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Long-term Outcomes for Synovial Sarcoma Treated with Surgery and Radiotherapy: The University of Florida Experience
Proceedings of the 51st Annual ASTRO Meeting 0.043). Wound complication and interval between surgery and TESS did not predict for TESS\80. A binary logistic regression of significant and near significant variables was used to assess for factors predictive of TESS\80. Only IORT predicted for TESS\80 (odds ratio 3.47, 95% confidence interval 1.635 – 641.6 p = 0.022). Conclusions: In our small study, IORT was associated with low TESS in patients with extremity STS; however, the confidence interval is very wide and the relationship should not be interpreted as causal. Selection bias for patients with aggressive disease to undergo IORT may predispose this group to have worse functional outcome which limits this retrospective study. Prospective trials assessing limb function with IORT for STS should be considered. Author Disclosure: T.P. Korytko, None; C.A. Alvarez-Breckenridge, None; J.L. Mayerson, None; A.S. Neki, None; P.E. Wakely, None; G.S. Young, None; E.Y. Kim, None.
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Long-term Outcomes for Synovial Sarcoma Treated with Surgery and Radiotherapy: The University of Florida Experience
W. Shi, C. G. Morris, R. A. Zlotecki University of Florida Shands Cancer Center, Gainesville, FL Purpose/Objective(s): Synovial sarcoma accounts for approximately 9% of all diagnosed soft tissue sarcomas. It most commonly develops within the soft tissues of the extremity in young adults. Pathologically, it is considered a high-grade sarcoma by histologic criteria. Surgery and radiotherapy comprise the standard treatment for patients with a localized tumor. Chemotherapy treatment remains investigational. In this study we reviewed the clinical presentation, characteristics, and outcome(s) of patients with localized synovial sarcoma treated at the University of Florida in the past 40 years, and evaluated which prognostic factors were of potential significance in predicting control and survival outcomes in synovial sarcoma with long-term follow-up. Materials/Methods: The clinical features, treatment parameters, and outcomes of 64 patients diagnosed and/or treated for synovial sarcoma at University of Florida from 1965 to 2005 were evaluated. Patients with metastatic disease at the time of diagnosis were excluded from the study. Results: Median follow-up of living patients was 16 years. The 5-year overall survival (OS) rate was 53%. The 5-year progression-free survival (PFS) rate was 50%. The 5-year local control (LC) rate was 84%. The 5-year distant metastasis (DM) rate was 52%. On multivariate analysis, tumor size . 8 cm predicted worse outcomes for OS and DFS, and a higher rate of DM, however it did not adversely impact LC. Age (older or younger than 20), once-daily or twice-daily treatment, tumor sites (extremity or other), and dose (more or less than 5540 cGy) showed no significant differences with respect to LC, OS, DFS, or DM rates. Conclusions: Synovial sarcoma is adequately controlled at the primary site by conservation surgery and radiotherapy regardless of primary tumor size. However, the occurrence of distant metastases remains the principal factor limiting patient survival, and appears directly related to primary tumor size at presentation. In the future, multi-institutional prospectively randomized, controlled studies will be needed to better define the role of systemic chemotherapy. Author Disclosure: W. Shi, None; C.G. Morris, None; R.A. Zlotecki, None.
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A Preliminary Report: Dynamic Contrast-enhanced Magnetic Resonance (DCE-MRI) for Assessing Intratumoral Microvascular Changes in Patients with High-grade Soft Tissue Sarcoma, Treated with Preoperative Radiotherapy
Y. J. Hitchcock1, M. Schabel2, D. C. Shrieve1, B. J. Salter1 1
University of Utah Health Sciences Center, Salt Lake City, UT, 2University of Utah, Salt Lake City, UT
Purpose/Objective(s): Patients with advanced stage and high-grade soft tissue sarcoma show high risk of local or distant failure. This pilot study was performed to assess the feasibility of use of DCE-MRI to quantitatively assess changes in tumor physiological parameters in high-grade soft tissue sarcomas treated with preoperative RT. Materials/Methods: Patients with high-grade soft tissue sarcoma underwent preoperative radiation to a median dose of 50 Gy. DCE-MRI was performed prior to RT started, and 4 weeks after RT completed. In addition to standard pre- and postcontrast anatomic imaging sequences, patients were scanned for 1 minute prior to and at least 5 minutes following injection of Gd contrast agent using a heavily T1-weighted spoiled gradient echo pulse sequence with a scan time of 6 seconds per frame or less. Standard pre-RT MRI images were also integrated and fused into RT treatment planning system. Tumors were identified using fat-saturated, T1-weighted postcontrast imaging data prior to and 4 weeks after completion of preoperative radiotherapy. Lesion-averaged pharmacokinetic model parameters for vascular permeability (Ktrans), washout rate (kep), and blood plasma volume (vp) were calculated for each patient both pre- and post-RT using the extended Tofts-Kety model. Lesion volume was estimated as an ellipsoid from measurements of three axes taken from fat-saturated T2-weighted pre-contrast images. Results: Of seven patients undergoing pre-RT DCE-MRI, 4 patients completed RT and received post-RT DCE-MRI for evaluation. Average pre-RT tumor volume was 448.4 cm3 (range, 10.3–1497 cm3), and average post-RT tumor volume reduction was 60.1% (24.5% – 76.6%) with significant intratumoral post-RT necrosis. Several interesting changes in tumor physiology were noted post-RT, including significantly increased blood volume observed for 3 of 4 patients, with one patient experiencing minimal blood volume increase (mean pre-RT = 0.33%, mean post-RT = 1.50%). Mean pre-RT Ktrans value was 0.110 min-1, with post-RT decreases ranging from 10.5–44.2% in three of the patients and an increase of 32.5% in a fourth. The decreases in permeability combined with increases in blood volume are suggestive of possible vascular normalization. All patients currently experience local control, but two have developed pulmonary metastases. Conclusions: DCE-MRI appears to have the potential to serve as a useful tool in assessing post-RT changes in patients with highgrade soft tissue sarcoma, and may have utility in quantifying revascularization and/or vascular normalization of these tumors. Author Disclosure: Y.J. Hitchcock, None; M. Schabel, None; D.C. Shrieve, None; B.J. Salter, None.
