Oligometastatic sarcoma treated with Curative intent Ablative Radiotherapy (OSCAR): A multicenter study on behalf of AIRO (Italian association of Radiotherapy and clinical Oncology)

BACKGROUND AND PURPOSE

Stereotactic Ablative Radiotherapy (SABR) is emerging as a valid alternative to surgery in the oligometastatic setting in soft tissue sarcomas (STS), although robust data are lacking. The aim of this study is to evaluate toxicity and efficacy of SABR in oligometastatic STS.

MATERIALS AND METHODS

This is a retrospective multicenter study including adult patients affected by stage IV STS, treated with SABR for a maximum of 5 cranial or extracranial metastases in up to 3 different organs. SABR was delivered with ablative purposes. Study endpoints were overall survival (OS), local control (LC), distant progression free survival (DPFS), time to polymetastatic progression (TTPP), time to new systemic therapy (TTNS) and toxicity.

RESULTS

From 10 Italian RT centers, 138 patients (202 metastases) treated between 2010 and 2022 were enrolled in the study. Treatment was generally well tolerated, no acute or late toxicity ≥ G3 was recorded. Median follow up was 42.5 months. Median OS was 39.7 months. Actuarial OS at 1 and 2 years was 91.5 % and 72.7 %. Actuarial LC at 1 and 2 years was 94.8 % and 88.0 %. Median DPFS was 9.7 months. Actuarial DPFS at 1 and 2 years was 40.8 % and 19.4 %.

CONCLUSION

SABR is a safe and effective approach for the treatment of oligometastatic sarcoma. One out of 5 patients is free of progression at 2-years.

Safety of heart radiotherapy for malignant cardiac tumors: a short and long term study

Background

Radiotherapy (RT) may be used as a complementary or palliative treatment for selected cases of malignant cardiac tumors, and improves the overall and relapse-free survival in cardiac sarcomas (1–3). Its use is limited by the risk of radiation injury on the cardiac structures (4). Only few data about the safety of cardiac RT are available.

Purpose

This study aimed to assess the short and long term adverse cardiac effects in a cohort of patients with cardiac malignancies treated with RT directly on the heart.

Methods

We reviewed the clinical and echocardiographic data of 25 patients (pts) treated with cardiac RT from 2002 to 2021, using Intensity Modulated RT or Tomotherapy at doses of 25–59 Gy over 5–25 fractions for primary or metastatic tumors (21 sarcomas). The patients had ECG and echocardiogram (ECHO) before RT and weekly during the treatment. After RT, the cardiac surveillance included a visit with ECG and ECHO every 3 months for the first 2 years, every 6 months for 3 years, and yearly thereafter. We compared the left ventricular ejection fraction (LVEF) before RT and at the last available follow-up for all patients; for 12 pts whose radiation field included the right chambers, we analyzed also the right ventricular shortening fraction (RVSF) at the last available follow-up.

Results

The pts were 14 males, 11 females, aged 22 to 75 (median 54) when treated. The intent was adiuvant after R1 surgery in 12 pts, preoperative in 3, palliative or curative for metastatic or unresectable tumors or in patients refusing redo surgery or chemotherapy (10 pts). Anthracyclines chemotherapy was used in 19 pts. The radiation field included the left atrium and/or ventricle in 11 pts, the right heart in 9, both left and right structures in 3. Two pts were lost to follow-up after 36 and 50 months; 17 died, 3 to 175 months after RT (median 12), all for non-cardiac causes; 6 are alive (with complete local remission) 15 to 126 months (median 79) after completing RT. Acute toxicities were: atrial fibrillation in 2 pts, pericarditis in 2 (both reverted in one week with medical therapy) and temporary worsening of ventricular arrhythmias in one pt with myocardial metastases. At last follow-up no significant valvular or pericardial disease was evident; the LVEF was >50% in all pts (5–10% decreased -compared to baseline- in 2 pts, improved in 3, stable in the others) and the RVSF was >35%.

