Adjuvant volumetric modulated arc therapy compared to 3D conformal radiation therapy for newly diagnosed soft tissue sarcoma of the extremities: outcome and toxicity evaluation

Lucia Di Brina; Antonella Fogliata; Pierina Navarria; Giuseppe D'Agostino; Ciro Franzese; Davide Franceschini; Fiorenza De Rose; Tiziana Comito; Alexia Bertuzzi; Andrea Marrari; Piergiuseppe Colombo; Vittorio Quagliuolo; Armando Santoro; Marta Scorsetti

doi:10.1259/bjr.20190252

Adjuvant volumetric modulated arc therapy compared to 3D conformal radiation therapy for newly diagnosed soft tissue sarcoma of the extremities: outcome and toxicity evaluation

Lucia Di Brina, Antonella Fogliata, Pierina Navarria, Giuseppe D'Agostino, Ciro Franzese, Davide Franceschini, Fiorenza De Rose, Tiziana Comito, Alexia Bertuzzi, Andrea Marrari, Piergiuseppe Colombo, Vittorio Quagliuolo, Armando Santoro, Marta Scorsetti

Istituto Clinico Humanitas

Research output: Contribution to journal › Article

Abstract

OBJECTIVE: To assess the impact of adjuvant volumetric modulated arc therapy (VMAT) compared with three-dimensional conformal radiation therapy (3DCRT) in terms of toxicity and local control (LC) in patients with soft tissue sarcoma of the extremities.

METHODS: From 2004 to 2016, 109 patients were treated, initially using 3DCRT and subsequently with VMAT. Clinical outcome was evaluated by contrast-enhanced MRI, thoracic and abdominal CT 3 months after treatments and then every 6 months. Toxicity was evaluated with Common Terminology Criteria for Adverse Events scale v. 4.3.

RESULTS: Patients presented Stage III soft tissue sarcoma disease (77%), localized tumor (95%) at the lower extremity (87%), adipocytic histotype (46%). Surgical resection was performed in all patients, followed by adjuvant 3DCRT in 38, and VMAT in 71. The median total dose was 66 Gy/33 fractions (range 60-70 Gy;25-35 fractions). More successful bone sparing was recorded using VMAT (p < 0.001). Median follow-up was 61 months, 93 and 58 months for 3DCRT and VMAT group, respectively. The 2- and 5 year LC were 95.3±2.1%, and 87.4±3.4% for the whole cohort, 92.0±4.5%, 82.9±6.4% for 3DCRT, 97.1±2.0%, 89.6±4.1% for VMAT (p = 0.150). On univariate and multivariate analysis the factors recorded as conditioning LC were the status of the surgical resection margins (p = 0.028) and the total dose delivered (p = 0.013).

CONCLUSION: The availability of modern radiotherapy technique permit a better conformity on the target with maximum sparing of normal tissue and acceptable side-effects. VMAT is a safe and feasible treatment with limited rate of toxicity, compared to 3DCRT. Results on LC of VMAT are encouraging.

ADVANCES IN KNOWLEDGE: Soft tissue sarcoma of the extremities can benefit from the use of VMAT, with a reduction of the high dose to bones to avoid radiation osteonecrosis. An adequate total dose of at least 66 Gy and a radical surgical margin allow a good local control.

Original language	English
Pages (from-to)	20190252
Journal	The British journal of radiology
Volume	92
Issue number	1102
DOIs	https://doi.org/10.1259/bjr.20190252
Publication status	Published - Oct 2019

Keywords

Adolescent
Adult
Aged
Aged, 80 and over
Analysis of Variance
Contrast Media
Extremities
Female
Humans
Kaplan-Meier Estimate
Magnetic Resonance Imaging/methods
Male
Middle Aged
Radiation Injuries/etiology
Radiotherapy Dosage
Radiotherapy, Adjuvant/adverse effects
Radiotherapy, Conformal/adverse effects
Radiotherapy, Intensity-Modulated/adverse effects
Retrospective Studies
Sarcoma/diagnostic imaging
Young Adult

