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Abdou M, Bogan AW, Thangaiah JJ, Grover AC, Ahmed SK, Houdek MT, Haddock MG, Pyfferoen BA, Petersen IA. Myxofibrosarcoma: Outcomes, Prognostic Factors, and Role of Neoadjuvant Radiation Therapy. Adv Radiat Oncol 2024; 9:101485. [PMID: 38681890 PMCID: PMC11043815 DOI: 10.1016/j.adro.2024.101485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/25/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose Myxofibrosarcoma (MFS) is a subtype of soft tissue sarcoma with a highly infiltrative growth pattern that leads to a higher risk of inadvertent positive surgical margins and local relapse. Poorly defined tumor margins also pose a challenge for radiation therapy (RT) planning, in terms of treatment volumes and administration of pre- versus postoperative RT. This study aims to evaluate local control and patterns of recurrence in patients with MFS treated with neoadjuvant RT followed by definitive surgical excision. Methods and Materials Multiple institutional databases were retrospectively searched for patients diagnosed with MFS between 2013 and 2021 who were exclusively treated with preoperative RT followed by definitive surgery at our institution. The endpoints of the study were defined as local tumor recurrence, distant metastasis, and death after the date of definitive surgery. Results Forty-nine patients met the inclusion criteria and were included in the final study. The median age at diagnosis was 67 years, and 71% of patients were male. The tumor was superficially located in 63% of patients, and the mean tumor size at presentation was 7.8 cm. All patients received neoadjuvant RT and completed their planned course of treatment. Neoadjuvant chemotherapy was administered in 22% of patients. Inadvertent excision (IE) before definitive treatment was performed in 25 patients (51%), 84% of which had superficially located tumors. All margins were assessed using frozen section analysis at the time of definitive surgery, and 100% of patients had negative surgical margins, with 25% having no residual tumor. With a median follow-up of 4.7 years, the 5-year local control rate was 87%, and 5-year overall survival was 98%. Tumor depth was associated with distant metastasis (P < .01). Conclusions Despite the infiltrative nature of MFS, preoperative RT followed by definitive surgical excision, especially in the setting of a reliable frozen section margin analysis, was associated with excellent local control.
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Affiliation(s)
- Maya Abdou
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - Aaron W. Bogan
- Department of Quantitative Health Sciences, Division of Biostatistics, Mayo Clinic, Scottsdale, Arizona
| | | | - Autumn C. Grover
- Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Safia K. Ahmed
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
| | | | | | | | - Ivy A. Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Shah SM, Tanke LB, Deufel CL, Petersen IA, Corbin KS, Hodge DO, Olsen TW, Dalvin LA. Central subfield thickness predicts visual acuity outcomes in plaque-irradiated eyes with choroidal melanoma. Graefes Arch Clin Exp Ophthalmol 2024; 262:1305-1320. [PMID: 37950755 DOI: 10.1007/s00417-023-06313-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/13/2023] Open
Abstract
OBJECTIVE To determine the association between pre-operative central subfield thickness (CST) and post-radiotherapy visual acuity (VA), cystoid macular edema (CME), and intravitreal anti-vascular endothelial growth factor (VEGF) requirement. DESIGN Single-center retrospective study. PARTICIPANTS Patients with plaque-irradiated extramacular choroidal melanoma treated between 11/11/2011 and 4/30/2021. Pre-operative CST difference between the affected and unaffected eye was used. Kaplan-Meier analysis and hazard ratios were calculated. RESULTS Of 85 patients, pre-operative CST was greater in the melanoma-affected eye (vs. fellow eye) by mean of 20.4 μm (median 14.0, range - 60.0-182.0). Greater CST at presentation (vs. fellow eye) was associated with larger tumor diameter (p = 0.02), greater tumor thickness (p < 0.001), and more frequent tumor-related Bruch's membrane rupture (p = 0.006). On univariate analysis of outcome data, greater CST at presentation (vs. fellow eye) was associated with higher 5-year risk (1.09 [1.02-1.17], p = 0.02) of VA 20/200 or worse and increased (1.10 [1.01-1.20], p = 0.03) likelihood for anti-VEGF injections after plaque irradiation. There was no significant association with CME. The association between CST and VA outcome remained significant on multivariate analysis accounting for impact of tumor thickness and radiation dose to optic disc, while tumor distance to fovea was the only significant factor on multivariate analysis for anti-VEGF injections. CONCLUSION Greater CST at presentation (vs. fellow eye) was associated with worse VA outcome following plaque radiotherapy for choroidal melanoma. Large-sized tumors may contribute to a higher intraocular VEGF burden, potentially leading to greater preoperative CST, which correlates with poor VA outcome post-plaque radiotherapy.
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Affiliation(s)
- Saumya M Shah
- Department of Ophthalmology, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA
| | - Laurel B Tanke
- Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA
| | - Christopher L Deufel
- Department of Radiation Oncology, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA
| | - Kimberly S Corbin
- Department of Radiation Oncology, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA
| | - David O Hodge
- Department of Biomedical Statistics and Informatics, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA
| | - Timothy W Olsen
- Department of Ophthalmology, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA.
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Deufel C, Dodoo C, Kavanaugh J, Finley R, Lang K, Sorenson K, Spreiter S, Brooks J, Moseley D, Ahmed SK, Haddock MG, Ma D, Park SS, Petersen IA, Owen DW, Grams MP. Automated target placement for VMAT lattice radiation therapy: enhancing efficiency and consistency. Phys Med Biol 2024; 69:075010. [PMID: 38422544 DOI: 10.1088/1361-6560/ad2ee8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/29/2024] [Indexed: 03/02/2024]
Abstract
Objective. An algorithm was developed for automated positioning of lattice points within volumetric modulated arc lattice radiation therapy (VMAT LRT) planning. These points are strategically placed within the gross tumor volume (GTV) to receive high doses, adhering to specific separation rules from adjacent organs at risk (OARs). The study goals included enhancing planning safety, consistency, and efficiency while emulating human performance.Approach. A Monte Carlo-based algorithm was designed to optimize the number and arrangement of lattice points within the GTV while considering placement constraints and objectives. These constraints encompassed minimum spacing between points, distance from OARs, and longitudinal separation along thez-axis. Additionally, the algorithm included an objective to permit, at the user's discretion, solutions with more centrally placed lattice points within the GTV. To validate its effectiveness, the automated approach was compared with manually planned treatments for 24 previous patients. Prior to clinical implementation, a failure mode and effects analysis (FMEA) was conducted to identify potential shortcomings.Main results.The automated program successfully met all placement constraints with an average execution time (over 24 plans) of 0.29 ±0.07 min per lattice point. The average lattice point density (# points per 100 c.c. of GTV) was similar for automated (0.725) compared to manual placement (0.704). The dosimetric differences between the automated and manual plans were minimal, with statistically significant differences in certain metrics like minimum dose (1.9% versus 1.4%), D5% (52.8% versus 49.4%), D95% (7.1% versus 6.2%), and Body-GTV V30% (20.7 c.c. versus 19.7 c.c.).Significance.This study underscores the feasibility of employing a straightforward Monte Carlo-based algorithm to automate the creation of spherical target structures for VMAT LRT planning. The automated method yields similar dose metrics, enhances inter-planner consistency for larger targets, and requires fewer resources and less time compared to manual placement. This approach holds promise for standardizing treatment planning in prospective patient trials and facilitating its adoption across centers seeking to implement VMAT LRT techniques.
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Affiliation(s)
- Christopher Deufel
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Christopher Dodoo
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ 85259, United States of America
| | - James Kavanaugh
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Randi Finley
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Karen Lang
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Kasie Sorenson
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Sheri Spreiter
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Jamison Brooks
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Douglas Moseley
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Safia K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ 85259, United States of America
| | - Michael G Haddock
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Daniel Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Dawn W Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Michael P Grams
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
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Ahmed SK, Petersen IA, Grams MP, Finley RR, Haddock MG, Owen D. Spatially Fractionated Radiation Therapy in Sarcomas: A Large Single-Institution Experience. Adv Radiat Oncol 2024; 9:101401. [PMID: 38495033 PMCID: PMC10943518 DOI: 10.1016/j.adro.2023.101401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/16/2023] [Indexed: 03/19/2024] Open
Abstract
Purpose Spatially fractionated radiation therapy (SFRT) is a recognized technique for enhancing tumor response in radioresistant and bulky tumors. We analyzed clinical and treatment outcomes in patients with bone and soft tissue sarcomas treated with modern SFRT techniques. Methods and Materials Patients with metastatic or unresectable sarcoma treated with brass collimator, volumetric modulated arc therapy lattice, or proton SFRT from December 2019 to June 2022 were retrospectively reviewed. Consolidative external beam radiation therapy (EBRT) was delivered at the physician's discretion. Patient and treatment characteristics, treatment response (symptom improvement, local control, and imaging response), and toxicity data were collected. Results The cohort consisted of 53 patients treated with 61 SFRT treatments. Median age at treatment was 60.0 years. The primary location was soft tissue in 46 courses (75%) and bone in 15 (25%). Fifty-three courses (87%) were treated for symptom relief. The most used SFRT technique was volumetric modulated arc therapy lattice (n = 52, 85%) to a dose of 20 Gy (n = 48, 79%; range, 16-20 Gy). EBRT was delivered post-SFRT in 55 (90%) treatment courses with a median time interval from SFRT to EBRT of 5 days (range, 0-14 days). Median physical EBRT dose and fractionation was 40 Gy (range, 9-73.5 Gy) and 10 fractions (range, 3-33 fractions). Median follow up was 7.4 months (range, 0.2-30 months). One-year overall survival and local control rates were 53% and 82%. Symptom relief was documented with 32 treatment courses (60%). Stable or partial response was observed with 47 treatment courses (90%). Four grade 3 to 4 acute and subacute toxicities were attributable to SFRT (8%). Conclusions The current series is the largest to date documenting outcomes for SFRT in sarcomas. Our results suggest combined SFRT with EBRT is associated with a favorable toxicity profile and high rates of symptomatic and radiographic responses for metastatic or unresectable sarcomas.
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Affiliation(s)
- Safia K. Ahmed
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Ivy A. Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Michael P. Grams
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Randi R. Finley
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Laughlin BS, Zaniletti I, Vern-Gross T, Van Der Walt C, Allen-Rhoades W, Polites S, Rose PS, Ashman JB, Petersen IA, Haddock MG, Mahajan A, Keole SR, Laack NN, Ahmed SK. Clinical Outcomes for Chest Wall Ewing Sarcoma: A Multi-Center Single Institution Experience. Int J Radiat Oncol Biol Phys 2023; 117:e525. [PMID: 37785633 DOI: 10.1016/j.ijrobp.2023.06.1799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We report tumor and treatment characteristics, oncologic outcomes, and treatment-associated toxicities in a cohort of chest wall Ewing sarcoma (cwES) patients treated at a single tertiary care institution. MATERIALS/METHODS After IRB approval, patients with cwES treated from 1997-2022 were retrospectively reviewed. Patient, tumor, treatment, outcomes, and toxicity data were abstracted. Local control (LC), progression-free survival (PFS), and overall survival (OS) were defined from end of treatment and assessed using the Kaplan-Meier method. Log-rank test and unadjusted Cox models were performed to determine factors associated with outcomes. RESULTS The cohort includes 45 patients. Median age at diagnosis was 19.8 years (range: 3.5 - 57.8 years). Five patients (11.1%) presented with pleural effusion and eight patients with lung metastases (17.8%). Two (4.4%) patients had metastatic disease outside the thorax. Median tumor volume (TV) was 138.6 mL (range: 3.0-6762.0 mL). All patients received VDC/IE chemotherapy. LC modality was surgery (S) in 21 patients (47%), radiation therapy (RT) in 5 (11%), and S+RT in 19 (42%). Median TV was larger in S+RT patients (319.4 mL, range: 5.3-6761.9 mL) compared to RT (152.3 mL, range: 20.4-366.9 mL) or S (70.4 mL, range: 3.1-1037.8 mL) (p = 0.03). R0 and R1 resections were performed in 36 (90%) and 4 (10%) patients, respectively. Proton beam therapy was used in 15 (63%) patients. Median dose was 50.40 Gy (range: 34.2 - 60 Gy) in 28 fractions to the primary tumor or post operative bed. Median dose for hemithorax (1 patient, 2.2%) and whole lung irradiation (7 patients, 15.6%) was 15.0 Gy (range: 15.0-15.0 Gy) in 10 fractions. Median follow-up was 2.38 years (range: 0 - 21.90 years). Five-year LC, PFS, and OS for all patients was 77.9% (95% CI, 65.3 - 92.9%), 54.2% (95% CI, 39.9 - 73.5%), and 63.5% (95% CI, 49.3 - 81.8%), respectively. In patients with localized disease, 5-year LC, PFS, and OS were 82.4% (95% CI, 67.9-99.8%), 66.4% (95% CI, 49.7-88.8%), and 71.3% (95% CI, 54.2-93.9%), respectively. Two-year LC by modality was 100% for RT (95% CI, 100-100%), 84.2% (95% CI, 69.3- 100%) for S and 73.3% (95% CI, 54 - 99.5%) for S+RT (p = 0.51). On univariate analysis, TV ≥ 200 mL was associated with a significantly worse 5-year OS (49.5%, TV ≥ 200 mL vs. 80.8%, TV < 200 mL; HR 4.44, p = 0.032) and PFS (35.2%, TV ≥ 200 mL vs. 76%, TV < 200 mL; HR 3.55, p = 0.025). TV ≥ 200 mL trended towards worse 5-year LC: 69.2% for TV ≥ 200 mL versus 81.5% for TV <200 mL [HR 2.26(95% CI 0.49 - 10.47), p = 0.287]. Overall, low rates of grade ≥2 toxicity were observed: 4 (8.9%) fatigue, 4 (8.9%) radiation dermatitis, 1 (2.2%) chyle leak, 3 (6.6%) scoliosis, 4 (8.9%) infection, 1 (2.2%) pneumonia, and 1 (2.2%) chest wall deformity. CONCLUSION RT is a safe, effective local therapy for small to moderate cwES tumors. Patients with TV ≥ 200 mL had significantly worse survival outcomes and an inferior LC rate. This suggests large cwES tumors may benefit from an aggressive multi-modality approach.