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Long-term Outcomes for Synovial Sarcoma Treated with Surgery and Radiotherapy: The University of Florida Experience
W. Shi, C. G. Morris, R. A. Zlotecki University of Florida Shands Cancer Center, Gainesville, FL Purpose/Objective(s): Synovial sarcoma accounts for approximately 9% of all diagnosed soft tissue sarcomas. It most commonly develops within the soft tissues of the extremity in young adults. Pathologically, it is considered a high-grade sarcoma by histologic criteria. Surgery and radiotherapy comprise the standard treatment for patients with a localized tumor. Chemotherapy treatment remains investigational. In this study we reviewed the clinical presentation, characteristics, and outcome(s) of patients with localized synovial sarcoma treated at the University of Florida in the past 40 years, and evaluated which prognostic factors were of potential significance in predicting control and survival outcomes in synovial sarcoma with long-term follow-up. Materials/Methods: The clinical features, treatment parameters, and outcomes of 64 patients diagnosed and/or treated for synovial sarcoma at University of Florida from 1965 to 2005 were evaluated. Patients with metastatic disease at the time of diagnosis were excluded from the study. Results: Median follow-up of living patients was 16 years. The 5-year overall survival (OS) rate was 53%. The 5-year progression-free survival (PFS) rate was 50%. The 5-year local control (LC) rate was 84%. The 5-year distant metastasis (DM) rate was 52%. On multivariate analysis, tumor size . 8 cm predicted worse outcomes for OS and DFS, and a higher rate of DM, however it did not adversely impact LC. Age (older or younger than 20), once-daily or twice-daily treatment, tumor sites (extremity or other), and dose (more or less than 5540 cGy) showed no significant differences with respect to LC, OS, DFS, or DM rates. Conclusions: Synovial sarcoma is adequately controlled at the primary site by conservation surgery and radiotherapy regardless of primary tumor size. However, the occurrence of distant metastases remains the principal factor limiting patient survival, and appears directly related to primary tumor size at presentation. In the future, multi-institutional prospectively randomized, controlled studies will be needed to better define the role of systemic chemotherapy. Author Disclosure: W. Shi, None; C.G. Morris, None; R.A. Zlotecki, None.
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A Preliminary Report: Dynamic Contrast-enhanced Magnetic Resonance (DCE-MRI) for Assessing Intratumoral Microvascular Changes in Patients with High-grade Soft Tissue Sarcoma, Treated with Preoperative Radiotherapy
Y. J. Hitchcock1, M. Schabel2, D. C. Shrieve1, B. J. Salter1 1
University of Utah Health Sciences Center, Salt Lake City, UT, 2University of Utah, Salt Lake City, UT
Purpose/Objective(s): Patients with advanced stage and high-grade soft tissue sarcoma show high risk of local or distant failure. This pilot study was performed to assess the feasibility of use of DCE-MRI to quantitatively assess changes in tumor physiological parameters in high-grade soft tissue sarcomas treated with preoperative RT. Materials/Methods: Patients with high-grade soft tissue sarcoma underwent preoperative radiation to a median dose of 50 Gy. DCE-MRI was performed prior to RT started, and 4 weeks after RT completed. In addition to standard pre- and postcontrast anatomic imaging sequences, patients were scanned for 1 minute prior to and at least 5 minutes following injection of Gd contrast agent using a heavily T1-weighted spoiled gradient echo pulse sequence with a scan time of 6 seconds per frame or less. Standard pre-RT MRI images were also integrated and fused into RT treatment planning system. Tumors were identified using fat-saturated, T1-weighted postcontrast imaging data prior to and 4 weeks after completion of preoperative radiotherapy. Lesion-averaged pharmacokinetic model parameters for vascular permeability (Ktrans), washout rate (kep), and blood plasma volume (vp) were calculated for each patient both pre- and post-RT using the extended Tofts-Kety model. Lesion volume was estimated as an ellipsoid from measurements of three axes taken from fat-saturated T2-weighted pre-contrast images. Results: Of seven patients undergoing pre-RT DCE-MRI, 4 patients completed RT and received post-RT DCE-MRI for evaluation. Average pre-RT tumor volume was 448.4 cm3 (range, 10.3–1497 cm3), and average post-RT tumor volume reduction was 60.1% (24.5% – 76.6%) with significant intratumoral post-RT necrosis. Several interesting changes in tumor physiology were noted post-RT, including significantly increased blood volume observed for 3 of 4 patients, with one patient experiencing minimal blood volume increase (mean pre-RT = 0.33%, mean post-RT = 1.50%). Mean pre-RT Ktrans value was 0.110 min-1, with post-RT decreases ranging from 10.5–44.2% in three of the patients and an increase of 32.5% in a fourth. The decreases in permeability combined with increases in blood volume are suggestive of possible vascular normalization. All patients currently experience local control, but two have developed pulmonary metastases. Conclusions: DCE-MRI appears to have the potential to serve as a useful tool in assessing post-RT changes in patients with highgrade soft tissue sarcoma, and may have utility in quantifying revascularization and/or vascular normalization of these tumors. Author Disclosure: Y.J. Hitchcock, None; M. Schabel, None; D.C. Shrieve, None; B.J. Salter, None.
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