Significant Reduction of Late Toxicities in Patients With Extremity Sarcoma Treated With Image-Guided Radiation Therapy to a Reduced Target Volume: Results of Radiation Therapy Oncology Group RTOG-0630 Trial
Significant Reduction of Late Toxicities in Patients With Extremity Sarcoma Treated With Image-Guided Radiation Therapy to a Reduced Target Volume: Results of Radiation Therapy Oncology Group RTOG-0630 Trial
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DOI：
10.1200/jco.2014.58.5828
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发表时间：
2015-07-10
影响因子：
45.3
通讯作者：
Kirsch, David G.
中科院分区：
文献类型：
--
作者：
Wang, Dian;Zhang, Qiang;Kirsch, David G.
PurposeWe进行了一项多机构的前瞻性II期试验，以评估晚期毒性与四肢软组织肉瘤（STS）治疗术前影像引导放射治疗（IGRT），以减少目标volume.Patients和MethodsPatients四肢STS接受IGRT（队列A）或不（队列B）化疗，然后肢体保留切除术。每日预处理图像与数字重建的X线片配准，以便在每次治疗前调整患者位置。所有患者均根据严格的方案指南接受IGRT以减小肿瘤体积。晚期毒性进行了评估，在2 years.ResultsIn所有，98例患者累计（队列A，12;队列B，86）。队列A因不良招募而提前关闭，未报告。来自队列B的79例合格患者构成本报告的基础。在中位随访3.6年时，5名患者因疾病进展而未接受手术。有5例局部治疗失败，均在现场。在2年时评估晚期毒性的57例患者中，10.5%的患者至少发生1次2级毒性，而加拿大国家癌症研究所SR 2中的患者为37%（CAN-NCIC-SR2：可治愈的恶性软组织肉瘤术前与术后放射治疗的III期随机研究）试验接受术前放射治疗而不接受IGRT结论术前IGRT治疗的四肢STS患者的晚期毒性显著降低，且无边缘野复发，表明放射治疗肿瘤组RTOG-0630中使用的靶体积（一项关于原发性软组织肉瘤的影像引导术前放疗的II期试验）研究适用于肢体STS的术前IGRT。(C)2015年美国临床肿瘤学会
PurposeWe performed a multi-institutional prospective phase II trial to assess late toxicities in patients with extremity soft tissue sarcoma (STS) treated with preoperative image-guided radiation therapy (IGRT) to a reduced target volume.Patients and MethodsPatients with extremity STS received IGRT with (cohort A) or without (cohort B) chemotherapy followed by limb-sparing resection. Daily pretreatment images were coregistered with digitally reconstructed radiographs so that the patient position could be adjusted before each treatment. All patients received IGRT to reduced tumor volumes according to strict protocol guidelines. Late toxicities were assessed at 2 years.ResultsIn all, 98 patients were accrued (cohort A, 12; cohort B, 86). Cohort A was closed prematurely because of poor accrual and is not reported. Seventy-nine eligible patients from cohort B form the basis of this report. At a median follow-up of 3.6 years, five patients did not have surgery because of disease progression. There were five local treatment failures, all of which were in field. Of the 57 patients assessed for late toxicities at 2 years, 10.5% experienced at least one grade 2 toxicity as compared with 37% of patients in the National Cancer Institute of Canada SR2 (CAN-NCIC-SR2: Phase III Randomized Study of Pre- vs Postoperative Radiotherapy in Curable Extremity Soft Tissue Sarcoma) trial receiving preoperative radiation therapy without IGRT (P < .001).ConclusionThe significant reduction of late toxicities in patients with extremity STS who were treated with preoperative IGRT and absence of marginal-field recurrences suggest that the target volumes used in the Radiation Therapy Oncology Group RTOG-0630 (A Phase II Trial of Image-Guided Preoperative Radiotherapy for Primary Soft Tissue Sarcomas of the Extremity) study are appropriate for preoperative IGRT for extremity STS. (C) 2015 by American Society of Clinical Oncology