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Affiliation(s)
- B S Laughlin
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - I Zaniletti
- Department of Quantitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ
| | - T Vern-Gross
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - C Van Der Walt
- Department of Quantitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ
| | - W Allen-Rhoades
- Department of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, MN
| | - S Polites
- Department of Pediatric Surgery, Mayo Clinic, Rochester, MN
| | - P S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - J B Ashman
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - I A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - M G Haddock
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - A Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S R Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - N N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
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Gunn HJ, DeWees TA, Voss MM, Corbin KS, Hallemeier CL, Stish BJ, Haddock MG, Petersen IA, Rule WG, Vallow LA, Brown PD, Olivier K, Trifiletti DM, Vargas CE, Ma DJ. Sensitivity of the PROMIS-10 for Capturing Radiation-Related Quality of Life Changes. Int J Radiat Oncol Biol Phys 2023; 117:e232-e233. [PMID: 37784929 DOI: 10.1016/j.ijrobp.2023.06.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patient reported outcomes (PROs) are becoming more common when assessing the effects of radiotherapy (RT). The aim of this study was to assess the sensitivity of the Mental and Physical domains of the Patient-Reported Outcomes Measurement Information System 10 (PROMIS-10) to radiotherapy and determine what predictors were associated with change in quality of life. MATERIALS/METHODS Patients, regardless of cancer type, were enrolled on a multi-site prospective registry. Inclusion criteria included curative radiotherapy and completion of the PROMIS-10 prior to treatment (Baseline) and at End of Treatment (EOT). To assess the strongest predictors of change in the T score of mental and physical health, we included 14 demographic characteristics and treatment variables in a multivariable stepwise regression. RESULTS A total of 7,586 patients were eligible for the analysis. The median age was 65 (range 18-94), 54% were males, and 94% were white. A majority received photons (62.5%) and the others received protons (37.5%) with an average dose of 52.3 Gy (range 20-80 Gy) over an average of 22.6 fractions (range 1-66). Patient disease sites were sub-grouped into 12 categories: Breast (25.5%), GU (23.0%), H&N (11.1%), CNS (8.5%), Pancreas-Biliary (6.7%), Thoracic (5.7%), Soft Tissue/Bone (5.0%), Esophagus-Gastric (4.7%), Colorectal-Anus (4.4%), Heme/Lymph (2.6%), GYN (1.8%), and Skin/Melanoma (1.0%). For both outcomes, the model selected disease group as an important predictor and it explained the most variance in the outcome compared to the rest of the predictors. When probing the effect of disease group, H&N, Esophagus-Gastric, Skin/Melanoma, and Colorectal-Anus had the largest mean decrease in quality of life for both domains. For mental health, the model also selected radiation type. Patients treated with protons indicated a bigger decrease in mental health compared to patients treated with photons (b = 0.43, 95% CI: -0.01, 0.69). For physical health, the model selected total fractions, ethnicity, and T stage. As number of fractions increased, the physical health change scores became more negative, on average (b = -0.03, 95% CI: -0.05, -0.01). Hispanic/Latino patients indicated a smaller decrease in physical health compared to White (b = -1.50, 95% CI: -2.60, -0.40) and Unknown ethnicity patients (b = -1.82, 95% CI: -3.36, -0.27). Finally, patients with a T stage of 3 or greater indicated a smaller decrease in physical health than patients with a T stage less than 3 (b = 0.76, 95% CI: 0.35, 1.16). CONCLUSION The PROMIS-10 did not capture significant change for patients undergoing curative radiotherapy except for patients with Head & Neck, Esophagus-Gastric, Skin, and Colorectal-Anus cancer. Further analyses should explore which patients experience the greatest change in quality of life within disease group.
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Affiliation(s)
| | - T A DeWees
- Department of Qualitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ
| | - M M Voss
- Department of Quantitative Health Sciences, Mayo Clinic, Arizona, Phoenix, AZ
| | - K S Corbin
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - B J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - M G Haddock
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - I A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - W G Rule
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - L A Vallow
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - P D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - K Olivier
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - D M Trifiletti
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - C E Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - D J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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Gergelis KR, Bogan AW, DeWees TA, Haddock MG, Glaser GE, Kumar A, Petersen IA, Garda AE. Assessing the Sexual Health of Female Survivors of Pelvic Malignancies after Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e231. [PMID: 37784927 DOI: 10.1016/j.ijrobp.2023.06.1146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To assess patient-reported sexual health outcomes of female survivors of pelvic malignancies after radiotherapy (RT). MATERIALS/METHODS Female patients treated with curative intent RT for pelvic malignancies between 2013 and 2019 were surveyed electronically post-RT using the PROMIS Sexual Function and Satisfaction Full Profile and Female Sexual Distress Scale-Revised questionnaires. Cervical and vaginal cancers were grouped together due to the similar treatment characteristics. RESULTS Surveys were sent to 544 patients, and 53 (10%) completed the questionnaires. Respondents included survivors of anal canal (N = 11), cervical or vaginal (N = 10), uterine (N = 30), and vulvar cancers (N = 2). The median age of patients at the time of treatment was 60 years (range 31,77). The median time between RT and survey completion was 6 years (range 3,9). A total of 22 (42%), 17 (32%), and 14 patients (26%) were treated with brachytherapy (BT), external beam RT (EBRT), or a combination of EBRT and BT, respectively. Of respondents, 96% were free of disease recurrence. Sexually active was defined as partaking in sexual activity within 30 days of survey response. Patients were stratified by age greater than or less than 52 at time of RT, representing the average age of menopause. A total of 30 patients (57%) had at least somewhat interest in sex. There was no difference in the proportion of patients who had at least somewhat interest in sex over 52 years compared to those 52 and (54% vs 67%, p = 0.424). A total of 39 patients (74%) were sexually active, and of those 30 (77%) were over the age of 52 at the time of RT. Of sexually active patients, 28 (72%) reported some, quite a bit, or a lot of satisfaction with their sex lives, whereas the remaining 11 (28%) reported having none or a little bit of satisfaction with their sex lives; the proportion of those with at least some satisfaction with their sex lives did not differ between those who were over or under 52 years at the time of RT (73% vs 67%, p = 0.697). Satisfaction with sex life differed by site of malignancy with 71% cervical or vaginal, 44% anal canal, 86% uterine, and 0% vulvar patients reporting at least some satisfaction (p = 0.043). Patients treated for anal canal cancer tended to have quite a bit or a lot of vaginal discomfort during sex (78%), compared to those treated for cervical/vaginal (29%), or endometrial (18%) cancers (p = 0.006). There was no difference in patients feeling frequently or always stressed about sex between those who were sexually active compared to those who were not (13% vs 14%, p = 0.890). Patients 52 or under at the time of RT were more likely to feel frequently or always stressed about sex compared to those receiving RT over the age of 52 (42% vs 5%, p<0.001). CONCLUSION In our cohort, the majority of female survivors of pelvic malignancies were sexually active post-RT, and this important topic warrants further investigation.
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Affiliation(s)
- K R Gergelis
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Wilmot Cancer Institute, Rochester, NY
| | - A W Bogan
- Department of Qualitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ
| | - T A DeWees
- Department of Qualitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ
| | - M G Haddock
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - G E Glaser
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Rochester, MN
| | - A Kumar
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Rochester, MN
| | - I A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - A E Garda
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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Degnim AC, Siontis BL, Ahmed SK, Hoskin TL, Hieken TJ, Jakub JW, Baum CL, Day C, Schrup SE, Smith L, Carter JM, Sae Kho TM, Glazebrook KN, Vijayasekaran A, Okuno SH, Petersen IA. Trimodality Therapy Improves Disease Control in Radiation-Associated Angiosarcoma of the Breast. Clin Cancer Res 2023; 29:2885-2893. [PMID: 37223927 DOI: 10.1158/1078-0432.ccr-23-0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/07/2023] [Accepted: 05/16/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE To evaluate the impact of trimodality treatment versus monotherapy or dual therapy for radiation-associated angiosarcoma of the breast (RAASB) after prior breast cancer treatment. EXPERIMENTAL DESIGN With Institutional Review Board approval, we identified patients diagnosed with RAASB and abstracted data on disease presentation, treatment, and oncologic outcomes. Trimodality therapy included (i) taxane induction, (ii) concurrent taxane/radiation, and then (iii) surgical resection with wide margins. RESULTS A total of 38 patients (median age 69 years) met inclusion criteria. Sixteen received trimodality therapy and 22 monotherapy/dual therapy. Skin involvement and disease extent were similar in both groups. All trimodality patients required reconstructive procedures for wound closure/coverage, compared with 48% of monotherapy/dual therapy patients (P < 0.001). Twelve of 16 (75%) patients receiving trimodality therapy had a pathologic complete response (pCR). With median follow-up of 5.6 years, none had local recurrence, 1 patient (6%) had distant recurrence, and no patients died. Among 22 patients in the monotherapy/dual therapy group, 10 (45%) had local recurrence, 8 (36%) had distant recurrence, and 7 (32%) died of disease. Trimodality therapy demonstrated significantly better 5-year recurrence-free survival [RFS; 93.8% vs. 42.9%; P = 0.004; HR, 7.6 (95% confidence interval, CI: 1.3-44.2)]. Combining all patients with RAASB regardless of treatment, local recurrence was associated with subsequent distant recurrence (HR, 9.0; P = 0.002); distant recurrence developed in 3 of 28 (11%) patients without local recurrence compared with 6 of 10 (60%) with local recurrence. The trimodality group had more surgical complications that required reoperation or prolonged healing. CONCLUSIONS Trimodality therapy for RAASB was more toxic but is promising, with a high rate of pCR, durable local control, and improved RFS.
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Affiliation(s)
- Amy C Degnim
- Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Safia K Ahmed
- Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Tanya L Hoskin
- Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Tina J Hieken
- Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota
| | - James W Jakub
- Division of Surgical Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Courtney Day
- Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Sarah E Schrup
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Lauren Smith
- Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Jodi M Carter
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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9
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Rummel KA, Gao RW, Francis LN, Petersen IA, Mutter RW, Corbin KS. Secondary breast angiosarcoma following accelerated partial breast irradiation with intracavitary multicatheter applicator brachytherapy. Brachytherapy 2023; 22:487-490. [PMID: 37217416 DOI: 10.1016/j.brachy.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/20/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE Secondary angiosarcoma of the breast is a rare complication of breast radiotherapy and is associated with a poor prognosis. There are many reported cases of secondary angiosarcoma following whole breast irradiation (WBI), however development of secondary angiosarcoma following brachytherapy-based accelerated partial breast irradiation (APBI) is not as well characterized. METHODS AND MATERIALS We reviewed and reported a case of a patient who developed secondary angiosarcoma of the breast following intracavitary multicatheter applicator brachytherapy APBI. RESULTS A 69-year-old female was originally diagnosed with T1N0M0 invasive ductal carcinoma of the left breast and treated with lumpectomy followed by adjuvant intracavitary multicatheter applicator brachytherapy APBI. Seven years following her treatment, she developed secondary angiosarcoma. However, the diagnosis of secondary angiosarcoma was delayed due to nonspecific imaging findings and a negative biopsy. CONCLUSIONS Our case highlights the need for secondary angiosarcoma to be considered in the differential diagnosis when patients present with symptoms such as breast ecchymosis and skin thickening following WBI or APBI. Prompt diagnosis and referral to a high-volume sarcoma treatment center for multidisciplinary evaluation is vital.
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Affiliation(s)
- Keaton A Rummel
- University of North Dakota School of Medicine and Health Sciences, Bismarck, ND.
| | - Robert W Gao
- Mayo Clinic Department of Radiation Oncology, Rochester, MN
| | - Leah N Francis
- Mayo Clinic Department of Radiation Oncology, Rochester, MN
| | - Ivy A Petersen
- Mayo Clinic Department of Radiation Oncology, Rochester, MN
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10
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Grams MP, Deufel CL, Kavanaugh JA, Corbin KS, Ahmed SK, Haddock MG, Lester SC, Ma DJ, Petersen IA, Finley RR, Lang KG, Spreiter SS, Park SS, Owen D. Clinical aspects of spatially fractionated radiation therapy treatments. Phys Med 2023; 111:102616. [PMID: 37311338 DOI: 10.1016/j.ejmp.2023.102616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/06/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
PURPOSE To provide clinical guidance for centers wishing to implement photon spatially fractionated radiation therapy (SFRT) treatments using either a brass grid or volumetric modulated arc therapy (VMAT) lattice approach. METHODS We describe in detail processes which have been developed over the course of a 3-year period during which our institution treated over 240 SFRT cases. The importance of patient selection, along with aspects of simulation, treatment planning, quality assurance, and treatment delivery are discussed. Illustrative examples involving clinical cases are shown, and we discuss safety implications relevant to the heterogeneous dose distributions. RESULTS SFRT can be an effective modality for tumors which are otherwise challenging to manage with conventional radiation therapy techniques or for patients who have limited treatment options. However, SFRT has several aspects which differ drastically from conventional radiation therapy treatments. Therefore, the successful implementation of an SFRT treatment program requires the multidisciplinary expertise and collaboration of physicians, physicists, dosimetrists, and radiation therapists. CONCLUSIONS We have described methods for patient selection, simulation, treatment planning, quality assurance and delivery of clinical SFRT treatments which were built upon our experience treating a large patient population with both a brass grid and VMAT lattice approach. Preclinical research and patient trials aimed at understanding the mechanism of action are needed to elucidate which patients may benefit most from SFRT, and ultimately expand its use.
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Affiliation(s)
- Michael P Grams
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Christopher L Deufel
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - James A Kavanaugh
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Kimberly S Corbin
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Safia K Ahmed
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Michael G Haddock
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Randi R Finley
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Karen G Lang
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Sheri S Spreiter
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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11
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Houdek MT, Mallett KE, Heidenreich MJ, Ahmed SK, Wenger DE, Smith JRH, Siontis BL, Robinson SI, Folpe AL, Petersen IA, Rose PS. Lack of radiosensitivity predicts poor disease specific survival in myxoid liposarcoma. J Surg Oncol 2023; 127:848-854. [PMID: 36573830 DOI: 10.1002/jso.27190] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/10/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Compared to other sarcomas, myxoid liposarcoma (ML) is known to be radiosensitive, with improved oncologic outcomes. Although these tumors "shrink" following radiotherapy, there is a paucity of data examining the degree of radiosensitivity and oncologic outcome. The purpose of the study was to evaluate pre- and postradiotherapy tumor volume to determine if size reduction impacts outcome. METHODS We reviewed 62 patients with ML undergoing surgical resection combined with preoperative radiotherapy, with pre- and postradiotherapy MRI. This included 34 (55%) males, with a mean age of 47 ± 14 years. All tumors were deep to the fascia, and 12 (19%) patients had tumors with a >5% round-cell component. RESULTS The mean volume reduction was 54% ± 29%. Compared to patients with >25% volume reduction, patients with reduction ≤25% had worse 10-year disease specific survival (86% vs. 37%, p < 0.01), in addition to an increased risk of metastatic disease (HR 4.63, p < 0.01) and death due to disease (HR 4.52, p < 0.01). CONCLUSION Lack of volume reduction is a risk factor for metastatic disease and subsequent death due to disease in patients with extremity ML treated with combined preoperative radiotherapy and surgery. This data could be used to stratify patients for adjuvant therapies and follow-up intervals.