Conclusions

In our experience, RT may be used in the treatment of cardiac malignancies with little adverse effects both on short term and at a median follow-up of 13 months (and lasting up to >10 years).

Funding Acknowledgement

Type of funding sources: None.

P4656Short- and long-term evaluation of safety of cardiac sarcomas radiotherapy

Background

Primary cardiac sarcomas (PCS) have a dismal prognosis (a reported median survival of 17 months). Complete surgical resection is the mainstay of treatment, but the resection may be incomplete or impossible because of the local extension. Multimodal treatment (MMT) with chemotherapy and radiotherapy (RT) is widely used in soft tissue sarcomas of the extremities, improving survival, and could be considered for PCS. A consequence of the inclusion of the heart in a radiation field, is acute and chronic radiation-induced heart disease (RIHD). New RT techniques, as Intensity Modulated Radiotherapy (IMRT) reduce the risk, focusing the radiation burden to the target neoplasm and limiting the involvement of the cardiac structures. Nevertheless, RT is rarely used in PCS, because the target lesion is inside the heart, and the heart's movement make difficult to avoid the irradiation of the surrounding structures.

Purpose

Our aim was to report the short and long term clinical and echocardiographic changes in patients (pts) with cardiac sarcomas treated with IMRT.

Methods

Amongst a group of 33 with PCS seen in our hospitals, we reviewed the data of 20 pts (12 males, 8 females) with PCS treated with local RT. The tumors were left-sided in 10 pts, right-sided in 8 and involved both right and left chambers in 2; fifteen patients had received also anthracyclines chemotherapy (CT). For every patient, we reviewed the clinical data and the echocardiograms performed (as for protocol) before and after CT, before starting RT, weekly during RT and at follow-up (FU), performed every 3 months for 2 years, every 6 months for 3 more years, then yearly. The mean age at diagnosis was 48 years (range 22–72). The FU lasted 2 to 131 months (mean 31, median 14). Five pts are alive 29–85 months (mean 57), after ending therapies, the others died of non-cardiac causes.

Results

At the end of RT 3 pts had atrial fibrillation (AF), which was cardioverted with Amiodarone, and one had acute pericarditis, treated with non-steroidal anti-inflammatory drugs for one week. Long-term therapy was not needed. The left ventricular ejection fraction (LVEF) was 52% to 70%, decreased by −1% to −10% in 10 pts. At last FU, LVEF ranged from 52 to 75%; it decreased (compared to baseline) by >11% in 1 pt only; global longitudinal LV strain (GLS), available in 8 pts only, was −17%. Amongst the pts with IMRT on the right heart, right ventricular function (evaluated by tricuspid annulus excursion, and right ventricular area shortening fraction) was within normal limits in all both at short and long term FU. There were no cases of constrictive pericarditis or of valvular disease.

Conclusion

In our experience IMRT for heart sarcomas seems to be relatively safe using modern RT techniques, without evident RIHD at long term follow-up. Larger studies are necessary to further evaluate the safety of RT in the multimodal treatment of cardiac sarcomas.

Multidisciplinary treatment approach for primary thyroid spindle cell sarcoma: A case report

A 25-year-old female with high-grade spindle cell sarcoma of the thyroid persistent after thyroidectomy performed at another hospital was referred to our institute. Chemotherapy followed by surgery with intraoperative radiotherapy and postoperative intensity-modulated radiotherapy were planned within the sarcoma board. Chemotherapy was discontinued after two cycles because of local disease progression and surgery with intraoperative radiotherapy, was anticipated. The treatment was completed with postoperative radiotherapy. After 36 months off-therapy, the patient was free of disease without significant late effects. Thyroid sarcomas are very rare and there is no consensus on their clinical management. Hence, case reports are useful to share treatment options. In this patient case, the histotype and the high-grade disease required a combined therapy program, managed in a multidisciplinary setting.