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Improved Outcomes With Iterative Local Treatments of Oligometastases in Sarcomas: A French Sarcoma Group Study
S614
International Journal of Radiation Oncology Biology Physics
melanoma. 1 patient was treated with adjuvant chemotherapy. KaplanMeier estimates of local-regional control (LRC), disease free survival (DFS), distant metastasis free survival (DMFS) and overall survival (OS) were calculated. Results: Five-year LRC, DFS, DMFS, and OS were 70%, 62%, 80%, and 62%, respectively. 10 (28%) patients died following treatment, 7 due to melanoma, and 3 from other causes that were not treatment related. Nine (25%) patients had recurrences, 2 had isolated distant, 2 had local and regional, 4 had regional and distant, and 1 had local and distant failures. There were no isolated local or regional failures. Of the 9 patients who had a recurrence 7 had a head and neck, 1 extremity, and 1 truncal primary. Of these 7 head and neck patients with recurrences only 3 had radiation. 1 of the head and neck patients that received postoperative radiation therapy had an in-field local recurrence. The 2 patients with non-head and neck primaries both had regional and distant failures. Conclusions: Although an uncommon form of melanoma, novel locoregional control methods need to be considered to improve locoregional control rates. Novel radiation therapy options, possibly including radiosensitizers, need to be considered. Author Disclosure: A.K. Willson: None. B.S. Chera: None. K.B. Stitzenberg: None. M.O. Myers: None. S.J. Moschos: None. C.B. Lee: None. F.A. Collichio: None. J.S. Frank: None. D.W. Ollila: None.
with 1 local treatment, 101.2 months (95% CI, 77.2-125.1) for 3 treatments, 107.4 months (95% CI, 86.6-128.9) for 6 treatments or more. Multivariate analysis showed that patients who benefited had non progressive primary [HR Z 0.46 (95% CI, 0.29- 0.72) p Z 0.03], and over 6 iterative local treatments [HR Z 8.2 (95% CI, 1.1-59.6) p Z 0.008]. Conclusions: Although intrinsically biased in patients with longer OS, aggressive iterative local treatments continue to be worth in oligometastatic sarcoma even with patients who further develop other metastases. Surgery is the standard treatment. Ablative radiation therapy may represent a promising strategy in patients with extra-pulmonary sites and/or in occasions where surgical morbidity is considered too high. Author Disclosure: A. Falk: None. L. Moureau-Zabotto: None. N. Penel: None. A. Italiano: None. J. Bay: None. M. Sunyach: None. M. Ducassou: None. T. Olivier: None. A. Thyss: None. J. Thariat: None.
3075 Improved Outcomes With Iterative Local Treatments of Oligometastases in Sarcomas: A French Sarcoma Group Study A. Falk,1,2 L. Moureau-Zabotto,3 N. Penel,4 A. Italiano,5 J. Bay,6 M. Sunyach,7 M. Ducassou,8 T. Olivier,9 A. Thyss,1 and J. Thariat1; 1 Centre Antoine Lacassagne, Nice, France, 2Faculty of Medicine University of Nice-Sophia Antipolis, Nice, France, 3Institut Paoli Calmette, Marseille, France, 4Centre Oscar Lambret, Lille, France, 5Institut Bergonie´, Bordeaux, France, 6Centre Hospitalier Universitaire Estaing, Clermont-Ferrand, France, 7Centre Le´on Berard, Lyon, France, 8Centre Claudius Re´gaud, Toulouse, France, 9Centre Val d’Aure´lie, Montpellier, France Purpose/Objective(s): About 50% of sarcomas become metastatic during their history. Median overall survival (OS) for metastatic sarcomas went from 12 months in the nineties to 18 months in recent studies. A new concept of oligometastases and oligo-recurrence has been proposed in the cancer metastasis natural history. Local treatment could improve OS and has been widely used in the last years with the emergence of ablative techniques: stereotactic radiation therapy, radiofrequency and aggressive surgical attitude. Our objective was to assess repeated local treatments on OS from diagnosis of metastases of oligometastatic sarcomas. Materials/Methods: A retrospective multicentric study was conducted. Inclusion criteria were patients presenting: 1-5 synchronous/metachronous metastases between 20002012 in the French Sarcoma Group (FSG) participating centers. Results: Three hundred twenty-six patients were included. 24 had uncontrolled primary, a criteria influencing the delivery of metastatic ablation (p < .001). Two hundred twenty-nine received local treatment. No difference was found for age, sex, performance status, histology and grade between patients with locally treated metastasis versus not treated. Patients with local treatment had fewer metastases. Median follow-up was 22.9 months. Median OS for the local treatment group was 90 months (CI 61.4 -120) since diagnosis of primary cancer and 45.6 months (CI 31.5-59.6) since diagnosis of metastases. In univariate analysis, patients that benefited from local treatment had a controlled primary [HR Z 2.4 (95% CI, 1.63.5)], a lower grade [HR Z 1.7 (95% CI, 1.2-2.3)] and were treated by surgery [HR Z 2.5 (95% CI, 1.8-3.5)] (with p < .001). Only 22 of 86 patients undergoing irradiation had doses over 50 Gy in 2 Gy equivalent doses and had better OS (p Z 0.021). Of these 22 patients, 6 only had lung metastases; other sites included soft tissue, bone, nodal metastases. The more iterative local treatments (with a maximum over 6 [HR Z 9.6 (95% CI, 1.3-69.8) p Z .004]), the higher benefit on survival. Median OS since diagnosis of metastasis were: 52.7 months (95% CI, 42-63.4) for patients
