Neoadjuvant Simultaneous Integrated Boost Radiation Therapy Improves Clinical Outcomes for Retroperitoneal Sarcoma.

Autor:	Liveringhouse CL; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida., Palm RF; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida., Bryant JM; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida., Yang GQ; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida., Mills MN; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida., Figura ND; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida., Ahmed KA; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida., Mullinax J; Sarcoma Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida., Gonzalez R; Sarcoma Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida., Johnstone PA; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida., Naghavi AO; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. Electronic address: Arash.Naghavi@Moffitt.org.
Jazyk:	angličtina
Zdroj:	International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2023 Sep 01; Vol. 117 (1), pp. 123-138. Date of Electronic Publication: 2023 Mar 18.
DOI:	10.1016/j.ijrobp.2023.03.037
Abstrakt:	Purpose: Neoadjuvant radiation therapy (RT) with standard techniques (ST) offers a modest benefit in retroperitoneal sarcoma (RPS). As the high-risk region (HRR) at risk for a positive surgical margin and recurrence is posterior and away from radiosensitive organs at risk, using a simultaneous integrated boost (SIB) allows targeted dose escalation to the HRR while sparing these organs. We hypothesized that neoadjuvant SIB RT can improve disease control compared with ST, without increasing toxicity. Methods and Materials: We retrospectively identified patients with resectable nonmetastatic RPS from 2000 to 2021 who received neoadjuvant RT of 180 to 200 cGy/fraction to standard volumes. SIB patients received 205 to 230 cGy/fraction to the appropriate HRR. Clinical endpoints included abdominopelvic control (APC), recurrence-free survival (RFS), overall survival (OS), and acute toxicity. Results: With a median follow-up of 57 months (95% confidence interval [CI], 50-64), there were 103 patients with RPS who received either ST (n = 69) or SIB (n = 34) RT. Median standard volume dose was 5000 cGy (ST) and 4500 cGy (SIB), with a median HRR SIB dose of 5750 cGy. Liposarcomas (79% vs 53%; P = .004) and cT4 tumors (59% vs 19%; P < .001) were more common in the SIB cohort, without a significant difference in the rate of resection (82% vs 81%; P = .88) or R1 margin (53.5% vs 50%; P = .36); there were no R2 resections. SIB was associated with a significant improvement in 5-year APC (96% vs 70%; P = .046) and RFS (60.2% vs 36.3%; P = .036), with a nonsignificant OS difference (90.1% vs 67.5%; P = .164). On multivariable analysis, SIB remained a predictor for APC (hazard ratio, 0.07; 95% CI, 0.01-0.74; P = .027) and RFS (hazard ratio, 0.036; 95% CI, 0.13-0.98; P = .045). SIB showed no significant detriment in toxicity, albeit with a lower rate of overall grade 3 acute toxicity (3% vs 22%; P = .023) compared with ST. Conclusions: In RPS, dose escalation with neoadjuvant SIB RT may be independently associated with improved APC and RFS, without a detriment in toxicity, compared with ST. With the addition of standard RT having only a modest benefit compared with surgery alone, our study suggests that future prospective studies evaluating for the benefit of SIB RT should be considered. (Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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