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Affiliation(s)
- Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mark J Heidenreich
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Safia K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Doris E Wenger
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Steven I Robinson
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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12
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Houdek MT, Heidenreich MJ, Ahmed SK, Allen-Rhoades W, Siontis BL, Robinson SI, Petersen IA, Rose PS. Treatment outcomes of extraskeletal Ewing sarcoma. J Surg Oncol 2023. [PMID: 36999583 DOI: 10.1002/jso.27250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/12/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE Extraskeletal Ewing sarcoma (EES), is a rare soft tissue sarcoma. Treatment for EES commonly involves chemotherapy and surgical resection (ST) or less commonly combined chemotherapy, surgery, and radiotherapy (ST + RT). The purpose of the current study was to evaluate our institutional experience treating EES. METHODS We reviewed 36 (18 males:18 females) patients (mean age 30 years) with a nonretroperitoneal/visceral EES treated with either ST (n = 24, 67%) or ST + RT (n = 12, 33%). All patients were treated with chemotherapy, most commonly vincristine, doxorubicin, cyclophosphamide/ifosfamide and etoposide (VDC/IE, n = 23, 66%) Radiotherapy was mostly delivered preoperatively (n = 9). The mean follow-up was 8 years. RESULTS The 10-year disease specific survival for patients was 78%, with no difference in the survival between patients in the ST versus the ST + RT groups (83% vs. 71%, p = 0.86). There was no difference in the 10-year local recurrence (91% vs. 100%, p = 0.29) or metastatic free survival (87% vs. 75%, p = 0.45) between the ST and ST + RT groups. CONCLUSION The results of the current study highlight the ability to achieve excellent local control with chemotherapy and surgery for EES. We recommend for multidisciplinary management of patients with EES, including chemotherapy and surgery, with use of radiotherapy if there is concern for a potentially close margin of resection.
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Affiliation(s)
- Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark J Heidenreich
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Safia K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Wendy Allen-Rhoades
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Steven I Robinson
- Department of Medical Oncology, Mayo Clinic , Rochester, Minnesota, USA
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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13
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Hoppe BS, Petersen IA, Wilke BK, DeWees TA, Imai R, Hug EB, Fiore MR, Debus J, Fossati P, Yamada S, Orlandi E, Zhang Q, Bao C, Seidensaal K, May BC, Harrell AC, Houdek MT, Vallow LA, Rose PS, Haddock MG, Ashman JB, Goulding KA, Attia S, Krishnan S, Mahajan A, Foote RL, Laack NN, Keole SR, Beltran CJ, Welch EM, Karim M, Ahmed SK. Pragmatic, Prospective Comparative Effectiveness Trial of Carbon Ion Therapy, Surgery, and Proton Therapy for the Management of Pelvic Sarcomas (Soft Tissue/Bone) Involving the Bone: The PROSPER Study Rationale and Design. Cancers (Basel) 2023; 15:1660. [PMID: 36980545 PMCID: PMC10046156 DOI: 10.3390/cancers15061660] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/10/2023] Open
Abstract
Surgical treatment of pelvic sarcoma involving the bone is the standard of care but is associated with several sequelae and reduced functional quality of life (QOL). Treatment with photon and proton radiotherapy is associated with relapse. Carbon ion radiotherapy (CIRT) may reduce both relapse rates and treatment sequelae. The PROSPER study is a tricontinental, nonrandomized, prospective, three-arm, pragmatic trial evaluating treatments of pelvic sarcoma involving the bone. Patients aged at least 15 years are eligible for inclusion. Participants must have an Eastern Cooperative Oncology Group Performance Status score of two or less, newly diagnosed disease, and histopathologic confirmation of pelvic chordoma, chondrosarcoma, osteosarcoma, Ewing sarcoma with bone involvement, rhabdomyosarcoma (RMS) with bone involvement, or non-RMS soft tissue sarcoma with bone involvement. Treatment arms include (1) CIRT (n = 30) delivered in Europe and Asia, (2) surgical treatment with or without adjuvant radiotherapy (n = 30), and (3) proton therapy (n = 30). Arms two and three will be conducted at Mayo Clinic campuses in Arizona, Florida, and Minnesota. The primary end point is to compare the 1-year change in functional QOL between CIRT and surgical treatment. Additional comparisons among the three arms will be made between treatment sequelae, local control, and other QOL measures.
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Affiliation(s)
- Bradford S. Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Ivy A. Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Benjamin K. Wilke
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Todd A. DeWees
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Phoenix, AZ 85054, USA
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Reiko Imai
- Division of Radiation Oncology, QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Eugen B. Hug
- Department of Radiation Oncology, MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria
| | - Maria Rosaria Fiore
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Piero Fossati
- Department of Radiation Oncology, MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria
- Department for Basic and Translational Oncology and Hematology, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
| | - Shigeru Yamada
- Division of Radiation Oncology, QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Qing Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai 201102, China
| | - Cihang Bao
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai 201102, China
| | - Katharina Seidensaal
- Department of Radiation Oncology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Byron C. May
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Anna C. Harrell
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Matthew T. Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Laura A. Vallow
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Peter S. Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | - Steven Attia
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Sunil Krishnan
- Department of Radiation Oncology, University of Texas Health Houston Neurosciences-Texas Medical Center, Houston, TX 77030, USA
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Robert L. Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Nadia N. Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Sameer R. Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Chris J. Beltran
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Eric M. Welch
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mohammed Karim
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Safia K. Ahmed
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
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14
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Garzon S, Grassi T, Mariani A, Kollikonda S, Weaver AL, McGree ME, Petersen IA, Weroha SJ, Glaser GE, Langstraat CL, Amarnath SR, AlHilli MM. Not all stage I and II endometrial cancers are created equal: Recurrence-free survival and cause-specific survival after observation or vaginal brachytherapy alone in all subgroups of early-stage high-intermediate and high-risk endometrial cancer. Gynecol Oncol 2022; 167:444-451. [PMID: 36244826 DOI: 10.1016/j.ygyno.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/14/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate recurrence-free survival (RFS) and cause-specific survival (CSS) after observation or vaginal brachytherapy (VB) alone in all subgroups of early-stage high-intermediate (HIR) and high-risk endometrial cancer (EC). METHODS We identified patients with stage I HIR (GOG-249 criteria) and stage II endometrioid EC, and stage I and II non-endometrioid EC who underwent surgery at Mayo Clinic and Cleveland Clinic between 1999 and 2016. Three-year RFS and CSS after observation or VB only were estimated in 16 subgroups defined by risk factors. RESULTS Among 4156 ECs, we identified 447 (10.8%) stage I endometrioid HIR, 52 (1.3%) stage II endometrioid, 350 (8.4%) stage I non-endometrioid, and 17 (0.4%) stage II non-endometrioid ECs; observation or VB alone was applied in 349 (78.1%), 24 (46.2%), 187 (53.4%), and 2 (11.8%) patients, respectively. After observation or VB, stage I HIR endometrioid EC subgroups with <2 factors among grade 3, LVSI, or stage IB had a 3-year CSS >95% (lower 95% confidence intervals limit: 89.8%), whereas subgroups with ≥2 factors had poorer outcomes. No EC-related deaths after 3 years were reported in 97 stage IA non-endometrioid ECs without myometrial invasion. Stage II ECs had poor outcomes regardless of histology. CONCLUSIONS Observation or VB only may be sufficient in stage I endometrioid HIR ECs with <2 factors among grade 3, LVSI, or IB and in stage IA non-endometrioid ECs without myometrial invasion. Stratification of early-stage HIR and high-risk ECs into risk subgroups potentially alleviates the overtreatment and undertreatment risk and should be considered in future research.
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Affiliation(s)
- Simone Garzon
- Department of Gynecology and Obstetrics, Mayo Clinic, Rochester, MN, USA
| | - Tommaso Grassi
- Department of Gynecology and Obstetrics, Mayo Clinic, Rochester, MN, USA
| | - Andrea Mariani
- Department of Gynecology and Obstetrics, Mayo Clinic, Rochester, MN, USA
| | - Swapna Kollikonda
- Department of Gynecology and Obstetrics, Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amy L Weaver
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Michaela E McGree
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - S John Weroha
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Gretchen E Glaser
- Department of Gynecology and Obstetrics, Mayo Clinic, Rochester, MN, USA
| | | | - Sudha R Amarnath
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mariam M AlHilli
- Department of Subspecialty Care for Women's Health, Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, OH, USA.
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15
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Anderson JD, Voss MM, Laughlin BS, Garda AE, Aziz K, Mullikin TC, Haddock MG, Petersen IA, DeWees TA, Vora SA. Outcomes of Proton Beam Therapy Compared With Intensity-Modulated Radiation Therapy for Uterine Cancer. Int J Part Ther 2022; 9:10-17. [PMID: 36721479 PMCID: PMC9875825 DOI: 10.14338/ijpt-22-00020.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose To compare Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) in patients with endometrial cancer receiving adjuvant pelvic radiation therapy with proton beam therapy (PT) versus intensity-modulated radiation therapy (IMRT). Materials and Methods Patients with uterine cancer treated with curative intent who received either adjuvant PT or IMRT between 2014 and 2020 were identified. Patients were enrolled into a prospective registry using a gynecologic-specific subset of PRO-CTCAE designed to assess symptom impact on daily living. Questions included gastrointestinal (GI) symptoms of diarrhea, flatulence, bowel incontinence, and constipation in addition to other pertinent gynecologic, urinary, and other general symptoms. Symptom-based questions were on a 0- to 4-point scale, with grade 3+ symptoms occurring frequently or almost always. Patient-reported toxicity was analyzed at baseline, end of treatment (EOT), and at 3, 6, 9, and 12 months after treatment. Unequal variance t tests were used to determine if treatment type was a significant factor in baseline-adjusted PRO-CTCAE. Results Sixty-seven patients met inclusion criteria. Twenty-two received PT and 45 patients received IMRT. Brachytherapy boost was delivered in 73% of patients. Median external beam dose was 45 Gy for both PT and IMRT (range, 45-58.8 Gy). When comparing PRO-CTCAE, PT was associated with less diarrhea at EOT (P = .01) and at 12 months (P = .24) than IMRT. Loss of bowel control at 12 months was more common in patients receiving IMRT (P = .15). Any patient reporting grade 3+ GI toxicity was noted more frequently with IMRT (31% versus 9%, P = .09). Discussion Adjuvant PT is a promising treatment for patients with uterine cancer and may reduce patient-reported GI toxicity as compared with IMRT.
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Affiliation(s)
| | - Molly M. Voss
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Allison E. Garda
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Khaled Aziz
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Trey C. Mullikin
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Ivy A. Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Todd A. DeWees
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Sujay A. Vora
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
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16
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von Mehren M, Kane JM, Riedel RF, Sicklick JK, Pollack SM, Agulnik M, Bui MM, Carr-Ascher J, Choy E, Connelly M, Dry S, Ganjoo KN, Gonzalez RJ, Holder A, Homsi J, Keedy V, Kelly CM, Kim E, Liebner D, McCarter M, McGarry SV, Mesko NW, Meyer C, Pappo AS, Parkes AM, Petersen IA, Poppe M, Schuetze S, Shabason J, Spraker MB, Zimel M, Bergman MA, Sundar H, Hang LE. NCCN Guidelines® Insights: Gastrointestinal Stromal Tumors, Version 2.2022. J Natl Compr Canc Netw 2022; 20:1204-1214. [PMID: 36351335 PMCID: PMC10245542 DOI: 10.6004/jnccn.2022.0058] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Gastrointestinal stromal tumors (GIST) are the most common type of soft tissue sarcoma that occur throughout the gastrointestinal tract. Most of these tumors are caused by oncogenic activating mutations in the KIT or PDGFRA genes. The NCCN Guidelines for GIST provide recommendations for the diagnosis, evaluation, treatment, and follow-up of patients with these tumors. These NCCN Guidelines Insights summarize the panel discussion behind recent important updates to the guidelines, including revised systemic therapy options for unresectable, progressive, or metastatic GIST based on mutational status, and updated recommendations for the management of GIST that develop resistance to specific tyrosine kinase inhibitors.
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Affiliation(s)
| | | | | | | | - Seth M Pollack
- 5Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Edwin Choy
- 9Massachusetts General Hospital Cancer Center
| | - Mary Connelly
- 10The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Sarah Dry
- 11UCLA Jonsson Comprehensive Cancer Center
| | | | | | | | - Jade Homsi
- 14UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | - David Liebner
- 10The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Nathan W Mesko
- 20Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Christian Meyer
- 21The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Alberto S Pappo
- 22St. Jude Children's Research Hospital/University of Tennessee Health Science Center
| | | | | | - Matthew Poppe
- 25Huntsman Cancer Institute at the University of Utah
| | | | - Jacob Shabason
- 27Abramson Cancer Center at the University of Pennsylvania
| | - Matthew B Spraker
- 28Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Melissa Zimel
- 29UCSF Helen Diller Family Comprehensive Cancer Center; and
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Morris LK, Garda AE, Cutsinger JM, Deufel CL, Haddock MG, Petersen IA. PO30 Presentation Time: 10:30 AM. Brachytherapy 2022. [DOI: 10.1016/j.brachy.2022.09.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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von Mehren M, Kane JM, Agulnik M, Bui MM, Carr-Ascher J, Choy E, Connelly M, Dry S, Ganjoo KN, Gonzalez RJ, Holder A, Homsi J, Keedy V, Kelly CM, Kim E, Liebner D, McCarter M, McGarry SV, Mesko NW, Meyer C, Pappo AS, Parkes AM, Petersen IA, Pollack SM, Poppe M, Riedel RF, Schuetze S, Shabason J, Sicklick JK, Spraker MB, Zimel M, Hang LE, Sundar H, Bergman MA. Soft Tissue Sarcoma, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20:815-833. [PMID: 35830886 PMCID: PMC10186762 DOI: 10.6004/jnccn.2022.0035] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Soft tissue sarcomas (STS) are rare malignancies of mesenchymal cell origin that display a heterogenous mix of clinical and pathologic characteristics. STS can develop from fat, muscle, nerves, blood vessels, and other connective tissues. The evaluation and treatment of patients with STS requires a multidisciplinary team with demonstrated expertise in the management of these tumors. The complete NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Soft Tissue Sarcoma provide recommendations for the diagnosis, evaluation, and treatment of extremity/superficial trunk/head and neck STS, as well as retroperitoneal/intra-abdominal STS, desmoid tumors, and rhabdomyosarcoma. This portion of the NCCN Guidelines discusses general principles for the diagnosis and treatment of retroperitoneal/intra-abdominal STS, outlines treatment recommendations, and reviews the evidence to support the guidelines recommendations.
