An Effective Preoperative Three-Dimensional Radiotherapy Target Volume for Extremity Soft Tissue Sarcoma and the Effect of Margin Width on Local Control

BoKyong Kim, Yen Lin E Chen, David G. Kirsch, Saveli I. Goldberg, Wendy Kobayashi, Jong Hyun Kung, John A. Wolfgang, Karen Doppke, Andrew Rosenberg, G. Petur Nielsen, Kevin A. Raskin, Dempsey S. Springfield, Joseph H. Schwab, Mark C. Gebhardt, Sam S. Yoon, Francis J. Hornicek, Thomas F. DeLaney

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Purpose: There is little information on the appropriate three-dimensional (3D) preoperative radiotherapy (XRT) volume for extremity soft-tissue sarcomas (STS). We retrospectively analyzed the pattern of local failure (LF) to help elucidate optimal field design. Methods and Materials: We analyzed the 56 patients who underwent computed tomography-planned XRT for Stage I to III extremity STS between June 2000 and December 2006. Clinical target volume (CTV) included the T1 post-gadolinium-defined gross tumor volume with 1- to 1.5-cm radial and 3.5-cm longitudinal margins. Planning target volume expansion was 5 to 7 mm, and ≥95% of dose was delivered to the planning target volume. Preoperative XRT was 44 to 50.4 Gy (median, 50). Postoperative boost of 10 to 20 Gy was given to 12 patients (6 with positive and 6 with close margins). Results: Follow-up ranged from 15 to 76 months (median, 41 months). The 5-year local control, freedom from distant metastasis, disease-free survival, and overall survival were 88.5%, 80.0%, 77.5% and 82.8%, respectively. Three patients (all with positive margin) experienced local failure (LF) as first relapse (2 isolated, 1 with distant failure), and 2 additional patients (all with margin<1 mm) had late LF after distant metastasis. The LFs were within the CTV in 3 patients and within and also extending beyond the CTV in 2 patients. Conclusions: These target volume definitions appear to be appropriate for most patients. No local recurrences were observed with surgical margins ≥1 mm, and it appears that these may be adequate for patients with extremity STS treated with preoperative radiotherapy.

Original languageEnglish
Pages (from-to)843-850
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume77
Issue number3
DOIs
StatePublished - May 27 2010
Externally publishedYes

Fingerprint

Sarcoma
radiation therapy
margins
Radiotherapy
Extremities
cancer
metastasis
planning
Neoplasm Metastasis
Recurrence
Gadolinium
gadolinium
acceleration (physics)
Tumor Burden
Disease-Free Survival
tumors
tomography
Tomography
dosage
expansion

Keywords

  • Extremity
  • Local failure
  • Preoperative radiotherapy
  • Radiation volume
  • Soft tissue sarcomas

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

An Effective Preoperative Three-Dimensional Radiotherapy Target Volume for Extremity Soft Tissue Sarcoma and the Effect of Margin Width on Local Control. / Kim, BoKyong; Chen, Yen Lin E; Kirsch, David G.; Goldberg, Saveli I.; Kobayashi, Wendy; Kung, Jong Hyun; Wolfgang, John A.; Doppke, Karen; Rosenberg, Andrew; Nielsen, G. Petur; Raskin, Kevin A.; Springfield, Dempsey S.; Schwab, Joseph H.; Gebhardt, Mark C.; Yoon, Sam S.; Hornicek, Francis J.; DeLaney, Thomas F.

In: International Journal of Radiation Oncology Biology Physics, Vol. 77, No. 3, 27.05.2010, p. 843-850.

