotherapy, outcome varies widely and is most impacted by site, size, and resectability. In amenable sites, aggressive treatment with surgical resection and hyperfractionated radiation therapy may offer the best prognosis. Author Disclosure: M. Scott, None; L. Portnow, None; R.B. Marcus, None; N.P. Mendenhall, None; W.M. Mendenhall, None; D.J. Indelicato, None. 2917 Stereotactic Body Radiotherapy for Pulmonary Metastases from Soft Tissue Sarcomas: Excellent Local Lesion Control and Improved Patient Survival S. Dhakal 1 , K. S. Corbin 2 , M. T. Milano 1 , A. Philip 1 , D. Sahasrabudhe 1 , C. Jones 1 , P. Okunieff 1 , L. S. Constine 1 1 University of Rochester, Rochester, NY, 2 University of Chicago, Chicago, IL Purpose/Objective(s): Patients with pulmonary metastases (PM) from soft tissue sarcomas (STS) have historically been treated with surgery and/or chemotherapy; however, survival is limited. Since 2001 we have treated extracranial metastases from various primary malignancies with stereotactic body radiation therapy (SBRT) resulting in outstanding local control (LC), unexpectedly favorable overall survival (OS), and minimal toxicity. We postulated that SBRT for patients with PM from STS yields excellent LC and OS. Materials/Methods: The medical records of 52 of 54 consecutive adult patients with PM from STS seen at our institution from 1990-2006 were evaluated. Most patients received multi-modality treatment with some combination of surgery, chemotherapy, and/or radiation. Chemotherapy was usually anthracycline-based. Surgical procedures varied. SBRT used the Novalis ExacTrac patient positioning platform, vacuum bag immobilization, and relaxed end-expiratory breath holding techniques. The PTV = GTV + 7-10 mm; dose was prescribed to the isocenter, usually 50 Gy in 10 fractions. Lesion growth $20% was considered a local failure (LF). Actuarial LC and OS were calculated using the Kaplan-Meier Method. LC was calculated from end of SBRT to LF or last CT scan; OS was calculated from diagnosis of PM to death or last follow-up. Results: Median age at diagnosis was 56 (range, 18-88) years. Extremities were the most frequent site (60%) of initial presen- tation. Leiomyosarcoma (23%), MFH (19%), and synovial sarcoma (15%) were the most common histologies. 48% percent of patients initially presented with PM, with the remainder developing PM at a median of 0.7 (range, 0.3-7.3) years after initial diagnosis. Median follow-up from diagnosis of PM was 0.9 (range, 0.3-7.3) years. 14 patients underwent SBRT, with 74 lesions treated. The median number of lesions treated per patient was 4 (range, 1-16) while the median number of lesions treated per session was 3.5 (range, 1-6). The 3-year actuarial LC was 82%. No patients experienced grade 3 or higher toxicity. Median OS was 2.1 (range, 0.8-11.5) years for patients treated with SBRT and 0.6 (0.1-7.8) years for those who never received SBRT (p value = 0.002). Conclusions: While survival for patients with PM from STS is generally limited, many are palliated and a subset experience pro- longed survival or possibly cure. SBRT provided excellent LC of PM and may extend OS. Although selection bias clearly exists, it occurs in both directions: some patients referred for SBRT had PM with favorable size, location, and/or number, while others were not candidates for resection due to comorbid conditions and/or the distribution, location, and/or size of PM. We are establishing criteria for the use of SBRT for STS patients with PM. Author Disclosure: S. Dhakal, None; K.S. Corbin, None; M.T. Milano, None; A. Philip, None; D. Sahasrabudhe, None; C. Jones, None; P. Okunieff, None; L.S. Constine, None. 2918 Femoral Fractures following Limb-sparing Surgery and Radiotherapy for Soft Tissue Sarcoma of the Proximal Lower-Extremity: Importance of Prophylactic Intramedullary Nail Stabilization E. Liu, A. Sabolch, D. Pak, J. Biermann, E. Ben-Josef, M. Feng University of Michigan Medical Center, Ann Arbor, MI S614 I. J. Radiation Oncology d Biology d Physics Volume 78, Number 3, Supplement, 2010
Transcript of Stereotactic Body Radiotherapy for Pulmonary Metastases from Soft Tissue Sarcomas: Excellent Local...
S614 I. J. Radiation Oncology d Biology d Physics Volume 78, Number 3, Supplement, 2010
2916 Radiotherapy for Angiosarcoma: The 35-Year University of Florida Experience
M. Scott, L. Portnow, R. B. Marcus, N. P. Mendenhall, W. M. Mendenhall, D. J. Indelicato
University of Florida, Gainesville, FL
Purpose/Objective(s): Angiosarcoma is a rare but aggressive malignant vascular tumor often associated with prior radiotherapy.This study aimed to define prognostic factors and to identify successful therapeutic approaches in the treatment of angiosarcomawith radiation therapy (RT).
Materials/Methods: Between 1964 and 2009, 41 patients with nonmetastatic, histologically proven angiosarcoma were treatedwith RT at the University of Florida. The median age of the patients was 67 years (range, 21 to 87 years). Sixteen of the 41 angio-sarcomas were considered radiation-induced. Twenty-two patients had angiosarcomas of the head and neck, including 9 of thescalp. Fourteen angiosarcomas were located on the breast or chest wall while 5 were located on the extremities, retroperitoneum,or deep soft tissues. Thirty-one patients were treated with both surgery and RT (12 with preoperative RT and 19 with postoperativeRT), whereas 10 patients were treated with RT alone. The median RT dose was 60 Gy (range, 37.5 to 76 Gy). Sixteen patients weretreated with RT once daily, 7 patients were treated twice daily, and 18 patients were treated three times daily. Two patients receivedadjuvant chemotherapy. The median follow-up was 44 months (range, 2 to 343 months).