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Affiliation(s)
| | | | | | | | | | - Edwin Choy
- Massachusetts General Hospital Cancer Center
| | - Mary Connelly
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Sarah Dry
- UCLA Jonsson Comprehensive Cancer Center
| | | | | | | | - Jade Homsi
- UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | - Edward Kim
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - David Liebner
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Nathan W Mesko
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Christian Meyer
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Alberto S Pappo
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Seth M Pollack
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Jacob Shabason
- Abramson Cancer Center at the University of Pennsylvania
| | | | - Matthew B Spraker
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Melissa Zimel
- UCSF Helen Diller Family Comprehensive Cancer Center; and
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Grams MP, Tseung HSWC, Ito S, Zhang Y, Owen D, Park SS, Ahmed SK, Petersen IA, Haddock MG, Harmsen WS, Ma DJ. A Dosimetric Comparison of Lattice, Brass, and Proton Grid Therapy Treatment Plans. Pract Radiat Oncol 2022; 12:e442-e452. [DOI: 10.1016/j.prro.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 11/28/2022]
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20
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Dalvin LA, Deufel CL, Corbin KS, Petersen IA, Olsen TW, Roddy GW. Postradiation Optic Atrophy Is Associated With Intraocular Pressure and May Manifest With Neuroretinal Rim Thinning. J Neuroophthalmol 2022; 42:e159-e172. [PMID: 34812759 PMCID: PMC9358970 DOI: 10.1097/wno.0000000000001465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To determine risk factors for postradiation optic atrophy (PROA) after plaque radiotherapy for uveal melanoma. METHODS A single center, retrospective cohort study of patients diagnosed with uveal melanoma involving choroid and/or ciliary body treated with plaque between January 1, 2008, and December 31, 2016. Outcomes included development of PROA with pallor alone or with concomitant neuroretinal rim thinning (NRT). Cox regression analysis was performed to identify risk factors for PROA. RESULTS Of 78 plaque-irradiated patients, PROA developed in 41 (53%), with concomitant NRT in 15 (19%). Risk factors for PROA of any type included presentation with worse visual acuity (odds ratio [95% confidence interval] 5.6 [2.3-14.1], P < 0.001), higher baseline intraocular pressure (IOP; 14 vs 16 mm Hg) (1.1 [1.0-1.2], P = 0.03), shorter tumor distance to optic disc (1.3 [1.2-1.5], P < 0.001) and foveola (1.2 [1.1-1.3], P < 0.001), subfoveal subretinal fluid (3.8 [2.0-7.1], P < 0.001), greater radiation prescription depth (1.3 [1.1-1.6], P = 0.002), dose to fovea (point dose) (1.01 [1.01-1.02], P < 0.001), and mean (1.02 [1.02-1.03], P < 0.001) and maximum dose to optic disc per 1 Gy increase (1.02 [1.01-1.03], P < 0.001). On multivariate modeling, dose to disc, baseline IOP, and subfoveal fluid remained significant. Subanalysis revealed risk factors for pallor with NRT of greater mean radiation dose to disc (1.03 [1.01-1.05], P = 0.003), higher maximum IOP (17 vs 20 mm Hg) (1.4 [1.2-1.7], P < 0.001), and subfoveal fluid (12 [2-63], P = 0.004). CONCLUSION PROA may result in NRT in addition to optic disc pallor. Risk factors for PROA included higher radiation dose to optic disc, higher baseline IOP, and subfoveal fluid. Higher maximum IOP contributed to concomitant NRT.
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Affiliation(s)
- Lauren A Dalvin
- Departments of Ophthalmology (LAD, TWO, GWR) and Medical Physics (CLD), and Radiation Oncology (KSC, IAP), Mayo Clinic, Rochester, Minnesota
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Yolcu YU, Zreik J, Wahood W, Bhatti AUR, Bydon M, Houdek MT, Rose PS, Mahajan A, Petersen IA, Haddock MG, Ahmed SK, Laack NN, Jethwa K, Jeans EB, Imai R, Yamada S, Foote RL. Comparison of Oncologic Outcomes and Treatment-Related Toxicity of Carbon Ion Radiotherapy and En Bloc Resection for Sacral Chordoma. JAMA Netw Open 2022; 5:e2141927. [PMID: 34994795 PMCID: PMC8742192 DOI: 10.1001/jamanetworkopen.2021.41927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Maximal resection is the preferred management for sacral chordomas but can be associated with unacceptable morbidity. Outcomes with radiotherapy are poor. Carbon ion radiotherapy (CIRT) is being explored as an alternative when surgery is not preferred. OBJECTIVE To compare oncologic outcomes and treatment-related toxicity of CIRT and en bloc resection for sacral chordoma. DESIGN, SETTING, AND PARTICIPANTS Univariable logistic regression was performed to evaluate the association between treatment type and oncologic and toxicity outcomes in this retrospective cohort study. Nearest-neighbor propensity score matching was used to match the CIRT cohort with the en bloc resection cohort and 10 National Cancer Database (NCDB) cohorts separately, with the objective of obtaining more homogeneous cohorts when comparing treatments. Patient- and tumor-related characteristics from 2 institutional cohorts were collected for patients diagnosed with sacral chordomas between April 1, 1994, and July 31, 2017. The NCDB was queried for data on patients with sacral chordoma from January 1, 2004, to December 31, 2016, as a comparator in overall survival (OS) analyses. Data analysis was conducted from February 24, 2020, to January 16, 2021. EXPOSURES En bloc resection, incomplete resection, photon radiotherapy, proton radiotherapy, and CIRT. MAIN OUTCOMES AND MEASURES Overall survival was estimated using the Kaplan-Meier method and compared using the Cox proportional hazards model. Peripheral motor nerve toxic effects were scored using Common Terminology Criteria for Adverse Events, version 4.03. RESULTS A total of 911 patients were included in the study (NCDB: n = 669; median age, 64 [IQR, 52-74] years; 410 [61.3%] men; CIRT: n = 188; median age, 66 [IQR, 58-71] years; 128 [68.1%] men; en bloc surgical resection: n = 54; median age, 53.5 [IQR 49-64] years, 36 [66.7%] men). Comparison of the propensity score-matched institutional en bloc resection and CIRT cohorts revealed no statistically significant difference in OS (CIRT: median OS, 68.1 [95% CI, 44.0-102.6] months; en bloc resection: median OS, 58.6 [95% CI, 25.6-123.5] months; P = .57; hazard ratio, 0.71 [95% CI, 0.25-2.06]; P = .53). The CIRT cohort experienced lower rates of peripheral motor neuropathy (odds ratio, 0.13 [95% CI, 0.04-0.40]; P < .001). On comparison of the propensity score-matched NCDB cohorts with the CIRT cohort, significantly higher OS was found for CIRT compared with margin-positive surgery without adjuvant radiotherapy (CIRT: median OS, 64.7 [95% CI, 57.8-69.7] months; margin-positive surgery without adjuvant radiotherapy: median OS, 60.6 [95% CI, 44.2-69.7] months, P = .03) and primary radiotherapy alone (CIRT: median OS, 64.9 [95% CI 57.0-70.5] months; primary radiotherapy alone: 31.8 [95% CI, 27.9-40.6] months; P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that CIRT can be used as treatment for older patients with high performance status and sacral chordoma in whom surgery is not preferred. CIRT might provide additional benefit for patients who undergo margin-positive resection or who are candidates for primary photon radiotherapy.
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Affiliation(s)
- Yagiz U Yolcu
- Mayo Clinic Neuro-informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jad Zreik
- Central Michigan University College of Medicine, Mount Pleasant
| | - Waseem Wahood
- Dr Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida
| | | | - Mohamad Bydon
- Mayo Clinic Neuro-informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Safia K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Krishan Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Reiko Imai
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Inageku, Chiba, Japan
| | - Shigeru Yamada
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Inageku, Chiba, Japan
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Ebner DW, Eckmann JD, Burger KN, Mahoney DW, Whitaker TJ, Petersen IA, Kisiel JB. High Positive Predictive Value of Multitarget Stool DNA After Aerodigestive Tract Radiotherapy. Gastro Hep Advances 2022; 1:746-754. [PMID: 36117548 PMCID: PMC9481191 DOI: 10.1016/j.gastha.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND AIMS: Multitarget stool DNA (mt-sDNA) is approved for average-risk colorectal cancer screening; test performance in persons with prior radiation therapy (RT) has not been studied. RT can induce gastrointestinal bleeding and alter DNA methylation, which may affect mt-sDNA accuracy. Among patients previously treated with RT, we aimed to measure the positive predictive value (PPV) of mt-sDNA and compare these results to historical estimates of mt-sDNA PPV among average-risk patients. METHODS: After institutional review board approval, we conducted a retrospective cohort study of a multisite academic and community-based practice. Patients with RT and subsequent mt-sDNA use during the study period (2014–2016) were identified. The findings at diagnostic colonoscopy were compared with published reports among average-risk patients. Nominal P values were generated by 2-tailed Fisher’s exact testing in comparisons of colorectal neoplasia (CRN) rates between groups. RESULTS: There were 220 patients who had RT before mt-sDNA testing. RT was delivered along the aerodigestive tract in 108 patients. Mt-sDNA tests were positive in 45 of 220 patients (20%), and colonoscopy findings were available for 42; 31 of 42 patients (74%) had CRN. PPV by mt-sDNA was similar when stratified by site of prior RT (along vs outside the aerodigestive tract; P = 1.00). Detection of advanced CRN (36%) was nominally higher than previously published retrospective (27%) and prospective (20%) studies. The median time from the start of RT to mt-sDNA use was 7 (interquartile range, 3–14) years. CONCLUSION: With a test positivity rate and PPV for CRN similar to reports among average-risk patients, prior RT does not appear to adversely affect mt-sDNA performance.
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Xu TT, Pulido JS, Deufel CL, Corbin KS, Petersen IA, Dalvin LA. Clinical outcomes of Modified Collaborative Ocular Melanoma Study IRIS plaques for treatment of iris, iridociliary, and ciliary body melanoma. Eye (Lond) 2021; 35:2754-2762. [PMID: 33235338 PMCID: PMC8452726 DOI: 10.1038/s41433-020-01295-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND/OBJECTIVES To report clinical outcomes of modified Collaborative Ocular Melanoma Study IRIS (COMS IRIS) plaques for treatment of iris, iridociliary, and ciliary body melanoma. SUBJECTS/METHODS Retrospective, single-centre cohort study of iris melanoma treated with COMS IRIS plaque radiotherapy from July 26, 2010 to October 15, 2018. Medical records were reviewed for demographics, tumour features, treatment parameters, and clinical outcomes. RESULTS There were 22 cases, diagnosed at mean age of 59 years (median 65, range 21-85 years) with female sex in 14 (64%). Presenting tumour features included Snellen visual acuity (VA) ≥ 20/40 in 18 (82%) cases, mean largest tumour basal diameter 4.7 mm (median 3.9, range 2.3-13.8 mm) and thickness 1.7 mm (median 1.6 mm, range 0.8-3.9 mm), iris stromal seeding in 3 (14%) cases, angle seeding in 16 (73%), and ciliary body involvement in 13 (59%). After mean follow-up of 51 months (median 44, range 4-113 months), Snellen VA was ≥20/40 in 14 (64%) cases, with local tumour recurrence in 2 (9%), and enucleation in 2 (9%). The 3-year Kaplan-Meier estimated risk of local tumour recurrence was 7%. The most common radiation side effects were cataract in 17 (77%) patients and dry eye in 5 (23%). Systemic metastasis occurred in no cases, and 1 (5%) non-melanoma-related death due to natural causes was observed at last follow-up. CONCLUSIONS COMS IRIS plaques are effective for treatment of iris, iridociliary, and ciliary body melanoma with modest VA outcomes and low frequency of local tumour recurrence, enucleation, radiation side effects, and systemic metastasis.
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Affiliation(s)
- Timothy T. Xu
- grid.66875.3a0000 0004 0459 167XAlix School of Medicine, Mayo Clinic, Rochester, MN USA
| | - Jose S. Pulido
- grid.66875.3a0000 0004 0459 167XDepartment of Ophthalmology, Mayo Clinic, Rochester, MN USA
| | - Christopher L. Deufel
- grid.66875.3a0000 0004 0459 167XDepartment of Radiation Oncology, Mayo Clinic, Rochester, MN USA
| | - Kimberly S. Corbin
- grid.66875.3a0000 0004 0459 167XDepartment of Radiation Oncology, Mayo Clinic, Rochester, MN USA
| | - Ivy A. Petersen
- grid.66875.3a0000 0004 0459 167XDepartment of Radiation Oncology, Mayo Clinic, Rochester, MN USA
| | - Lauren A. Dalvin
- grid.66875.3a0000 0004 0459 167XDepartment of Ophthalmology, Mayo Clinic, Rochester, MN USA
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Deufel CL, Dalvin LA, Qian J, Vaishnav B, Cutsinger JM, Wittich MN, Petersen IA. How to design, fabricate, and validate a customized COMS-style eye plaque: Illustrated with a narrow-slotted plaque example. Brachytherapy 2021; 20:1235-1244. [PMID: 34217602 DOI: 10.1016/j.brachy.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/09/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE A customized Collaborative Ocular Melanoma Study (COMS)-style eye plaque may provide superior dosimetric coverage compared with standard models for certain intraocular tumor locations and shapes. This work provides a recipe for developing and validating such customized plaques. METHODS AND MATERIALS The concept-into-clinical treatment process for a customized COMS-style eye plaque begins with a CAD model design that meets the specifications of the radiation oncologist and surgeon based on magnetic resonance, ultrasound, and clinical measurements, as well as a TG-43 hybrid heterogeneity-corrected dose prediction to model the dose distribution. Next, a 3D printed plastic prototype is created and reviewed. After design approval, a Modulay plaque is commercially fabricated. Quality assurance (QA) is subsequently performed to verify the physical measurements of the Modulay and Silastic and also includes dosimetric measurement of the calibration, depth dose, and dose profiles. Sterilization instructions are provided by the commercial fabricator. This customization procedure and QA methodology is demonstrated with a narrow-slotted plaque that was recently constructed for the treatment of a circumpapillary (e.g., surrounding the optic disk) ocular tumor. RESULTS The production of a customized COMS-style eye plaque is a multistep process. Dosimetric modeling is recommended to ensure that the design will meet the patient's needs, and QA is essential to confirm that the plaque has the proper dimensions and dose distribution. The customized narrow-slotted plaque presented herein was successfully implemented in the clinic, and provided superior dose coverage of juxtapapillary and circumpapillary tumors compared with standard or notched COMS-style plaques. Plaque development required approximately 30 h of physicist time and a fabrication cost of $1500. CONCLUSION Customized eye plaques may be used to treat intraocular tumors that cannot be adequately managed with standard models. The procedure by which a customized COMS-style plaque may be designed, fabricated, and validated was presented along with a clinical example.
