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Prospective evaluation of intensity-modulated radiotherapy toxicity in extremity soft tissue sarcomas patients: A role for irradiated healthy soft tissue volume?

AIM: To prospectively assess toxicities of curative-intent intensity-modulated conformal radiotherapy (IMRT) in patients with extremity soft tissue sarcomas (ESTS). METHODS: Data from 59 consecutive patients with ESTS between 2014 and 2019 were both retrospectively and prospectively analysed. Toxici...

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Autores principales: Bourdais, Rémi, Achkar, Samir, Honoré, Charles, Faron, Matthieu, Cavalcanti, Andrea, Auzac, Guillaume, Ngo, Carine, Haddag-Miliani, Leila, Verret, Benjamin, Dumont, Sarah, Deutsch, Eric, Le Cesne, Axel, Mir, Olivier, Le Péchoux, Cécile, Levy, Antonin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8213831/
https://www.ncbi.nlm.nih.gov/pubmed/34179521
http://dx.doi.org/10.1016/j.ctro.2021.05.007
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author Bourdais, Rémi
Achkar, Samir
Honoré, Charles
Faron, Matthieu
Cavalcanti, Andrea
Auzac, Guillaume
Ngo, Carine
Haddag-Miliani, Leila
Verret, Benjamin
Dumont, Sarah
Deutsch, Eric
Le Cesne, Axel
Mir, Olivier
Le Péchoux, Cécile
Levy, Antonin
author_facet Bourdais, Rémi
Achkar, Samir
Honoré, Charles
Faron, Matthieu
Cavalcanti, Andrea
Auzac, Guillaume
Ngo, Carine
Haddag-Miliani, Leila
Verret, Benjamin
Dumont, Sarah
Deutsch, Eric
Le Cesne, Axel
Mir, Olivier
Le Péchoux, Cécile
Levy, Antonin
author_sort Bourdais, Rémi
collection PubMed
description AIM: To prospectively assess toxicities of curative-intent intensity-modulated conformal radiotherapy (IMRT) in patients with extremity soft tissue sarcomas (ESTS). METHODS: Data from 59 consecutive patients with ESTS between 2014 and 2019 were both retrospectively and prospectively analysed. Toxicity data were collected both by confidential mailed survey (39% completed) and medical charts, and graded according to CTCAE v5.0. Normal tissues dosimetric data (healthy soft tissue segment, joint and bone) were included. The healthy soft tissue segment was created by adding 5 cm on either side of the PTV on CT axial slices, the PTV and bone (and articulation if present) were then removed from the generated volume. RESULTS: IMRT was delivered post-operatively for nearly half of patients (n = 24, 41%), preoperatively for 18 (31%) and exclusively for 17 (28%; salvage: 13% or immediately inoperable: 15%). The median total dose delivered to the planned target volume (PTV) was 50.4 Gy (36–68 Gy) and 13 patients (22%) received a boost. With a median follow-up of 27 months (6–94 months), a total of 87 late effects were identified in 44/59 (75%) patients: 89% G1–2, and 11% G3–4. The main G1-2 toxicities were: functional limitation (36%), oedema (29%), gait disorders (20%), neurological disorders (20%) and chronic pain (32%). G3-4 toxicities were pain (n = 2), arterial stricture (n = 1) and a chronic wound requiring skin graft (n = 2). No bone fracture was observed. Quality of life was rated as good or very good in 70% patients who completed the survey. Larger (>3500 cm(3)) healthy soft tissue segment volume was associated with decreased late toxicities (p = 0.02). No other predictive factor of toxicity was identified. The 2-year rates of local control, overall survival and recurrence-free survival were 90%, 90% and 64%, respectively. CONCLUSION: Healthy soft tissue segment volume influenced toxicity. Long-term prospective monitoring in a homogeneous population remains critical to assess the impact of IMRT induced chronic toxicity in ESTS patients. This should ideally lead to a validated normal tissue dose constraint (e.g.: healthy soft tissue segment volume > 3500 cm(3)) to recommend for practitioners to help reduce the late toxicity risk.