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Di Brina, L., Fogliata, A., Navarria, P., D'Agostino, G., Franzese, C., Franceschini, D., De Rose, F., Comito, T., Bertuzzi, A., Marrari, A., Colombo, P., Quagliuolo, V., Santoro, A., & Scorsetti, M. (2019). Adjuvant volumetric modulated arc therapy compared to 3D conformal radiation therapy for newly diagnosed soft tissue sarcoma of the extremities: outcome and toxicity evaluation. The British journal of radiology, 92(1102), 20190252. https://doi.org/10.1259/bjr.20190252

Adjuvant volumetric modulated arc therapy compared to 3D conformal radiation therapy for newly diagnosed soft tissue sarcoma of the extremities : outcome and toxicity evaluation. / Di Brina, Lucia ; Fogliata, Antonella ; Navarria, Pierina ; D'Agostino, Giuseppe ; Franzese, Ciro ; Franceschini, Davide ; De Rose, Fiorenza ; Comito, Tiziana ; Bertuzzi, Alexia ; Marrari, Andrea ; Colombo, Piergiuseppe ; Quagliuolo, Vittorio ; Santoro, Armando ; Scorsetti, Marta.

In: The British journal of radiology, Vol. 92, No. 1102, 10.2019, p. 20190252.

Research output: Contribution to journal › Article

Di Brina, L , Fogliata, A , Navarria, P , D'Agostino, G , Franzese, C , Franceschini, D , De Rose, F , Comito, T , Bertuzzi, A , Marrari, A , Colombo, P , Quagliuolo, V , Santoro, A & Scorsetti, M 2019, 'Adjuvant volumetric modulated arc therapy compared to 3D conformal radiation therapy for newly diagnosed soft tissue sarcoma of the extremities: outcome and toxicity evaluation', The British journal of radiology, vol. 92, no. 1102, pp. 20190252. https://doi.org/10.1259/bjr.20190252

Di Brina, Lucia ; Fogliata, Antonella ; Navarria, Pierina ; D'Agostino, Giuseppe ; Franzese, Ciro ; Franceschini, Davide ; De Rose, Fiorenza ; Comito, Tiziana ; Bertuzzi, Alexia ; Marrari, Andrea ; Colombo, Piergiuseppe ; Quagliuolo, Vittorio ; Santoro, Armando ; Scorsetti, Marta. / Adjuvant volumetric modulated arc therapy compared to 3D conformal radiation therapy for newly diagnosed soft tissue sarcoma of the extremities : outcome and toxicity evaluation. In: The British journal of radiology. 2019 ; Vol. 92, No. 1102. pp. 20190252.

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title = "Adjuvant volumetric modulated arc therapy compared to 3D conformal radiation therapy for newly diagnosed soft tissue sarcoma of the extremities: outcome and toxicity evaluation",

abstract = "OBJECTIVE: To assess the impact of adjuvant volumetric modulated arc therapy (VMAT) compared with three-dimensional conformal radiation therapy (3DCRT) in terms of toxicity and local control (LC) in patients with soft tissue sarcoma of the extremities.METHODS: From 2004 to 2016, 109 patients were treated, initially using 3DCRT and subsequently with VMAT. Clinical outcome was evaluated by contrast-enhanced MRI, thoracic and abdominal CT 3 months after treatments and then every 6 months. Toxicity was evaluated with Common Terminology Criteria for Adverse Events scale v. 4.3.RESULTS: Patients presented Stage III soft tissue sarcoma disease (77%), localized tumor (95%) at the lower extremity (87%), adipocytic histotype (46%). Surgical resection was performed in all patients, followed by adjuvant 3DCRT in 38, and VMAT in 71. The median total dose was 66 Gy/33 fractions (range 60-70 Gy;25-35 fractions). More successful bone sparing was recorded using VMAT (p < 0.001). Median follow-up was 61 months, 93 and 58 months for 3DCRT and VMAT group, respectively. The 2- and 5 year LC were 95.3±2.1%, and 87.4±3.4% for the whole cohort, 92.0±4.5%, 82.9±6.4% for 3DCRT, 97.1±2.0%, 89.6±4.1% for VMAT (p = 0.150). On univariate and multivariate analysis the factors recorded as conditioning LC were the status of the surgical resection margins (p = 0.028) and the total dose delivered (p = 0.013).CONCLUSION: The availability of modern radiotherapy technique permit a better conformity on the target with maximum sparing of normal tissue and acceptable side-effects. VMAT is a safe and feasible treatment with limited rate of toxicity, compared to 3DCRT. Results on LC of VMAT are encouraging.ADVANCES IN KNOWLEDGE: Soft tissue sarcoma of the extremities can benefit from the use of VMAT, with a reduction of the high dose to bones to avoid radiation osteonecrosis. An adequate total dose of at least 66 Gy and a radical surgical margin allow a good local control.",