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Affiliation(s)
| | | | - Jing Qian
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Birjoo Vaishnav
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | | | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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Qian J, Dalvin LA, Vaishnav B, Cutsinger SM, Wittich MN, Petersen IA, Deufel CL. PP20 Presentation Time: 3:30 PM. Brachytherapy 2021. [DOI: 10.1016/j.brachy.2021.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Jeans EB, Breen WG, Mullikin TC, Looker BA, Mariani A, Keeney GL, Haddock MG, Petersen IA. Adjuvant brachytherapy for FIGO stage I serous or clear cell endometrial cancer. Int J Gynecol Cancer 2021; 31:859-867. [PMID: 33563642 PMCID: PMC8223628 DOI: 10.1136/ijgc-2020-002217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives Optimal adjuvant treatment for early-stage clear cell and serous endometrial cancer remains unclear. We report outcomes for women with surgically staged International Federation of Gynecology and Obstetrics (FIGO) stage I clear cell, serous, and mixed endometrial cancers following adjuvant vaginal cuff brachytherapy with or without chemotherapy. Methods From April 1998 to January 2020, women with FIGO stage IA–IB clear cell, serous, and mixed endometrial cancer underwent surgery and adjuvant vaginal cuff brachytherapy. Seventy-six patients received chemotherapy. High-dose rate vaginal cuff brachytherapy was planned to a total dose of 21 gray in three fractions using a multichannel vaginal cylinder. The primary objective was to determine the effectiveness of adjuvant vaginal cuff brachytherapy and to identify surgicopathological risk factors that could portend towards worse oncological outcomes. Results A total of 182 patients were included in the analysis. Median follow-up was 5.3 years (2.3–12.2). Ten-year survival was 73.3%. Five-year cumulative incidence (CI) of vaginal, pelvic, and para-aortic relapse was 1.4%, 2.1%, and 0.9%, respectively. Five-year locoregional failure, any recurrence, peritoneal relapse, and other distant recurrence was 4.4%, 11.6%, 5.3%, and 6.7%, respectively. On univariate analysis, locoregional failure was worse for larger tumors (per 1 cm) (HR 1.9, 95% CI 1.2 to 3.0, p≤0.01). Any recurrence was worse for tumors of at least 3.5 cm (HR 3.8, 95% CI 1.3 to 11.7, p=0.02) and patients with positive/suspicious cytology (HR 4.4, 95% CI 1.5 to 12.4, p≤0.01). Ten-year survival for tumors of at least 3.5 cm was 56.9% versus 86.6% for those with smaller tumors (HR 2.9, 95% CI 1.4 to 5.8, p≤0.01). Ten-year survival for positive/suspicious cytology was 50.9% versus 77.4% (HR 2.2, 95% CI 0.9 to 5.4, p=0.09). Multivariate modeling demonstrated worse locoregional failure, any recurrence, and survival with larger tumors, as well as any recurrence with positive/suspicious cytology. Subgroup analysis demonstrated improved outcomes with the use of adjuvant chemotherapy in patients with large tumors or positive/suspicious cytology. Conclusion Adjuvant vaginal cuff brachytherapy alone without chemotherapy is an appropriate treatment for women with negative peritoneal cytology and small, early-stage clear cell, serous, and mixed endometrial cancer. Larger tumors or positive/suspicious cytology are at increased risk for relapse and worse survival, and should be considered for additional upfront adjuvant treatments, such as platinum-based chemotherapy.
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Affiliation(s)
- Elizabeth B Jeans
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - William G Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Trey C Mullikin
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brittany A Looker
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrea Mariani
- Department of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gary L Keeney
- Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael G Haddock
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Honig RL, Tibbo ME, Mallett KE, Bakri K, Ahmed SK, Petersen IA, Rose PS, Moran SL, Houdek MT. Outcome of Soft-tissue Reconstruction in the Setting of Combined Preoperative and Intraoperative Radiotherapy for Extremity Soft-tissue Sarcomas. Anticancer Res 2020; 40:6941-6945. [PMID: 33288588 DOI: 10.21873/anticanres.14718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Reconstruction for soft-tissue sarcomas is complex and often uses soft-tissue flaps. To preserve critical structures, intraoperative radiotherapy (IORT) can be used to boost the total dose to these critical structures and close margins; however, there are limited data on the outcome of soft-tissue reconstruction in patients treated with IORT. PATIENTS AND METHODS Twenty patients received IORT with soft-tissue flap coverage. There were 14 tumors of the lower extremities and six of the upper, including seven free-flaps and 13 pedicle flaps. Mean preoperative and IORT doses were 49.4 Gy and 10.4 Gy, respectively, with a mean total dose of 59.8 Gy. RESULTS Seven (35%) patients had a complication, most commonly an infection (n=4, 27%). Total flap loss occurred in one treated with pedicle flap. Four (20%) patients suffered a radiation-associated fracture. At the final follow-up, the mean Musculoskeletal Tumor Society Score was 75±11%. CONCLUSION Complications and postoperative fractures were common with IORT, however, there were no cases requiring amputation.
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Affiliation(s)
- Rachel L Honig
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | - Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | | | - Karim Bakri
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | - Safia K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, U.S.A
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, U.S.A
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A.
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Gorman CA, Garrity JA, Fatourechi V, Bahn RS, Petersen IA, Stafford SL, Earle JD, Forbes GS, Kline RW, Bergstralh EJ, Offord KP, Rademacher DM, Stanley NM, Bartley GB. A Prospective, Randomized, Double-blind, Placebo-controlled Study of Orbital Radiotherapy for Graves' Ophthalmopathy. Ophthalmology 2020; 127:S160-S171. [PMID: 32200817 DOI: 10.1016/j.ophtha.2020.01.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2000] [Accepted: 03/07/2001] [Indexed: 11/19/2022] Open
Abstract
CONTEXT Although widely used for more than 85 years, the efficacy of radiotherapy for Graves' ophthalmopathy (GO) has not been established convincingly. OBJECTIVE To evaluate the efficacy of radiotherapy for GO. DESIGN Prospective, randomized, internally controlled, double-blind clinical trial in a tertiary care academic medical center. PARTICIPANTS The patients were ethnically diverse males and females over age 30 seen in a referral practice. The patients had moderate, symptomatic Graves' ophthalmopathy (mean clinical activity score, 6.2) but no optic neuropathy, diabetes, recent steroid treatment, previous decompression, or muscle surgery. Forty-two of 53 consecutive patients were enrolled after giving informed consent and fulfilling study entry criteria. Eleven eligible patients declined to participate because of inconvenience, desire for alternative therapy, or concern about radiation. INTERVENTION One randomly selected orbit was treated with 20 Gy of external beam therapy; sham therapy was given to the other side. Six months later, the therapies were reversed. MAIN OUTCOME MEASURES Every 3 months for 1 year, we measured the volume of extraocular muscle and fat, proptosis, range of extraocular muscle motion, area of diplopia fields, and lid fissure width. Effective treatment for GO will modify one or more of these parameters. RESULTS No clinically or statistically significant difference between the treated and untreated orbit was observed in any of the main outcome measures at 6 months. At 12 months, muscle volume and proptosis improved slightly more in the orbit that was treated first. CONCLUSIONS In this group of patients, representative of those for whom radiotherapy is frequently recommended, we were unable to demonstrate any beneficial therapeutic effect. The slight improvement noted in both orbits at 12 months may be the result of natural remission or of radiotherapy, but the changes are of marginal clinical significance.
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Affiliation(s)
- Colum A Gorman
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota.
| | - James A Garrity
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | | | - Rebecca S Bahn
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | | | | | - John D Earle
- Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | | | - Nancy M Stanley
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
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von Mehren M, Kane JM, Bui MM, Choy E, Connelly M, Dry S, Ganjoo KN, George S, Gonzalez RJ, Heslin MJ, Homsi J, Keedy V, Kelly CM, Kim E, Liebner D, McCarter M, McGarry SV, Meyer C, Pappo AS, Parkes AM, Paz IB, Petersen IA, Poppe M, Riedel RF, Rubin B, Schuetze S, Shabason J, Sicklick JK, Spraker MB, Zimel M, Bergman MA, George GV. NCCN Guidelines Insights: Soft Tissue Sarcoma, Version 1.2021. J Natl Compr Canc Netw 2020; 18:1604-1612. [PMID: 33285515 DOI: 10.6004/jnccn.2020.0058] [Citation(s) in RCA: 149] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The NCCN Guidelines for Soft Tissue Sarcoma provide recommendations for the diagnosis, evaluation, treatment, and follow-up for patients with soft tissue sarcomas. These NCCN Guidelines Insights summarize the panel discussion behind recent important updates to the guidelines, including the development of a separate and distinct guideline for gastrointestinal stromal tumors (GISTs); reconception of the management of desmoid tumors; inclusion of further recommendations for the diagnosis and management of extremity/body wall, head/neck sarcomas, and retroperitoneal sarcomas; modification and addition of systemic therapy regimens for sarcoma subtypes; and revision of the principles of radiation therapy for soft tissue sarcomas.
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Affiliation(s)
| | | | | | - Edwin Choy
- 4Massachusetts General Hospital Cancer Center
| | - Mary Connelly
- 5The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Sarah Dry
- 6UCLA Jonsson Comprehensive Cancer Center
| | | | | | | | | | - Jade Homsi
- 10UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | - Edward Kim
- 13Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - David Liebner
- 5The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Christian Meyer
- 16The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Alberto S Pappo
- 17St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | - Matthew Poppe
- 21Huntsman Cancer Institute at the University of Utah
| | | | - Brian Rubin
- 23Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Jacob Shabason
- 25Abramson Cancer Center at the University of Pennsylvania
| | | | - Matthew B Spraker
- 27Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Melissa Zimel
- 28UCSF Helen Diller Family Comprehensive Cancer Center; and
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Deufel CL, McCauley Cutsinger S, Corbin KS, Dalvin LA, Petersen IA. EyeDose: An open-source tool for using published Monte Carlo results to estimate the radiation dose delivered to the tumor and critical ocular structures for 125I Collaborative Ocular Melanoma Study eye plaques. Brachytherapy 2020; 20:189-199. [PMID: 33187821 DOI: 10.1016/j.brachy.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/07/2020] [Accepted: 09/11/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Radiation side effects and visual outcome for uveal melanoma patients managed with plaque radiotherapy are dependent on the radiation dose administered to the tumor and nearby healthy tissues. We have developed an open-source software tool, EyeDose, to simplify and standardize tumor and critical structure dose reporting for Collaborative Ocular Melanoma Study eye plaques. METHODS AND MATERIALS EyeDose is a MATLAB-based program that calculates point dose and volume dose metrics for standard models of the tumor and critical ocular structures. It uses published three-dimensional dose distributions for eye plaques, calculated with Monte Carlo methods, which are oriented with respect to the eye using the tumor's position on a fundus diagram. A standard model for the ocular structures was created using published measurements and patient CT scans. EyeDose reports radiation statistics for the fovea, optic disc, lens, lacrimal gland, retina, and tumor. The dosimetric margin for implant placement uncertainty is also calculated. RESULTS EyeDose calculations were validated against previously published Monte Carlo results for eight different tumor positions, including the dose to the fovea, optic disc, lacrimal gland, lens, and along the central axis. EyeDose accepts a spreadsheet input for rapidly processing large retrospective patient data sets, with an average run time of <40 s per patient. EyeDose is published as an open-source tool for easy adaptation at different institutions. CONCLUSIONS EyeDose calculates radiation statistics for Collaborative Ocular Melanoma Study eye plaque patients with Monte Carlo accuracy and without a treatment planning system. EyeDose streamlines data collection for large retrospective studies and can also be used prospectively to assess plaque applicability.
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Affiliation(s)
| | | | | | | | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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Grams MP, Owen D, Park SS, Petersen IA, Haddock MG, Jeans EB, Finley RR, Ma DJ. VMAT Grid Therapy: A Widely Applicable Planning Approach. Pract Radiat Oncol 2020; 11:e339-e347. [PMID: 33130318 DOI: 10.1016/j.prro.2020.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/26/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe a novel and practical volumetric modulated arc therapy (VMAT) planning approach for grid therapy. METHODS AND MATERIALS Dose is prescribed to 1.5-cm diameter spherical contours placed throughout the gross tumor volume (GTV). Placement of spheres is variable, but they must maintain at least a 3-cm (center to center) separation, and the edge of any sphere must be at least 1 cm from any organ at risk (OAR). Three concentric ring structures are used during optimization to confine the highest doses to the center of the spheres and maximize dose sparing between them. The end result is alternating regions of high and low dose throughout the GTV and minimal dose to OARs. High-intensity flattening filter-free (FFF) modes are used to efficiently deliver the plans, and entire treatments typically take only 15 to 20 minutes. RESULTS The approach is illustrated with 2 examples treated at our institution. Patient #1 had a 1703-cm3 mediastinal mass and was prescribed 20 Gray (Gy) to 24 spherical regions within the GTV. Patient #2 had a 3680-cm3 abdominal tumor and was prescribed 18 Gy to 32 spherical regions within the GTV. Both patients received additional consolidative radiation approximately 1 week after the initial VMAT grid treatment. Each patient experienced marked reduction in tumor size and symptomatic relief without treatment-related complications. CONCLUSIONS We have described in detail a planning approach for VMAT grid therapy treatments that can typically be delivered in a clinically practical time span. The VMAT approach is especially useful for tumors that are surrounded by sensitive critical structures. As many centers offer VMAT treatments, the approach is widely accessible and can be readily implemented once appropriate patient selection and delivery processes are established.