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spelling pubmed-82138312021-06-25 Prospective evaluation of intensity-modulated radiotherapy toxicity in extremity soft tissue sarcomas patients: A role for irradiated healthy soft tissue volume? Bourdais, Rémi Achkar, Samir Honoré, Charles Faron, Matthieu Cavalcanti, Andrea Auzac, Guillaume Ngo, Carine Haddag-Miliani, Leila Verret, Benjamin Dumont, Sarah Deutsch, Eric Le Cesne, Axel Mir, Olivier Le Péchoux, Cécile Levy, Antonin Clin Transl Radiat Oncol Article AIM: To prospectively assess toxicities of curative-intent intensity-modulated conformal radiotherapy (IMRT) in patients with extremity soft tissue sarcomas (ESTS). METHODS: Data from 59 consecutive patients with ESTS between 2014 and 2019 were both retrospectively and prospectively analysed. Toxicity data were collected both by confidential mailed survey (39% completed) and medical charts, and graded according to CTCAE v5.0. Normal tissues dosimetric data (healthy soft tissue segment, joint and bone) were included. The healthy soft tissue segment was created by adding 5 cm on either side of the PTV on CT axial slices, the PTV and bone (and articulation if present) were then removed from the generated volume. RESULTS: IMRT was delivered post-operatively for nearly half of patients (n = 24, 41%), preoperatively for 18 (31%) and exclusively for 17 (28%; salvage: 13% or immediately inoperable: 15%). The median total dose delivered to the planned target volume (PTV) was 50.4 Gy (36–68 Gy) and 13 patients (22%) received a boost. With a median follow-up of 27 months (6–94 months), a total of 87 late effects were identified in 44/59 (75%) patients: 89% G1–2, and 11% G3–4. The main G1-2 toxicities were: functional limitation (36%), oedema (29%), gait disorders (20%), neurological disorders (20%) and chronic pain (32%). G3-4 toxicities were pain (n = 2), arterial stricture (n = 1) and a chronic wound requiring skin graft (n = 2). No bone fracture was observed. Quality of life was rated as good or very good in 70% patients who completed the survey. Larger (>3500 cm(3)) healthy soft tissue segment volume was associated with decreased late toxicities (p = 0.02). No other predictive factor of toxicity was identified. The 2-year rates of local control, overall survival and recurrence-free survival were 90%, 90% and 64%, respectively. CONCLUSION: Healthy soft tissue segment volume influenced toxicity. Long-term prospective monitoring in a homogeneous population remains critical to assess the impact of IMRT induced chronic toxicity in ESTS patients. This should ideally lead to a validated normal tissue dose constraint (e.g.: healthy soft tissue segment volume > 3500 cm(3)) to recommend for practitioners to help reduce the late toxicity risk. Elsevier 2021-06-04 /pmc/articles/PMC8213831/ /pubmed/34179521 http://dx.doi.org/10.1016/j.ctro.2021.05.007 Text en © 2021 Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Article
Bourdais, Rémi
Achkar, Samir
Honoré, Charles
Faron, Matthieu
Cavalcanti, Andrea
Auzac, Guillaume
Ngo, Carine
Haddag-Miliani, Leila
Verret, Benjamin
Dumont, Sarah
Deutsch, Eric
Le Cesne, Axel
Mir, Olivier
Le Péchoux, Cécile
Levy, Antonin
Prospective evaluation of intensity-modulated radiotherapy toxicity in extremity soft tissue sarcomas patients: A role for irradiated healthy soft tissue volume?
title Prospective evaluation of intensity-modulated radiotherapy toxicity in extremity soft tissue sarcomas patients: A role for irradiated healthy soft tissue volume?
title_full Prospective evaluation of intensity-modulated radiotherapy toxicity in extremity soft tissue sarcomas patients: A role for irradiated healthy soft tissue volume?
title_fullStr Prospective evaluation of intensity-modulated radiotherapy toxicity in extremity soft tissue sarcomas patients: A role for irradiated healthy soft tissue volume?
title_full_unstemmed Prospective evaluation of intensity-modulated radiotherapy toxicity in extremity soft tissue sarcomas patients: A role for irradiated healthy soft tissue volume?
title_short Prospective evaluation of intensity-modulated radiotherapy toxicity in extremity soft tissue sarcomas patients: A role for irradiated healthy soft tissue volume?
title_sort prospective evaluation of intensity-modulated radiotherapy toxicity in extremity soft tissue sarcomas patients: a role for irradiated healthy soft tissue volume?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8213831/
https://www.ncbi.nlm.nih.gov/pubmed/34179521
http://dx.doi.org/10.1016/j.ctro.2021.05.007
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