Results: The 5-year local control and overall survival rates were 64% and 54%, respectively. Of 23 patients who relapsed, 15 hada component of local failure: 11 had an isolated local recurrence and 4 occurred in conjunction with metastatic disease. The mediantime to a local failure was 1.5 years from RT and the longest time interval to a local failure was 10.2 years. Predictors of 5-year localcontrol were non-scalp primary location (92% breast vs. 80% other vs. 60% non-scalp head and neck vs. 18% scalp; p\ 0.05),tumor size # 5 cm (76% vs. 26%; p \0.01), radiation-induced tumors versus de novo angiosarcoma (92% vs. 47%; p \ 0.01),and combined-modality local therapy (78% surgery + RT vs. 30% RT alone; p\0.01). Predictors of 5-year overall survivalwere non-scalp primary location (79% breast vs. 69% non-scalp head and neck vs. 20% other vs. 9% scalp; p \ 0.05) and tumorsize # 5 cm (69% vs. 17%; p\0.05). With regard to both local control and overall survival, the most favorable cohort was com-prised of patients who were treated with radiotherapy three times daily combined with surgery for angiosarcoma of the breast.
Conclusions: For angiosarcomas treated with radiotherapy, outcome varies widely and is most impacted by site, size, andresectability. In amenable sites, aggressive treatment with surgical resection and hyperfractionated radiation therapy may offerthe best prognosis.
Author Disclosure: M. Scott, None; L. Portnow, None; R.B. Marcus, None; N.P. Mendenhall, None; W.M. Mendenhall, None; D.J.Indelicato, None.
2917 Stereotactic Body Radiotherapy for Pulmonary Metastases from Soft Tissue Sarcomas: Excellent Local
Lesion Control and Improved Patient SurvivalS. Dhakal1, K. S. Corbin2, M. T. Milano1, A. Philip1, D. Sahasrabudhe1, C. Jones1, P. Okunieff1, L. S. Constine1
1University of Rochester, Rochester, NY, 2University of Chicago, Chicago, IL
Purpose/Objective(s): Patients with pulmonary metastases (PM) from soft tissue sarcomas (STS) have historically been treated withsurgery and/or chemotherapy; however, survival is limited. Since 2001 we have treated extracranial metastases from various primarymalignancies with stereotactic body radiation therapy (SBRT) resulting in outstanding local control (LC), unexpectedly favorableoverall survival (OS), and minimal toxicity. We postulated that SBRT for patients with PM from STS yields excellent LC and OS.
Materials/Methods: The medical records of 52 of 54 consecutive adult patients with PM from STS seen at our institution from1990-2006 were evaluated. Most patients received multi-modality treatment with some combination of surgery, chemotherapy,and/or radiation. Chemotherapy was usually anthracycline-based. Surgical procedures varied. SBRT used the Novalis ExacTracpatient positioning platform, vacuum bag immobilization, and relaxed end-expiratory breath holding techniques. The PTV =GTV + 7-10 mm; dose was prescribed to the isocenter, usually 50 Gy in 10 fractions. Lesion growth $20% was considered a localfailure (LF). Actuarial LC and OS were calculated using the Kaplan-Meier Method. LC was calculated from end of SBRT to LF orlast CT scan; OS was calculated from diagnosis of PM to death or last follow-up.
Results: Median age at diagnosis was 56 (range, 18-88) years. Extremities were the most frequent site (60%) of initial presen-tation. Leiomyosarcoma (23%), MFH (19%), and synovial sarcoma (15%) were the most common histologies. 48% percent ofpatients initially presented with PM, with the remainder developing PM at a median of 0.7 (range, 0.3-7.3) years after initialdiagnosis. Median follow-up from diagnosis of PM was 0.9 (range, 0.3-7.3) years. 14 patients underwent SBRT, with 74 lesionstreated. The median number of lesions treated per patient was 4 (range, 1-16) while the median number of lesions treated persession was 3.5 (range, 1-6). The 3-year actuarial LC was 82%. No patients experienced grade 3 or higher toxicity. MedianOS was 2.1 (range, 0.8-11.5) years for patients treated with SBRT and 0.6 (0.1-7.8) years for those who never receivedSBRT (p value = 0.002).
Conclusions: While survival for patients with PM from STS is generally limited, many are palliated and a subset experience pro-longed survival or possibly cure. SBRT provided excellent LC of PM and may extend OS. Although selection bias clearly exists, itoccurs in both directions: some patients referred for SBRT had PM with favorable size, location, and/or number, while others werenot candidates for resection due to comorbid conditions and/or the distribution, location, and/or size of PM. We are establishingcriteria for the use of SBRT for STS patients with PM.
Author Disclosure: S. Dhakal, None; K.S. Corbin, None; M.T. Milano, None; A. Philip, None; D. Sahasrabudhe, None; C. Jones,None; P. Okunieff, None; L.S. Constine, None.
2918 Femoral Fractures following Limb-sparing Surgery and Radiotherapy for Soft Tissue Sarcoma of the
Proximal Lower-Extremity: Importance of Prophylactic Intramedullary Nail StabilizationE. Liu, A. Sabolch, D. Pak, J. Biermann, E. Ben-Josef, M. Feng
University of Michigan Medical Center, Ann Arbor, MI