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Affiliation(s)
- Michael P Grams
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Randi R Finley
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Ahmed SK, Kaggal S, Harmsen WS, Sawyer JW, Houdek MT, Rose PS, Petersen IA. Patient-reported functional outcomes in a cohort of hand and foot sarcoma survivors treated with limb sparing surgery and radiation therapy. J Surg Oncol 2020; 123:110-116. [PMID: 33125739 DOI: 10.1002/jso.26258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/11/2020] [Accepted: 10/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Describe patient-reported functional outcomes for hand and foot sarcoma survivors treated with limb-sparing surgery and radiation therapy (LSS + RT). METHODS Fifty-four patients with hand/wrist and foot/ankle sarcomas treated with LSS + RT from 1991 to 2015 were identified. Survivors ≥18 years old without subsequent amputation completed self-assessed functional surveys: Toronto upper extremity salvage score (TESS-UE) and Michigan hand outcomes (MHQ) surveys for hand; TESS lower extremity (TESS-LE) and Foot and Ankle Outcomes (FAOS) surveys for foot. Scoring scales: 0-100, MHQ and TESS; -26 to 56 and 25-59, FAOS core and shoe comfort, respectively. Higher scores denote superior function. RESULTS Five-year local tumor control was 88%. Fourteen of 24 hand (58%) and 14/18 foot (78%) survivors completed surveys. Mean TESS-UE and MHQ scores were 89.4 and 72.8, respectively. Mean TESS-LE, core FAOS, and shoe comfort scores were 92.4, 46.19, and 53.1, respectively. No factors correlated with outcomes. TESS-UE and MHQ scores strongly correlated (r = .87). TESS-LE and FAOS scores were associated with a poor correlation (r = .02 and r = .69). CONCLUSIONS The largest patient-reported functional outcomes analysis for hand and foot sarcoma survivors treated with LSS + RT demonstrates excellent local tumor control and acceptable functional outcomes. Further exploration of optimal functional assessment tools is needed given the potential scope differences.
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Affiliation(s)
- Safia K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Suneetha Kaggal
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - William S Harmsen
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Jeans EB, Beard TB, Boon AL, Brown PD, Ma DJ, Petersen IA, Laack NN, Foote RL, Corbin KS, Olivier KR. Empowering Residents into Independent Practice: A Single-Institutional Endeavor Aimed at Developing Resident Autonomy Through Implementation of a Chief Resident Service in Radiation Oncology. Int J Radiat Oncol Biol Phys 2020; 107:23-26. [PMID: 32277921 DOI: 10.1016/j.ijrobp.2020.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Teresa B Beard
- Department of Medicare Regulation and Reimbursement, Mayo Clinic, Rochester, Minnesota
| | - Ashton L Boon
- Department of Legal Counsel, Mayo Clinic, Rochester, Minnesota
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Kenneth R Olivier
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
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Bogani G, Cappuccio S, Casarin J, Narasimhulu DMM, Cilby WA, Glaser GE, Weaver AL, McGree ME, Keeney GL, Weroha J, Petersen IA, Mariani A. Role of adjuvant therapy in stage IIIC2 endometrial cancer. Int J Gynecol Cancer 2020; 30:1169-1176. [PMID: 32646864 DOI: 10.1136/ijgc-2020-001446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The role of the different types of adjuvant treatments in endometrial cancer with para-aortic node metastases is unclear. The aim of this study was to report oncologic outcomes after adjuvant therapy in patients with stage IIIC2 endometrial cancer. METHODS This retrospective single-institution study assessed patients with stage IIIC2 endometrial cancer who underwent primary surgery from January 1984 to December 2014. All patients had hysterectomy (±salpingo-oophorectomy) plus lymphadenectomy (para-aortic nodes, ±pelvic nodes). We included all patients with stage III endometrial cancer and documented para-aortic lymph node metastases (International Federation of Obstetrics and Gynecologists stage IIIC2). We excluded patients who did not provide consent, who had synchronous cancer, or who underwent neoadjuvant chemotherapy. Follow-up was restricted to the first 5 years post-operatively. Cox proportional hazards models, with age as the time scale, was used to evaluate associations of risk factors with disease-free survival and overall survival. RESULTS Among 105 patients with documented adjuvant therapy, external beam radiotherapy was administered to 25 patients (24%), chemotherapy to 24 (23%), and a combination (chemotherapy and external beam radiotherapy) to 56 (53%) patients. Most patients receiving chemotherapy and external beam radiotherapy (80%) had chemotherapy first. The majority of relapses had a distant component (31/46, 67%) and only one patient had an isolated para-aortic recurrence. Non-endometrioid subtypes had poorer disease-free survival (HR 2.57; 95% CI 1.38 to 4.78) and poorer overall survival (HR 2.00; 95% CI 1.09 to 3.65) compared with endometrioid. Among patients with endometrioid histology (n=60), chemotherapy and external beam radiotherapy improved disease-free survival (HR 0.22; 95% CI 0.07 to 0.71) and overall survival (HR 0.28; 95% CI 0.09 to 0.89) compared with chemotherapy or external beam radiotherapy alone. Combination therapy did not improve prognosis for patients with non-endometrioid histology (n=45). CONCLUSIONS In our cohort of patients with stage IIIC2 endometrioid endometrial cancer, those receiving chemotherapy and external beam radiotherapy had improved survival compared with patients receiving chemotherapy or external beam radiotherapy alone. However, the prognosis of patients with non-endometrioid endometrial cancer remained poor, regardless of the adjuvant therapy administered. Distant recurrences were the most common sites of failure.
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Affiliation(s)
- Giorgio Bogani
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Serena Cappuccio
- Department of Woman's, Child's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | | | - William A Cilby
- Division of Gynecologic Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Gretchen E Glaser
- Division of Gynecologic Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Michaela E McGree
- Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Gary L Keeney
- Division of Anatomic Pathology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - John Weroha
- Division of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Andrea Mariani
- Division of Gynecologic Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Munaretto NF, Logli AL, Rose PS, Petersen IA, Ahmed SK, Bakri K, Moran SL, Houdek MT. Radiotherapy Does Not Impact Long-term Function Following Resection of Soft-tissue Sarcomas of the Hand. Anticancer Res 2020; 40:1463-1466. [PMID: 32132044 DOI: 10.21873/anticanres.14089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Radiotherapy for soft tissue sarcomas (STS) of the hand is thought to be associated with poor function. The aim of this study was to compare the long-term functional outcome in patients with and without radiotherapy. PATIENTS AND METHODS At long-term follow-up (mean 10±5 years), 33 (13 males, 20 female) patients, were alive for review. The mean patient age at surgery was 33±17 years and 13 (39%) patients received radiotherapy (mean dose 55±6 Gy). RESULTS Postoperatively, the mean QuickDASH and MSTS93 were 7±8 and 92±8%, respectively. Comparing patients with and without radiotherapy, there was no difference (p>0.05) between the mean QuickDASH (5±5 vs. 8±9) or MSTS93 (93±9% vs. 91±8%). Surgical complication occurred more commonly in patients with radiotherapy (46% vs. 15%, p=0.10). CONCLUSION The use of radiotherapy was associated with a higher rate of complications, however, was not associated with a worse long-term functional outcome in patients with hand STS.
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Affiliation(s)
| | - Anthony L Logli
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, U.S.A
| | - Safia K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, U.S.A
| | - Karim Bakri
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | - Steven L Moran
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A.
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Vicini FA, Cecchini RS, White JR, Arthur DW, Julian TB, Rabinovitch RA, Kuske RR, Ganz PA, Parda DS, Scheier MF, Winter KA, Paik S, Kuerer HM, Vallow LA, Pierce LJ, Mamounas EP, McCormick B, Costantino JP, Bear HD, Germain I, Gustafson G, Grossheim L, Petersen IA, Hudes RS, Curran WJ, Bryant JL, Wolmark N. Long-term primary results of accelerated partial breast irradiation after breast-conserving surgery for early-stage breast cancer: a randomised, phase 3, equivalence trial. Lancet 2019; 394:2155-2164. [PMID: 31813636 PMCID: PMC7199428 DOI: 10.1016/s0140-6736(19)32514-0] [Citation(s) in RCA: 280] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/20/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Whole-breast irradiation after breast-conserving surgery for patients with early-stage breast cancer decreases ipsilateral breast-tumour recurrence (IBTR), yielding comparable results to mastectomy. It is unknown whether accelerated partial breast irradiation (APBI) to only the tumour-bearing quadrant, which shortens treatment duration, is equally effective. In our trial, we investigated whether APBI provides equivalent local tumour control after lumpectomy compared with whole-breast irradiation. METHODS We did this randomised, phase 3, equivalence trial (NSABP B-39/RTOG 0413) in 154 clinical centres in the USA, Canada, Ireland, and Israel. Adult women (>18 years) with early-stage (0, I, or II; no evidence of distant metastases, but up to three axillary nodes could be positive) breast cancer (tumour size ≤3 cm; including all histologies and multifocal breast cancers), who had had lumpectomy with negative (ie, no detectable cancer cells) surgical margins, were randomly assigned (1:1) using a biased-coin-based minimisation algorithm to receive either whole-breast irradiation (whole-breast irradiation group) or APBI (APBI group). Whole-breast irradiation was delivered in 25 daily fractions of 50 Gy over 5 weeks, with or without a supplemental boost to the tumour bed, and APBI was delivered as 34 Gy of brachytherapy or 38·5 Gy of external bream radiation therapy in 10 fractions, over 5 treatment days within an 8-day period. Randomisation was stratified by disease stage, menopausal status, hormone-receptor status, and intention to receive chemotherapy. Patients, investigators, and statisticians could not be masked to treatment allocation. The primary outcome of invasive and non-invasive IBTR as a first recurrence was analysed in the intention-to-treat population, excluding those patients who were lost to follow-up, with an equivalency test on the basis of a 50% margin increase in the hazard ratio (90% CI for the observed HR between 0·667 and 1·5 for equivalence) and a Cox proportional hazard model. Survival was assessed by intention to treat, and sensitivity analyses were done in the per-protocol population. This trial is registered with ClinicalTrials.gov, NCT00103181. FINDINGS Between March 21, 2005, and April 16, 2013, 4216 women were enrolled. 2109 were assigned to the whole-breast irradiation group and 2107 were assigned to the APBI group. 70 patients from the whole-breast irradiation group and 14 from the APBI group withdrew consent or were lost to follow-up at this stage, so 2039 and 2093 patients respectively were available for survival analysis. Further, three and four patients respectively were lost to clinical follow-up (ie, survival status was assessed by phone but no physical examination was done), leaving 2036 patients in the whole-breast irradiation group and 2089 in the APBI group evaluable for the primary outcome. At a median follow-up of 10·2 years (IQR 7·5-11·5), 90 (4%) of 2089 women eligible for the primary outcome in the APBI group and 71 (3%) of 2036 women in the whole-breast irradiation group had an IBTR (HR 1·22, 90% CI 0·94-1·58). The 10-year cumulative incidence of IBTR was 4·6% (95% CI 3·7-5·7) in the APBI group versus 3·9% (3·1-5·0) in the whole-breast irradiation group. 44 (2%) of 2039 patients in the whole-breast irradiation group and 49 (2%) of 2093 patients in the APBI group died from recurring breast cancer. There were no treatment-related deaths. Second cancers and treatment-related toxicities were similar between the two groups. 2020 patients in the whole-breast irradiation group and 2089 in APBI group had available data on adverse events. The highest toxicity grade reported was: grade 1 in 845 (40%), grade 2 in 921 (44%), and grade 3 in 201 (10%) patients in the APBI group, compared with grade 1 in 626 (31%), grade 2 in 1193 (59%), and grade 3 in 143 (7%) in the whole-breast irradiation group. INTERPRETATION APBI did not meet the criteria for equivalence to whole-breast irradiation in controlling IBTR for breast-conserving therapy. Our trial had broad eligibility criteria, leading to a large, heterogeneous pool of patients and sufficient power to detect treatment equivalence, but was not designed to test equivalence in patient subgroups or outcomes from different APBI techniques. For patients with early-stage breast cancer, our findings support whole-breast irradiation following lumpectomy; however, with an absolute difference of less than 1% in the 10-year cumulative incidence of IBTR, APBI might be an acceptable alternative for some women. FUNDING National Cancer Institute, US Department of Health and Human Services.
