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EP-1271 TREATMENT OUTCOME OF POSTOPERATIVE RADIOTHERAPY AFTER CONSERVATIVE SURGERY WITH EXTREMITY SOFT TISSUE SARCOMA
ESTRO 31
S485
classification was: one intermediate and three high grades. Only one patient had negative margins. (Table1) Median follow up was 38.5 months. Median metastasis- free survival was 41.6 months. The local tumor relapse was encountered in two patients at 24 and 43 months of follow-up, these patients died due to distant metastasis at 31 months and 90 months respectively after the initial diagnosis. The metastasis was found in three patients at 24, 68 and 33 months. One remained disease free at the last control. Acute radiation toxicity (nausea and asthenia grade 2) was detected in two patients. No late radiation toxicity was reported. (Table 1) Patient Sex Age Treatm. Margins Adjuvant Dose therapy 1. 2.
F F
53 Surgery Positive RT+CT 61 Surgery Positive RT
3. 4.
F F
65 Surgery Positive RT 59 Surgery Negative RT+CT
Local Metas Survival Metas relapse (mths) Free (mths) 66.6Gy Yes Lung 31* 24 50.4Gy Yes Lung, 90* 68 kidney, bone 45Gy No Breast 46 33 50.4Gy No No 11 0**
*deceased ** No metastasis found at the last control Conclusions: Complete resection with negative margins is the gold standard for treatment of leiomyosarcoma of IVC. Due to its rarity, there are no data about the medical management. Kyriazi et al in 2010 reported that aggressive and adjuvant RT-CT is showing the benefit of the disease-free survival. The experience in our institution, showed that adjuvant radiotherapy should be considered at the local control of this tumor. EP-1271 TREATMENT OUTCOME OF POSTOPERATIVE RADIOTHERAPY AFTER CONSERVATIVE SURGERY WITH EXTREMITY SOFT TISSUE SARCOMA J.E. Lee1, Y.J. Park1, D.S. Yang1, W.S. Yoon1, J.A. Lee1, S. Lee1, C.Y. Kim1 1 Korea university medical center, Radiation oncology, Seoul, Korea Republic of Purpose/Objective: We analyzed the treatment outcomes, prognostic factors of conservative surgery plus radiation therapy(RTx) in the treatment of patients with extremity soft tissue sarcoma(STS). Materials and Methods: Between January 1981 and December 2010, adult patients with non-metastatic extremity STS were treated at Korea University Medical Center. 24 were male and 19 were female. Ages ranged from 20 to 71 years with a mean of 44 years. The distribution of lesions was as follows, 10 were in the upper extremity and 33 were in the lower extremity. Histologic classification was as follows, 14 were liposarcoma, 10 were synovial sarcoma, 8 were malignant fibrous histiocytoma, 5 were chnodrosarcoma and 6 were other histology. AJCC staging I, II, III were 11, 21, 11, respectively. Histologic grade I, II, III were 11, 13, 19, respectively. Resection margin positive were 11, close margin were 12 and negative margin were 20. Daily dose was 1.8~2.0 Gy and total dose was 50~74.4 Gy (median 60.0 Gy). Chemotherapy(CTx) was given to 7. We retrospectively analyzed survival rate, prognostic factor and complications. RTOG grade were used for acute and chronic complication. Results: The follow-up time ranged from 5 to 302 months (median 70 months). Twelve sustained relapse of their disease. Local recurrence(LR) occurred in 3 (7.0%). No Regional nodal metastases developed and hematogenous metastases developed in 10 (23.3%). The most common site was lung (70%) followed by bone (20%), retroperitoneum (10%). The local control rates and distant relapsefree survival(DRFS) rates at 5 years were 90.7% and 73.3% respectively. Overall survival rates(OS), disease-free survival rates(DFS), disease-specific survival rate(DSS) at 5 years were 69.2%, 67.9% and 74.0% respectively. On univariate analysis, grade did not have a significant impact on local control, but did influence the development of DRFS, DSS and OS (p=0.01, p=0.01, p=0.03, respectively). No significant prognostic factors were associated with LR. AJCC stage, margin status and age influenced the development of distant metastases in the univariate analysis (p<0.05). On multivariate analysis, grade had a significant impact on DSS and OS (p=0.03, p=0.04, respectively). Severe acute radiation-related complications, RTOG grade 3 or 4, developed in 6 (14.0%). 4 had skin desquamation, 1 had pruritis and 1 had ulcer. Complications was higher among