keywords = "Adolescent, Adult, Aged, Aged, 80 and over, Analysis of Variance, Contrast Media, Extremities, Female, Humans, Kaplan-Meier Estimate, Magnetic Resonance Imaging/methods, Male, Middle Aged, Radiation Injuries/etiology, Radiotherapy Dosage, Radiotherapy, Adjuvant/adverse effects, Radiotherapy, Conformal/adverse effects, Radiotherapy, Intensity-Modulated/adverse effects, Retrospective Studies, Sarcoma/diagnostic imaging, Young Adult",

author = "{Di Brina}, Lucia and Antonella Fogliata and Pierina Navarria and Giuseppe D'Agostino and Ciro Franzese and Davide Franceschini and {De Rose}, Fiorenza and Tiziana Comito and Alexia Bertuzzi and Andrea Marrari and Piergiuseppe Colombo and Vittorio Quagliuolo and Armando Santoro and Marta Scorsetti",

year = "2019",

month = oct,

doi = "10.1259/bjr.20190252",

language = "English",

volume = "92",

pages = "20190252",

journal = "British Journal of Radiology",

issn = "0007-1285",

publisher = "British Institute of Radiology",

number = "1102",

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TY - JOUR

T1 - Adjuvant volumetric modulated arc therapy compared to 3D conformal radiation therapy for newly diagnosed soft tissue sarcoma of the extremities