Research output: Contribution to journalArticle

Kim, B, Chen, YLE, Kirsch, DG, Goldberg, SI, Kobayashi, W, Kung, JH, Wolfgang, JA, Doppke, K, Rosenberg, A, Nielsen, GP, Raskin, KA, Springfield, DS, Schwab, JH, Gebhardt, MC, Yoon, SS, Hornicek, FJ & DeLaney, TF 2010, 'An Effective Preoperative Three-Dimensional Radiotherapy Target Volume for Extremity Soft Tissue Sarcoma and the Effect of Margin Width on Local Control', International Journal of Radiation Oncology Biology Physics, vol. 77, no. 3, pp. 843-850. https://doi.org/10.1016/j.ijrobp.2009.06.086
Kim, BoKyong ; Chen, Yen Lin E ; Kirsch, David G. ; Goldberg, Saveli I. ; Kobayashi, Wendy ; Kung, Jong Hyun ; Wolfgang, John A. ; Doppke, Karen ; Rosenberg, Andrew ; Nielsen, G. Petur ; Raskin, Kevin A. ; Springfield, Dempsey S. ; Schwab, Joseph H. ; Gebhardt, Mark C. ; Yoon, Sam S. ; Hornicek, Francis J. ; DeLaney, Thomas F. / An Effective Preoperative Three-Dimensional Radiotherapy Target Volume for Extremity Soft Tissue Sarcoma and the Effect of Margin Width on Local Control. In: International Journal of Radiation Oncology Biology Physics. 2010 ; Vol. 77, No. 3. pp. 843-850.
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abstract = "Purpose: There is little information on the appropriate three-dimensional (3D) preoperative radiotherapy (XRT) volume for extremity soft-tissue sarcomas (STS). We retrospectively analyzed the pattern of local failure (LF) to help elucidate optimal field design. Methods and Materials: We analyzed the 56 patients who underwent computed tomography-planned XRT for Stage I to III extremity STS between June 2000 and December 2006. Clinical target volume (CTV) included the T1 post-gadolinium-defined gross tumor volume with 1- to 1.5-cm radial and 3.5-cm longitudinal margins. Planning target volume expansion was 5 to 7 mm, and ≥95{\%} of dose was delivered to the planning target volume. Preoperative XRT was 44 to 50.4 Gy (median, 50). Postoperative boost of 10 to 20 Gy was given to 12 patients (6 with positive and 6 with close margins). Results: Follow-up ranged from 15 to 76 months (median, 41 months). The 5-year local control, freedom from distant metastasis, disease-free survival, and overall survival were 88.5{\%}, 80.0{\%}, 77.5{\%} and 82.8{\%}, respectively. Three patients (all with positive margin) experienced local failure (LF) as first relapse (2 isolated, 1 with distant failure), and 2 additional patients (all with margin<1 mm) had late LF after distant metastasis. The LFs were within the CTV in 3 patients and within and also extending beyond the CTV in 2 patients. Conclusions: These target volume definitions appear to be appropriate for most patients. No local recurrences were observed with surgical margins ≥1 mm, and it appears that these may be adequate for patients with extremity STS treated with preoperative radiotherapy.",
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AU - Kirsch, David G.

AU - Goldberg, Saveli I.

AU - Kobayashi, Wendy

AU - Kung, Jong Hyun

AU - Wolfgang, John A.

AU - Doppke, Karen

AU - Rosenberg, Andrew

AU - Nielsen, G. Petur

AU - Raskin, Kevin A.

AU - Springfield, Dempsey S.

AU - Schwab, Joseph H.

AU - Gebhardt, Mark C.

AU - Yoon, Sam S.

AU - Hornicek, Francis J.

AU - DeLaney, Thomas F.

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AB - Purpose: There is little information on the appropriate three-dimensional (3D) preoperative radiotherapy (XRT) volume for extremity soft-tissue sarcomas (STS). We retrospectively analyzed the pattern of local failure (LF) to help elucidate optimal field design. Methods and Materials: We analyzed the 56 patients who underwent computed tomography-planned XRT for Stage I to III extremity STS between June 2000 and December 2006. Clinical target volume (CTV) included the T1 post-gadolinium-defined gross tumor volume with 1- to 1.5-cm radial and 3.5-cm longitudinal margins. Planning target volume expansion was 5 to 7 mm, and ≥95% of dose was delivered to the planning target volume. Preoperative XRT was 44 to 50.4 Gy (median, 50). Postoperative boost of 10 to 20 Gy was given to 12 patients (6 with positive and 6 with close margins). Results: Follow-up ranged from 15 to 76 months (median, 41 months). The 5-year local control, freedom from distant metastasis, disease-free survival, and overall survival were 88.5%, 80.0%, 77.5% and 82.8%, respectively. Three patients (all with positive margin) experienced local failure (LF) as first relapse (2 isolated, 1 with distant failure), and 2 additional patients (all with margin<1 mm) had late LF after distant metastasis. The LFs were within the CTV in 3 patients and within and also extending beyond the CTV in 2 patients. Conclusions: These target volume definitions appear to be appropriate for most patients. No local recurrences were observed with surgical margins ≥1 mm, and it appears that these may be adequate for patients with extremity STS treated with preoperative radiotherapy.

KW - Extremity

KW - Local failure

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KW - Radiation volume

KW - Soft tissue sarcomas

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