patients receiving CTx(42.9%) compared with those not receiving CTx (8.3%). Severe late radiation-related complication developed in 2 patients (4.7%), ulcer and leg edema. Conclusions: In our series, conservative surgery with postoperative RTx achieves a satisfactory rate of local control with acceptable complication rate and it was comparable to other reported studies. Disease has a high distant metastatic propensity that correlates with tumor grade, stage, age and resection margin status. Tumor grade was the most important factor for OS and there was no significant factor associated with LR. Almost of LR developed in field regardless of surgical margin status or total radiation dose. New systemic treatment is needed to reduce distant metastasis. EP-1272 MEDICO-ECONOMICAL PROSPECTIVE RANDOMIZED TRIALS OF CARBON IONS THERAPY P. Pommier1, J. Balosso2, M. Lièvre3, S. Patin4, M.H. Baron5, G. Vogin6 1 Centre Léon Bérard, Department of Radiation Oncology, Lyon, France 2 University Hospital, Department of Radiation Oncology, Grenoble, France 3 Claude Bernard University, Department of statistics, Lyon, France 4 GCS ETOILE, Medical Unit, Lyon, France 5 Centre J. Perrin, Radiotherapy department, Clermont-Ferrand, France 6 Centre A Vautrin, Radiotherapy department, Nancy, France Purpose/Objective: Carbon ion therapy is an innovative radiotherapy modality mostly dedicated to cancers considered as unresectable and radio-resistant to photons thanks to its radiobiological properties combining the advantages of the high dose distribution conformity of protons for deep tumors and of the higher biological effectiveness of high Linear Energy Transfer (LET) particles. The accumulated clinical experience in more than 7000 patients has indicated that certain types of tumors such as advanced unrectable or R2 radio-resistant head and neck tumors (adenoid cystic carcinoma (ACC)) and sarcomas may beneficiate from this therapy. The main objective of this study is to bring high level evidences on the benefit of carbon ions therapy based on a prospective randomized study for selected tumors. The secondary objective will be to perform a prospective and comparative medico-economical evaluation between carbon ions and photons (+/- protons) Materials and Methods: 250 French patients with either unresectable or R2 sarcoma (all locations) or head and neck ACC will be randomized between two therapeutic strategies: a 'carbon ions strategy' (carbon ions alone for sarcoma; photons and a carbon ions boost for ACC) vs. a 'referent strategy' (photons alone or photons and protons as a boost). Carbon ions therapy will be performed in the Heidelberg Ion Therapy unit (HIT), and photons (+/- protons) in France. A specific network is being built to secure and permitt the exchange of clinical, radiological and radiotherapy data between French investigators and the HIT. A French national grants has been obtained in 2011 from the French National Cancer Institute after an international evaluation of the project, and the National Health Insurance has joined the project in financing carbon ions therapy and for the economical comparative assessments (societal perspective including the initial treatment phase, but aslo long term follow -up) Inclusions will begin in 2012 for a period of 4 years. Results: The expectation is to demonstrate a 20% increase of the Disease Free Survival with carbon ions at 5 years, and also a favorable cost/benefit ratio thanks to the avoided costs of recurrence and toxicity, despite a much higher initial cost. Conclusions: This study will be the first international collaboration to prospectively assess carbon ions therapy, in the framework of ULICE (Union for Light Ions in Europe) financed by a grant from the European Community. EP-1273 PRELIMINARY RESULTS OF HELICAL TOMOTHERAPY FOR SOFT TISSUE SARCOMA OF THE THIGH C. Verry1, C. Alapetite2, S. Zefkili2, A. Sedrati2, W. Ksouri2, R. Dendale2, A. Fourquet2, S. Helfre2 1 University Hospital Grenoble, Radiotherapy, Grenoble, France 2 Curie Institute, Radiotherapy, Paris, France Purpose/Objective: To report the feasibility and preliminary clinical results of Helical Tomotherapy (HT) for adjuvant treatment in primary soft tissue sarcoma of the thigh.