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Affiliation(s)
- Frank A Vicini
- NRG Oncology, Pittsburgh, PA, USA; MHP Radiation Oncology Institute, St Joseph Mercy Hospital Campus, Pontiac, MI, USA.
| | - Reena S Cecchini
- NRG Oncology, Pittsburgh, PA, USA; University of Pittsburgh, Pittsburgh, PA, USA
| | - Julia R White
- NRG Oncology, Pittsburgh, PA, USA; Ohio State University Comprehensive Cancer Center-Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, OH, USA
| | - Douglas W Arthur
- NRG Oncology, Pittsburgh, PA, USA; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Thomas B Julian
- NRG Oncology, Pittsburgh, PA, USA; Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Rachel A Rabinovitch
- NRG Oncology, Pittsburgh, PA, USA; University of Colorado Cancer Center, Aurora, CO, USA
| | - Robert R Kuske
- NRG Oncology, Pittsburgh, PA, USA; Arizona Breast Cancer Specialists, Arizona Center for Cancer Care, Scottsdale, AZ, USA
| | - Patricia A Ganz
- NRG Oncology, Pittsburgh, PA, USA; University of California at Los Angeles, Los Angeles, CA, USA
| | - David S Parda
- NRG Oncology, Pittsburgh, PA, USA; Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | | | - Kathryn A Winter
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Soonmyung Paik
- NRG Oncology, Pittsburgh, PA, USA; Yonsei University College of Medicine, Seoul, Korea
| | - Henry M Kuerer
- NRG Oncology, Pittsburgh, PA, USA; MD Anderson Cancer Center, Houston, TX, USA
| | | | - Lori J Pierce
- Southwest Oncology Group Cancer Research Network, Hope Foundation for Cancer Research, Portland, OR, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Eleftherios P Mamounas
- NRG Oncology, Pittsburgh, PA, USA; Orlando Health, UF Health Cancer Center, Orlando, FL, USA
| | - Beryl McCormick
- NRG Oncology, Pittsburgh, PA, USA; Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph P Costantino
- NRG Oncology, Pittsburgh, PA, USA; University of Pittsburgh, Pittsburgh, PA, USA
| | - Harry D Bear
- NRG Oncology, Pittsburgh, PA, USA; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Isabelle Germain
- NRG Oncology, Pittsburgh, PA, USA; Centre Hospitalier Universitaire de Québec-Université Laval, Pavillon Hôtel-Dieu de Québec, Québec City, QC, Canada
| | - Gregory Gustafson
- NRG Oncology, Pittsburgh, PA, USA; Community Clinical Oncology Program, William Beaumont Hospital, Sterling Heights, MI, USA
| | - Linda Grossheim
- NRG Oncology, Pittsburgh, PA, USA; Summit Cancer Center, Post Falls, ID, USA
| | - Ivy A Petersen
- NRG Oncology, Pittsburgh, PA, USA; Mayo Clinic, Rochester, MN, USA
| | - Richard S Hudes
- NRG Oncology, Pittsburgh, PA, USA; Saint Agnes Hospital, Baltimore, MD, USA; Thomas Jefferson University, Baltimore, MD, USA
| | - Walter J Curran
- NRG Oncology, Pittsburgh, PA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - John L Bryant
- NRG Oncology, Pittsburgh, PA, USA; University of Pittsburgh, Pittsburgh, PA, USA
| | - Norman Wolmark
- NRG Oncology, Pittsburgh, PA, USA; University of Pittsburgh, Pittsburgh, PA, USA; Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
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von Mehren M, Randall RL, Benjamin RS, Boles S, Bui MM, Ganjoo KN, George S, Gonzalez RJ, Heslin MJ, Kane JM, Keedy V, Kim E, Koon H, Mayerson J, McCarter M, McGarry SV, Meyer C, Morris ZS, O'Donnell RJ, Pappo AS, Paz IB, Petersen IA, Pfeifer JD, Riedel RF, Ruo B, Schuetze S, Tap WD, Wayne JD, Bergman MA, Scavone JL. Soft Tissue Sarcoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 16:536-563. [PMID: 29752328 DOI: 10.6004/jnccn.2018.0025] [Citation(s) in RCA: 400] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Soft tissue sarcomas (STS) are rare solid tumors of mesenchymal cell origin that display a heterogenous mix of clinical and pathologic characteristics. STS can develop from fat, muscle, nerves, blood vessels, and other connective tissues. The evaluation and treatment of patients with STS requires a multidisciplinary team with demonstrated expertise in the management of these tumors. The complete NCCN Guidelines for STS provide recommendations for the diagnosis, evaluation, and treatment of extremity/superficial trunk/head and neck STS, as well as intra-abdominal/retroperitoneal STS, gastrointestinal stromal tumors, desmoid tumors, and rhabdomyosarcoma. This portion of the NCCN Guidelines discusses general principles for the diagnosis, staging, and treatment of STS of the extremities, superficial trunk, or head and neck; outlines treatment recommendations by disease stage; and reviews the evidence to support the guidelines recommendations.
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Deufel CL, Tian S, Yan BB, Vaishnav BD, Haddock MG, Petersen IA. Automated applicator digitization for high-dose-rate cervix brachytherapy using image thresholding and density-based clustering. Brachytherapy 2019; 19:111-118. [PMID: 31594729 DOI: 10.1016/j.brachy.2019.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/13/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of the study was to develop and evaluate an automated digitization algorithm for high-dose-rate cervix brachytherapy, with the goal of reducing the duration of treatment planning, staff resources, variability, and potential for human error. METHODS An automated digitization algorithm was developed and retrospectively evaluated using treatment planning data from 10 patients with cervix cancer who were treated with a titanium tandem and ovoids applicator set. Applicators were segmented, without human interaction, by thresholding CT images to isolate high-density voxels and assigning the voxels to applicator and nonapplicator structures using HDBSCAN, a density-based linkage clustering algorithm. The applicator contours were determined from the centroid of the clustered voxels on each image slice and written to a treatment plan file. Automated contours were evaluated against manual digitization using distance and dosimetric metrics. RESULTS A close agreement between automatic and manual digitization was observed. The mean magnitude of contour disagreement for 10 patients equaled 0.3 mm. Hausdorff distances were ≤1.0 mm. The applicator tip coordinates had submillimeter agreement. The median and mean dose volume histogram parameter differences were less than or equal to 1% for high-risk clinical target volume D90, high-risk clinical target volume D95, bladder D2cc, rectum D2cc, large bowel D2cc, and small bowel D2cc. The average execution time for the automated algorithm was less than 30 s. CONCLUSION The digitization of titanium tandem and ovoids applicators for high-dose-rate brachytherapy treatment planning can be automated using straightforward thresholding and clustering algorithms. The adoption of automated digitization is expected to improve the consistency of treatment plans and reduce the duration of treatment planning.
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Affiliation(s)
| | - Shulan Tian
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Benjamin B Yan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | | | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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Vicini FA, Cecchini RS, White JR, Julian TB, Arthur DW, Rabinovitch RA, Kuske RR, Parda DS, Ganz PA, Scheier MF, Winter KA, Paik S, Kuerer HM, Vallow LA, Pierce LJ, Mamounas EP, Costantino JP, Bear HD, Germaine I, Gustafson G, Grossheim L, Petersen IA, Hudes RS, Curran WJ, Wolmark N. Abstract GS4-04: Primary results of NSABP B-39/RTOG 0413 (NRG Oncology): A randomized phase III study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) for women with stage 0, I, or II breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs4-04] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Conventional WBI after lumpectomy for early-stage breast cancer decreases ipsilateral breast tumor recurrence (IBTR), yielding comparable results to mastectomy. Accelerated PBI appears effective in reducing IBTR by treating only the tumor bed area. As the majority of IBTR occur at or in the vicinity of the tumor bed, we hypothesized that PBI would be as effective as WBI in controlling IBTR. The primary aim of NSABP B-39/RTOG 0413 was to determine if PBI provides equivalent local tumor control post lumpectomy compared to WBI in pts with early-stage breast cancer. The equivalency test was based on a 50% margin of increase in the hazard ratio (HR=1.5). Secondary endpoints included: overall survival (OS), recurrence-free interval (RFI), distant disease-free interval (DDFI), and toxicity.
Methods: Eligible pts had lumpectomy with histologically-free margins and 0-3 positive axillary nodes. Pts were stratified by stage, menopausal status, hormone receptor status, and intent to receive chemotherapy and then randomized to PBI or WBI. PBI was 10 fractions of 3.4-3.85 Gy, given twice daily with either brachytherapy or 3D external beam radiation. WBI was 50 Gy in 2 Gy fractions given daily with a sequential boost to the surgical cavity. Follow-up was every 6 mos for 5 yrs and then annually. All analyses were by intent-to-treat.
Results: From 3-21-05 to 4-16-13, 4216 pts were randomized: 2107 PBI; 2109 WBI. 61% were postmenopausal; 81% were hormone receptor-positive; 29% intended to receive chemotherapy. Stage distribution was: DCIS, 24%; invasive pN0, 65%; invasive pN1, 10%. As of 7-31-18, median follow-up was 10.2 yrs. There were 161 IBTRs as first events: 90 PBI v 71 WBI (HR 1.22; 90%CI 0.94-1.58). Per protocol-defined margin, to declare PBI and WBI equivalent regarding IBTR risk, the 90% CI for the observed HR had to lie entirely between 0.667 and 1.5. The percent of pts IBTR-free at 10 yrs was 95.2% PBI v 95.9% WBI. A statistically significant difference in the 10-yr RFI rate favored WBI (91.9% PBI v 93.4% WBI; HR 1.32; 95%CI 1.04-1.68; p=0.02). No statistically significant differences existed between PBI and WBI in DDFI (HR 1.31; 95%CI 0.91-1.91; p=0.15), OS (HR 1.10; 95%CI 0.90-1.35; p=0.35), or DFS (HR 1.12; 95%CI 0.98-1.29; p=0.11). Grade 3 toxicity was 9.6% PBI v 7.1% WBI, and grade 4-5 toxicity was 0.5% v 0.3%, respectively.
Discussion: PBI did not meet the criteria for equivalence to WBI in controlling IBTR based on the upper limit of the hazard ratio confidence interval. However, the absolute difference in 10-yr rate of IBTR was <1% (4.8% PBI v 4.1% WBI). The risk of an RFI event was statistically significantly higher for PBI compared to WBI, but the absolute difference in 10-yr RFI rate was also small (8.1% PBI v 6.6% WBI). DDFI, OS, and DFS were not statistically different for PBI v WBI. Grade 3-5 toxicities, although low, were more common for PBI than WBI. The trial population was heterogeneous, ranging from Stage 0-2 breast cancer, and outcome by risk categories are being analyzed.
Support: U10CA180868, -180822, UG1CA189867.
Citation Format: Vicini FA, Cecchini RS, White JR, Julian TB, Arthur DW, Rabinovitch RA, Kuske RR, Parda DS, Ganz PA, Scheier MF, Winter KA, Paik S, Kuerer HM, Vallow LA, Pierce LJ, Mamounas EP, Costantino JP, Bear HD, Germaine I, Gustafson G, Grossheim L, Petersen IA, Hudes RS, Curran, Jr. WJ, Wolmark N. Primary results of NSABP B-39/RTOG 0413 (NRG Oncology): A randomized phase III study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) for women with stage 0, I, or II breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS4-04.
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Affiliation(s)
- FA Vicini
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - RS Cecchini
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - JR White
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - TB Julian
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - DW Arthur
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - RA Rabinovitch
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - RR Kuske
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - DS Parda
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - PA Ganz
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - MF Scheier
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - KA Winter
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - S Paik
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - HM Kuerer
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - LA Vallow
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - LJ Pierce
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - EP Mamounas
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - JP Costantino
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - HD Bear
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - I Germaine
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - G Gustafson
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - L Grossheim
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - IA Petersen
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - RS Hudes
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - WJ Curran
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - N Wolmark
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
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Houdek MT, Rose PS, Hevesi M, Schwab JH, Griffin AM, Healey JH, Petersen IA, DeLaney TF, Chung PW, Yaszemski MJ, Wunder JS, Hornicek FJ, Boland PJ, Sim FH, Ferguson PC. Low dose radiotherapy is associated with local complications but not disease control in sacral chordoma. J Surg Oncol 2019; 119:856-863. [PMID: 30734292 DOI: 10.1002/jso.25399] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 01/20/2019] [Accepted: 01/23/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND We reviewed the disease control and complications of the treatment of sacrococcygeal chordoma from four tertiary cancer centers with emphasis on the effects of radiotherapy in surgically treated patients. METHODS A total of 193 patients with primary sacrococcygeal chordoma from 1990 to 2015 were reviewed. There were 124 males, with a mean age of 59 ± 15 years and a mean follow-up of 7 ± 4 years. Eighty-nine patients received radiotherapy with a mean total dose of 61.8 ± 10.9 Gy. RESULTS The 10-year disease-free and disease-specific survival was 58% and 72%, respectively. Radiation was not associated with local recurrence (hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.59-2.17; P = 0.71), metastases (HR, 0.93; 95% CI, 0.45-1.91; P = 0.85) or disease-specific survival (HR, 0.96; 95% CI, 0.46-2.00; P = 0.91). Higher doses (≥70 Gy; HR, 0.52; 95% CI, 0.20-1.32; P = 0.17) may be associated with reduced local recurrence. Radiotherapy was associated with wound complications (HR, 2.76; 95% CI, 1.64-4.82;, P < 0.001) and sacral stress fractures (HR, 4.73; 95% CI, 1.88-14.38; P < 0.001). CONCLUSIONS In this multicenter review, radiotherapy was not associated with tumor outcome but associated with complications. The routine use of radiotherapy with en-bloc resection of sacrococcygeal chordomas should be reconsidered in favor of a selective, individualized approach with a radiation dose of ≥70 Gy.
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Affiliation(s)
- Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Anthony M Griffin
- Division of Orthopaedic Surgery, Department of Surgery, University Musculoskeletal Oncology Unit Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - John H Healey
- Orthopaedic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center and Weill College of Medicine, Cornell University, New York, New York
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Peter W Chung
- Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada
| | | | - Jay S Wunder
- Division of Orthopaedic Surgery, Department of Surgery, University Musculoskeletal Oncology Unit Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Francis J Hornicek
- Department of Orthopedic Surgery, University of California Los Angeles, Los Angeles, California
| | - Patrick J Boland
- Orthopaedic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center and Weill College of Medicine, Cornell University, New York, New York
| | - Franklin H Sim
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Peter C Ferguson
- Division of Orthopaedic Surgery, Department of Surgery, University Musculoskeletal Oncology Unit Mount Sinai Hospital, University of Toronto, Toronto, Canada
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von Mehren M, Randall RL, Benjamin RS, Boles S, Bui MM, Conrad EU, Ganjoo KN, George S, Gonzalez RJ, Heslin MJ, Kane JM, Koon H, Mayerson J, McCarter M, McGarry SV, Meyer C, O'Donnell RJ, Pappo AS, Paz IB, Petersen IA, Pfeifer JD, Riedel RF, Schuetze S, Schupak KD, Schwartz HS, Tap WD, Wayne JD, Bergman MA, Scavone J. Soft Tissue Sarcoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2017; 14:758-86. [PMID: 27283169 DOI: 10.6004/jnccn.2016.0078] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Soft tissue sarcomas (STS) are rare solid tumors of mesenchymal cell origin that display a heterogenous mix of clinical and pathologic characteristics. STS can develop from fat, muscle, nerves, blood vessels, and other connective tissues. The evaluation and treatment of patients with STS requires a multidisciplinary team with demonstrated expertise in the management of these tumors. The complete NCCN Guidelines for Soft Tissue Sarcoma (available at NCCN.org) provide recommendations for the diagnosis, evaluation, and treatment of extremity/superficial trunk/head and neck STS, as well as intra-abdominal/retroperitoneal STS, gastrointestinal stromal tumor, desmoid tumors, and rhabdomyosarcoma. This manuscript discusses guiding principles for the diagnosis and staging of STS and evidence for treatment modalities that include surgery, radiation, chemoradiation, chemotherapy, and targeted therapy.