T2 - outcome and toxicity evaluation

AU - Di Brina, Lucia

AU - Fogliata, Antonella

AU - Navarria, Pierina

AU - D'Agostino, Giuseppe

AU - Franzese, Ciro

AU - Franceschini, Davide

AU - De Rose, Fiorenza

AU - Comito, Tiziana

AU - Bertuzzi, Alexia

AU - Marrari, Andrea

AU - Colombo, Piergiuseppe

AU - Quagliuolo, Vittorio

AU - Santoro, Armando

AU - Scorsetti, Marta

PY - 2019/10

Y1 - 2019/10

N2 - OBJECTIVE: To assess the impact of adjuvant volumetric modulated arc therapy (VMAT) compared with three-dimensional conformal radiation therapy (3DCRT) in terms of toxicity and local control (LC) in patients with soft tissue sarcoma of the extremities.METHODS: From 2004 to 2016, 109 patients were treated, initially using 3DCRT and subsequently with VMAT. Clinical outcome was evaluated by contrast-enhanced MRI, thoracic and abdominal CT 3 months after treatments and then every 6 months. Toxicity was evaluated with Common Terminology Criteria for Adverse Events scale v. 4.3.RESULTS: Patients presented Stage III soft tissue sarcoma disease (77%), localized tumor (95%) at the lower extremity (87%), adipocytic histotype (46%). Surgical resection was performed in all patients, followed by adjuvant 3DCRT in 38, and VMAT in 71. The median total dose was 66 Gy/33 fractions (range 60-70 Gy;25-35 fractions). More successful bone sparing was recorded using VMAT (p < 0.001). Median follow-up was 61 months, 93 and 58 months for 3DCRT and VMAT group, respectively. The 2- and 5 year LC were 95.3±2.1%, and 87.4±3.4% for the whole cohort, 92.0±4.5%, 82.9±6.4% for 3DCRT, 97.1±2.0%, 89.6±4.1% for VMAT (p = 0.150). On univariate and multivariate analysis the factors recorded as conditioning LC were the status of the surgical resection margins (p = 0.028) and the total dose delivered (p = 0.013).CONCLUSION: The availability of modern radiotherapy technique permit a better conformity on the target with maximum sparing of normal tissue and acceptable side-effects. VMAT is a safe and feasible treatment with limited rate of toxicity, compared to 3DCRT. Results on LC of VMAT are encouraging.ADVANCES IN KNOWLEDGE: Soft tissue sarcoma of the extremities can benefit from the use of VMAT, with a reduction of the high dose to bones to avoid radiation osteonecrosis. An adequate total dose of at least 66 Gy and a radical surgical margin allow a good local control.

AB - OBJECTIVE: To assess the impact of adjuvant volumetric modulated arc therapy (VMAT) compared with three-dimensional conformal radiation therapy (3DCRT) in terms of toxicity and local control (LC) in patients with soft tissue sarcoma of the extremities.METHODS: From 2004 to 2016, 109 patients were treated, initially using 3DCRT and subsequently with VMAT. Clinical outcome was evaluated by contrast-enhanced MRI, thoracic and abdominal CT 3 months after treatments and then every 6 months. Toxicity was evaluated with Common Terminology Criteria for Adverse Events scale v. 4.3.RESULTS: Patients presented Stage III soft tissue sarcoma disease (77%), localized tumor (95%) at the lower extremity (87%), adipocytic histotype (46%). Surgical resection was performed in all patients, followed by adjuvant 3DCRT in 38, and VMAT in 71. The median total dose was 66 Gy/33 fractions (range 60-70 Gy;25-35 fractions). More successful bone sparing was recorded using VMAT (p < 0.001). Median follow-up was 61 months, 93 and 58 months for 3DCRT and VMAT group, respectively. The 2- and 5 year LC were 95.3±2.1%, and 87.4±3.4% for the whole cohort, 92.0±4.5%, 82.9±6.4% for 3DCRT, 97.1±2.0%, 89.6±4.1% for VMAT (p = 0.150). On univariate and multivariate analysis the factors recorded as conditioning LC were the status of the surgical resection margins (p = 0.028) and the total dose delivered (p = 0.013).CONCLUSION: The availability of modern radiotherapy technique permit a better conformity on the target with maximum sparing of normal tissue and acceptable side-effects. VMAT is a safe and feasible treatment with limited rate of toxicity, compared to 3DCRT. Results on LC of VMAT are encouraging.ADVANCES IN KNOWLEDGE: Soft tissue sarcoma of the extremities can benefit from the use of VMAT, with a reduction of the high dose to bones to avoid radiation osteonecrosis. An adequate total dose of at least 66 Gy and a radical surgical margin allow a good local control.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Analysis of Variance

KW - Contrast Media

KW - Extremities

KW - Female

KW - Humans

KW - Kaplan-Meier Estimate

KW - Magnetic Resonance Imaging/methods

KW - Male

KW - Middle Aged

KW - Radiation Injuries/etiology

KW - Radiotherapy Dosage

KW - Radiotherapy, Adjuvant/adverse effects

KW - Radiotherapy, Conformal/adverse effects

KW - Radiotherapy, Intensity-Modulated/adverse effects

KW - Retrospective Studies

KW - Sarcoma/diagnostic imaging

KW - Young Adult

U2 - 10.1259/bjr.20190252

DO - 10.1259/bjr.20190252

M3 - Article

C2 - 31322910

VL - 92

SP - 20190252

JO - British Journal of Radiology

JF - British Journal of Radiology

SN - 0007-1285

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ER -