S485
classification was: one intermediate and three high grades. Only one patient had negative margins. (Table1) Median follow up was 38.5 months. Median metastasis- free survival was 41.6 months. The local tumor relapse was encountered in two patients at 24 and 43 months of follow-up, these patients died due to distant metastasis at 31 months and 90 months respectively after the initial diagnosis. The metastasis was found in three patients at 24, 68 and 33 months. One remained disease free at the last control. Acute radiation toxicity (nausea and asthenia grade 2) was detected in two patients. No late radiation toxicity was reported. (Table 1) Patient Sex Age Treatm. Margins Adjuvant Dose therapy 1. 2.
F F
53 Surgery Positive RT+CT 61 Surgery Positive RT
3. 4.
F F
65 Surgery Positive RT 59 Surgery Negative RT+CT
Local Metas Survival Metas relapse (mths) Free (mths) 66.6Gy Yes Lung 31* 24 50.4Gy Yes Lung, 90* 68 kidney, bone 45Gy No Breast 46 33 50.4Gy No No 11 0**
*deceased ** No metastasis found at the last control Conclusions: Complete resection with negative margins is the gold standard for treatment of leiomyosarcoma of IVC. Due to its rarity, there are no data about the medical management. Kyriazi et al in 2010 reported that aggressive and adjuvant RT-CT is showing the benefit of the disease-free survival. The experience in our institution, showed that adjuvant radiotherapy should be considered at the local control of this tumor. EP-1271 TREATMENT OUTCOME OF POSTOPERATIVE RADIOTHERAPY AFTER CONSERVATIVE SURGERY WITH EXTREMITY SOFT TISSUE SARCOMA J.E. Lee1, Y.J. Park1, D.S. Yang1, W.S. Yoon1, J.A. Lee1, S. Lee1, C.Y. Kim1 1 Korea university medical center, Radiation oncology, Seoul, Korea Republic of Purpose/Objective: We analyzed the treatment outcomes, prognostic factors of conservative surgery plus radiation therapy(RTx) in the treatment of patients with extremity soft tissue sarcoma(STS). Materials and Methods: Between January 1981 and December 2010, adult patients with non-metastatic extremity STS were treated at Korea University Medical Center. 24 were male and 19 were female. Ages ranged from 20 to 71 years with a mean of 44 years. The distribution of lesions was as follows, 10 were in the upper extremity and 33 were in the lower extremity. Histologic classification was as follows, 14 were liposarcoma, 10 were synovial sarcoma, 8 were malignant fibrous histiocytoma, 5 were chnodrosarcoma and 6 were other histology. AJCC staging I, II, III were 11, 21, 11, respectively. Histologic grade I, II, III were 11, 13, 19, respectively. Resection margin positive were 11, close margin were 12 and negative margin were 20. Daily dose was 1.8~2.0 Gy and total dose was 50~74.4 Gy (median 60.0 Gy). Chemotherapy(CTx) was given to 7. We retrospectively analyzed survival rate, prognostic factor and complications. RTOG grade were used for acute and chronic complication. Results: The follow-up time ranged from 5 to 302 months (median 70 months). Twelve sustained relapse of their disease. Local recurrence(LR) occurred in 3 (7.0%). No Regional nodal metastases developed and hematogenous metastases developed in 10 (23.3%). The most common site was lung (70%) followed by bone (20%), retroperitoneum (10%). The local control rates and distant relapsefree survival(DRFS) rates at 5 years were 90.7% and 73.3% respectively. Overall survival rates(OS), disease-free survival rates(DFS), disease-specific survival rate(DSS) at 5 years were 69.2%, 67.9% and 74.0% respectively. On univariate analysis, grade did not have a significant impact on local control, but did influence the development of DRFS, DSS and OS (p=0.01, p=0.01, p=0.03, respectively). No significant prognostic factors were associated with LR. AJCC stage, margin status and age influenced the development of distant metastases in the univariate analysis (p<0.05). On multivariate analysis, grade had a significant impact on DSS and OS (p=0.03, p=0.04, respectively). Severe acute radiation-related complications, RTOG grade 3 or 4, developed in 6 (14.0%). 4 had skin desquamation, 1 had pruritis and 1 had ulcer. Complications was higher among