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Ahmed SK, Robinson SI, Arndt CAS, Petersen IA, Haddock MG, Rose PS, Issa Laack NN. Pelvis Ewing sarcoma: Local control and survival in the modern era. Pediatr Blood Cancer 2017; 64. [PMID: 28244685 DOI: 10.1002/pbc.26504] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/10/2017] [Accepted: 01/30/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Local control for Ewing sarcoma (ES) has improved in modern studies. However, it is unclear if these gains have also been achieved for pelvis tumors. The purpose of this study is to evaluate local control and survival in pelvis ES patients treated in the modern era. METHODS All pelvis ES patients diagnosed from 1990 to 2012 and seen at Mayo Clinic were identified. Factors relevant to survival and local control were analyzed. RESULTS The cohort consisted of 48 patients. Fifty-two percent had metastatic disease at diagnosis. The 5-year overall survival and event-free survival was 73% and 65%, respectively, for localized disease. The 5-year cumulative incidence of local recurrence was 19%, with a 26% incidence for radiation, 13% for surgery, and 0% for surgery + radiation (P = 0.54). All local failures occurred in-field. Sacral involvement by tumor trended toward a higher incidence of local recurrence (hazard ratio 3.06, P = 0.09). Patients treated with definitive radiation doses ≥5,600 cGy had a lower incidence of local recurrence (17% vs. 28%, P = 0.61). CONCLUSIONS Our study demonstrates excellent survival for localized tumors in the modern era. Anatomical localization within the pelvis likely correlates with outcomes. Local control remains problematic, especially for patients treated with definitive radiation. Though statistically not significant, surgery + radiation and definitive radiation dose ≥5,600 cGy were associated with the lowest incidence of local failure, suggesting treatment intensification may improve local control for pelvis ES.
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Affiliation(s)
- Safia K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Carola A S Arndt
- Division of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, Minnesota
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Peter S Rose
- Division of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, Minnesota.,Division of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Petersen IA. Preoperative Radiation Therapy With Simultaneous Integrated Boost Dose Escalation for Optimal Local Control of Retroperitoneal Dedifferentiated Liposarcoma. Int J Radiat Oncol Biol Phys 2017; 98:272-273. [DOI: 10.1016/j.ijrobp.2017.01.232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Saiki H, Petersen IA, Scott CG, Bailey KR, Dunlay SM, Finley RR, Ruddy KJ, Yan E, Redfield MM. Risk of Heart Failure With Preserved Ejection Fraction in Older Women After Contemporary Radiotherapy for Breast Cancer. Circulation 2017; 135:1388-1396. [PMID: 28132957 DOI: 10.1161/circulationaha.116.025434] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/13/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cardiomyocytes are resistant to radiation. However, cardiac radiation exposure causes coronary microvascular endothelial inflammation, a perturbation implicated in the pathogenesis of heart failure (HF) and particularly HF with preserved ejection fraction (HFpEF). Radiotherapy for breast cancer results in variable cardiac radiation exposure and may increase the risk of HF. METHODS We conducted a population-based case-control study of incident HF in 170 female residents of Olmsted County, Minnesota (59 cases and 111 controls), who underwent contemporary (1998-2013) radiotherapy for breast cancer with computed tomography-assisted radiotherapy planning. Controls were matched to cases for age, tumor side, chemotherapy use, diabetes mellitus, and hypertension. Mean cardiac radiation dose (MCRD) in each patient was calculated from the patient's computed tomography images and radiotherapy plan. RESULTS Mean age at radiotherapy was 69±9 years. Of HF cases, 38 (64%) had EF≥50% (HFpEF), 18 (31%) had EF<50% (HF with reduced EF), and 3 (5%) did not have EF measured. The EF was ≥40% in 50 of the 56 HF cases (89%) with an EF measurement. The mean interval from radiotherapy to HF was 5.8±3.4 years. The odds of HF was higher in patients with a history of ischemic heart disease or atrial fibrillation. The MCRD was 2.5 Gy (range, 0.2-13.1 Gy) and higher in cases (3.3±2.7 Gy) than controls (2.1±2.0 Gy; P=0.004). The odds ratio (95% confidence interval) for HF per log MCRD was 9.1 (3.4-24.4) for any HF, 16.9 (3.9-73.7) for HFpEF, and 3.17 (0.8-13.0) for HF with reduced EF. The increased odds of any HF or HFpEF with increasing MCRD remained significant after adjustment for HF risk factors and in sensitivity analyses matching by cancer stage rather than tumor side. Only 18.6% of patients experienced new or recurrent ischemic events between radiotherapy and the onset of HF. CONCLUSIONS The relative risk of HFpEF increases with increasing cardiac radiation exposure during contemporary conformal breast cancer radiotherapy. These data emphasize the importance of radiotherapy techniques that limit MCRD during breast cancer treatment. Moreover, these data provide further support for the importance of coronary microvascular compromise in the pathophysiology of HFpEF.
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Affiliation(s)
- Hirofumi Saiki
- From Department of Cardiovascular Disease (H.S., S.M.D., M.M.R.), Department of Radiation Oncology (I.A.P., R.R.F., E.Y.), Department of Health Science Research (C.G.S., K.R.B., S.M.D.), and Division of Medical Oncology (K.J.R.), Mayo Clinic and Foundation, Rochester, MN
| | - Ivy A Petersen
- From Department of Cardiovascular Disease (H.S., S.M.D., M.M.R.), Department of Radiation Oncology (I.A.P., R.R.F., E.Y.), Department of Health Science Research (C.G.S., K.R.B., S.M.D.), and Division of Medical Oncology (K.J.R.), Mayo Clinic and Foundation, Rochester, MN
| | - Christopher G Scott
- From Department of Cardiovascular Disease (H.S., S.M.D., M.M.R.), Department of Radiation Oncology (I.A.P., R.R.F., E.Y.), Department of Health Science Research (C.G.S., K.R.B., S.M.D.), and Division of Medical Oncology (K.J.R.), Mayo Clinic and Foundation, Rochester, MN
| | - Kent R Bailey
- From Department of Cardiovascular Disease (H.S., S.M.D., M.M.R.), Department of Radiation Oncology (I.A.P., R.R.F., E.Y.), Department of Health Science Research (C.G.S., K.R.B., S.M.D.), and Division of Medical Oncology (K.J.R.), Mayo Clinic and Foundation, Rochester, MN
| | - Shannon M Dunlay
- From Department of Cardiovascular Disease (H.S., S.M.D., M.M.R.), Department of Radiation Oncology (I.A.P., R.R.F., E.Y.), Department of Health Science Research (C.G.S., K.R.B., S.M.D.), and Division of Medical Oncology (K.J.R.), Mayo Clinic and Foundation, Rochester, MN
| | - Randi R Finley
- From Department of Cardiovascular Disease (H.S., S.M.D., M.M.R.), Department of Radiation Oncology (I.A.P., R.R.F., E.Y.), Department of Health Science Research (C.G.S., K.R.B., S.M.D.), and Division of Medical Oncology (K.J.R.), Mayo Clinic and Foundation, Rochester, MN
| | - Kathryn J Ruddy
- From Department of Cardiovascular Disease (H.S., S.M.D., M.M.R.), Department of Radiation Oncology (I.A.P., R.R.F., E.Y.), Department of Health Science Research (C.G.S., K.R.B., S.M.D.), and Division of Medical Oncology (K.J.R.), Mayo Clinic and Foundation, Rochester, MN
| | - Elizabeth Yan
- From Department of Cardiovascular Disease (H.S., S.M.D., M.M.R.), Department of Radiation Oncology (I.A.P., R.R.F., E.Y.), Department of Health Science Research (C.G.S., K.R.B., S.M.D.), and Division of Medical Oncology (K.J.R.), Mayo Clinic and Foundation, Rochester, MN
| | - Margaret M Redfield
- From Department of Cardiovascular Disease (H.S., S.M.D., M.M.R.), Department of Radiation Oncology (I.A.P., R.R.F., E.Y.), Department of Health Science Research (C.G.S., K.R.B., S.M.D.), and Division of Medical Oncology (K.J.R.), Mayo Clinic and Foundation, Rochester, MN.
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Ross CK, Petersen IA. Distal Vaginal Recurrences after Vaginal Brachytherapy. Brachytherapy 2016. [DOI: 10.1016/j.brachy.2016.04.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mayo CS, Pisansky TM, Petersen IA, Yan ES, Davis BJ, Stafford SL, Garces YI, Miller RC, Martenson JA, Mutter RW, Choo R, Hallemeier CL, Laack NN, Park SS, Ma DJ, Olivier KR, Keole SR, Fatyga M, Foote RL, Haddock MG. Establishment of practice standards in nomenclature and prescription to enable construction of software and databases for knowledge-based practice review. Pract Radiat Oncol 2016; 6:e117-e126. [PMID: 26825250 DOI: 10.1016/j.prro.2015.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 09/05/2015] [Accepted: 11/02/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Establishment of standards within a practice and across disease site groups for nomenclatures, prescription formatting, and measured dose-volume histogram (DVH) metrics is a key enabling step for creating software and database solutions to make routine aggregation of dosimetric data for all patients treated in a practice, practical. A process of physician-driven, iterative dialogs coupled with development of technical tools is required to implement the cultural and procedural changes. The cumulative reward for this effort is a database that can be used for defining practice norms, benchmarking against national standards, and tracking dosimetric effects of longitudinal practice pattern changes. METHODS AND MATERIALS A 4-year project was carried out to develop and introduce standardizations, modify processes, and develop computer-based tools for reporting, aggregation, and analysis of prescription and DVH metrics. Physician disease site groups developed 42 target and 81 normal tissue templates. From the database of 32,002 DVH metrics, benchmarking was illustrated for a subgroup of breast (281) and prostate (324) patients treated with conventional fractionation over a 16-month period. Breast patients were segregated according to prescription template used: simple (S, tangents only) vs complex (C, tangents + supraclavicular ± intramammary nodes) and left (S-L or C-L) versus right (S-R or C-R). RESULTS Prostate patients' median and 50% confidence intervals (CIs) for bladder, stated according to the nomenclature: the percentage of bladder volume receiving doses of ≥40 Gy (V40[%]), V65Gy[%], V70Gy[%], V75Gy[%], and V80Gy[%] were 45.5 (24.9-57.0), 15.6 (9.0-23.8), 7.6 (3.3-13.6), 2.0 (0.0-7.9), and 0.0 (0.0-1.4), respectively. Values for rectum: V50Gy[%], V60 Gy[%], V65Gy[%], V70Gy[%], and V75Gy[%] were 37.1 (27.8-43.5), 21.8 (15.6-25.5), 14.6 (9.6-18.0), 7.7 (1.9-12.3), and 1.0 (0-7.0), respectively. For breast patients, heart:mean Gray values were 1.5 (1.0-2.0), 3.1 (2.2-4.8), 0.4 (0.3-0.7), and 1.1 (0.8-2.2) for S-L, C-L, S-R, and C-R, respectively. Longitudinal, moving window plots of median, 50% CI, and 90% CI for 6-month periods demonstrated the effect of practice changes to reduce heart doses. CONCLUSIONS Standardization was challenging as a practice change, but has resulted in significant improvements for both our clinical and research efforts.
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Affiliation(s)
- Charles S Mayo
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | | | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth S Yan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Scott L Stafford
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Yolanda I Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Sameer R Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Mirek Fatyga
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Brown LC, Diehn FE, Boughey JC, Childs SK, Park SS, Yan ES, Petersen IA, Mutter RW. Delineation of Supraclavicular Target Volumes in Breast Cancer Radiation Therapy. In Reply to Yang and Guo. Int J Radiat Oncol Biol Phys 2016; 93:723-4. [PMID: 26461016 DOI: 10.1016/j.ijrobp.2015.06.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 06/30/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Lindsay C Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Felix E Diehn
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Judy C Boughey
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth S Yan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Deufel CL, Courneyea LA, McLemore LB, Petersen IA. Experimental and theoretical dosimetry of the RIC-100 phosphorus-32 brachytherapy source for implant geometries encountered in the intraoperative setting. Brachytherapy 2015; 14:734-50. [DOI: 10.1016/j.brachy.2015.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/11/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
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Brown LC, Diehn FE, Boughey JC, Childs SK, Park SS, Yan ES, Petersen IA, Mutter RW. Delineation of Supraclavicular Target Volumes in Breast Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys 2015; 92:642-9. [DOI: 10.1016/j.ijrobp.2015.02.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/06/2015] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
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Baldini EH, Bosch W, Kane JM, Abrams RA, Salerno KE, Deville C, Raut CP, Petersen IA, Chen YL, Mullen JT, Millikan KW, Karakousis G, Kendrick ML, DeLaney TF, Wang D. Retroperitoneal sarcoma (RPS) high risk gross tumor volume boost (HR GTV boost) contour delineation agreement among NRG sarcoma radiation and surgical oncologists. Ann Surg Oncol 2015; 22:2846-52. [PMID: 26018727 DOI: 10.1245/s10434-015-4633-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE Curative intent management of retroperitoneal sarcoma (RPS) requires gross total resection. Preoperative radiotherapy (RT) often is used as an adjuvant to surgery, but recurrence rates remain high. To enhance RT efficacy with acceptable tolerance, there is interest in delivering "boost doses" of RT to high-risk areas of gross tumor volume (HR GTV) judged to be at risk for positive resection margins. We sought to evaluate variability in HR GTV boost target volume delineation among collaborating sarcoma radiation and surgical oncologist teams. METHODS Radiation planning CT scans for three cases of RPS were distributed to seven paired radiation and surgical oncologist teams at six institutions. Teams contoured HR GTV boost volumes for each case. Analysis of contour agreement was performed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. RESULTS HRGTV boost volume contour agreement between the seven teams was "substantial" or "moderate" for all cases. Agreement was best on the torso wall posteriorly (abutting posterior chest abdominal wall) and medially (abutting ipsilateral para-vertebral space and great vessels). Contours varied more significantly abutting visceral organs due to differing surgical opinions regarding planned partial organ resection. CONCLUSIONS Agreement of RPS HRGTV boost volumes between sarcoma radiation and surgical oncologist teams was substantial to moderate. Differences were most striking in regions abutting visceral organs, highlighting the importance of collaboration between the radiation and surgical oncologist for "individualized" target delineation on the basis of areas deemed at risk and planned resection.
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Affiliation(s)
- Elizabeth H Baldini
- Department of Radiation Oncology, Brigham and Women's Hospital L2, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA,
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