patients receiving CTx(42.9%) compared with those not receiving CTx (8.3%). Severe late radiation-related complication developed in 2 patients (4.7%), ulcer and leg edema. Conclusions: In our series, conservative surgery with postoperative RTx achieves a satisfactory rate of local control with acceptable complication rate and it was comparable to other reported studies. Disease has a high distant metastatic propensity that correlates with tumor grade, stage, age and resection margin status. Tumor grade was the most important factor for OS and there was no significant factor associated with LR. Almost of LR developed in field regardless of surgical margin status or total radiation dose. New systemic treatment is needed to reduce distant metastasis. EP-1272 MEDICO-ECONOMICAL PROSPECTIVE RANDOMIZED TRIALS OF CARBON IONS THERAPY P. Pommier1, J. Balosso2, M. Lièvre3, S. Patin4, M.H. Baron5, G. Vogin6 1 Centre Léon Bérard, Department of Radiation Oncology, Lyon, France 2 University Hospital, Department of Radiation Oncology, Grenoble, France 3 Claude Bernard University, Department of statistics, Lyon, France 4 GCS ETOILE, Medical Unit, Lyon, France 5 Centre J. Perrin, Radiotherapy department, Clermont-Ferrand, France 6 Centre A Vautrin, Radiotherapy department, Nancy, France Purpose/Objective: Carbon ion therapy is an innovative radiotherapy modality mostly dedicated to cancers considered as unresectable and radio-resistant to photons thanks to its radiobiological properties combining the advantages of the high dose distribution conformity of protons for deep tumors and of the higher biological effectiveness of high Linear Energy Transfer (LET) particles. The accumulated clinical experience in more than 7000 patients has indicated that certain types of tumors such as advanced unrectable or R2 radio-resistant head and neck tumors (adenoid cystic carcinoma (ACC)) and sarcomas may beneficiate from this therapy. The main objective of this study is to bring high level evidences on the benefit of carbon ions therapy based on a prospective randomized study for selected tumors. The secondary objective will be to perform a prospective and comparative medico-economical evaluation between carbon ions and photons (+/- protons) Materials and Methods: 250 French patients with either unresectable or R2 sarcoma (all locations) or head and neck ACC will be randomized between two therapeutic strategies: a 'carbon ions strategy' (carbon ions alone for sarcoma; photons and a carbon ions boost for ACC) vs. a 'referent strategy' (photons alone or photons and protons as a boost). Carbon ions therapy will be performed in the Heidelberg Ion Therapy unit (HIT), and photons (+/- protons) in France. A specific network is being built to secure and permitt the exchange of clinical, radiological and radiotherapy data between French investigators and the HIT. A French national grants has been obtained in 2011 from the French National Cancer Institute after an international evaluation of the project, and the National Health Insurance has joined the project in financing carbon ions therapy and for the economical comparative assessments (societal perspective including the initial treatment phase, but aslo long term follow -up) Inclusions will begin in 2012 for a period of 4 years. Results: The expectation is to demonstrate a 20% increase of the Disease Free Survival with carbon ions at 5 years, and also a favorable cost/benefit ratio thanks to the avoided costs of recurrence and toxicity, despite a much higher initial cost. Conclusions: This study will be the first international collaboration to prospectively assess carbon ions therapy, in the framework of ULICE (Union for Light Ions in Europe) financed by a grant from the European Community. EP-1273 PRELIMINARY RESULTS OF HELICAL TOMOTHERAPY FOR SOFT TISSUE SARCOMA OF THE THIGH C. Verry1, C. Alapetite2, S. Zefkili2, A. Sedrati2, W. Ksouri2, R. Dendale2, A. Fourquet2, S. Helfre2 1 University Hospital Grenoble, Radiotherapy, Grenoble, France 2 Curie Institute, Radiotherapy, Paris, France Purpose/Objective: To report the feasibility and preliminary clinical results of Helical Tomotherapy (HT) for adjuvant treatment in primary soft tissue sarcoma of the thigh.