3076 Perioperative High-Dose-Rate Interstitial Brachytherapy in Patients With Soft Tissue Sarcomas D. Sharma,1 S. Deo,2 G.K. Rath,1 A.K. Gandhi,1 S. Bakhshi,3 P. Julka,1 K. Haresh,1 and S. Gupta1; 1Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India, 2Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India, 3 Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India Purpose/Objective(s): Interstitial brachytherapy with or without external beam radiation therapy (EBRT) has an established role in adjuvant treatment of soft tissue sarcomas (STS). Most experience is based on low dose rate brachytherapy and there is limited data on high-dose-rate (HDR) brachytherapy. The aim of our study was to evaluate the clinical results of perioperative high-dose-rate interstitial brachytherapy (PHDRIBT) combined with EBRT in adult patients with STS. Materials/Methods: From year 2004-2010, 52 patients with STS were treated with wide local excision plus PHDIBT followed by EBRT. There were 33 males and 19 females with a median age of 43 years (range, 18-75 years). Distribution of patients according to site was: thigh 40; arm; 6; shoulder 3; pelvis 2; breast 1. Median size of the tumor was 8 cm (range, 4-19 cm). Liposarcoma was the commonest histopathology observed in 10 patients. Majority of patients (75%) had high grade tumor. The brachytherapy implant (single plane with average of 9 catheters) was performed during the surgical procedure. The PHDIBT was started on 3rd postoperative day to deliver a HDR dose of 16 Gy in 4 fractions over 2 days. After an interval of 3-4 weeks, EBRT was started for a prescription dose of 45-50 Gy by conventional fractionation. Subsequently, adjuvant chemotherapy was given to patients with high risk features for distant metastases. Local control, survival and toxicity were studied. Results: At a median follow-up of 46 months (range, 3-84 months), no patient developed local recurrence but 12 patients developed distant metastases. The 5-year overall survival and disease free survival were 67% and 63% respectively. Main acute toxicity was delayed wound healing observed in 3 patients (5.7%). Commonest late toxicity was chronic skin/ subcutaneous fibrosis noticed in 5 patients (9.6%). No significant prognostic factor affecting the survival could be identified. Conclusions: PHDRIBT combined with EBRT provides excellent local control and acceptable acute and chronic toxicity in patients with STS. Author Disclosure: D. Sharma: None. S. Deo: None. G.K. Rath: None. A.K. Gandhi: None. S. Bakhshi: None. P. Julka: None. K. Haresh: None. S. Gupta: None.
3077 Reproducibility Evaluation of Tissue Expander in Patients With Retroperitoneal Sarcomas Treated by Postoperative Radiation Therapy Y. Kim,1 B. Kim,1 D. Lim,1 and S. Kim2; 1Department of Radiation Oncology, Samsung Medical Center, Seoul, Korea, Republic of Korea, 2 Department of Surgery, Samsung Medical Center, Seoul, Korea, Republic of Korea
International Journal of Radiation Oncology Biology Physics
melanoma. 1 patient was treated with adjuvant chemotherapy. KaplanMeier estimates of local-regional control (LRC), disease free survival (DFS), distant metastasis free survival (DMFS) and overall survival (OS) were calculated. Results: Five-year LRC, DFS, DMFS, and OS were 70%, 62%, 80%, and 62%, respectively. 10 (28%) patients died following treatment, 7 due to melanoma, and 3 from other causes that were not treatment related. Nine (25%) patients had recurrences, 2 had isolated distant, 2 had local and regional, 4 had regional and distant, and 1 had local and distant failures. There were no isolated local or regional failures. Of the 9 patients who had a recurrence 7 had a head and neck, 1 extremity, and 1 truncal primary. Of these 7 head and neck patients with recurrences only 3 had radiation. 1 of the head and neck patients that received postoperative radiation therapy had an in-field local recurrence. The 2 patients with non-head and neck primaries both had regional and distant failures. Conclusions: Although an uncommon form of melanoma, novel locoregional control methods need to be considered to improve locoregional control rates. Novel radiation therapy options, possibly including radiosensitizers, need to be considered. Author Disclosure: A.K. Willson: None. B.S. Chera: None. K.B. Stitzenberg: None. M.O. Myers: None. S.J. Moschos: None. C.B. Lee: None. F.A. Collichio: None. J.S. Frank: None. D.W. Ollila: None.
with 1 local treatment, 101.2 months (95% CI, 77.2-125.1) for 3 treatments, 107.4 months (95% CI, 86.6-128.9) for 6 treatments or more. Multivariate analysis showed that patients who benefited had non progressive primary [HR Z 0.46 (95% CI, 0.29- 0.72) p Z 0.03], and over 6 iterative local treatments [HR Z 8.2 (95% CI, 1.1-59.6) p Z 0.008]. Conclusions: Although intrinsically biased in patients with longer OS, aggressive iterative local treatments continue to be worth in oligometastatic sarcoma even with patients who further develop other metastases. Surgery is the standard treatment. Ablative radiation therapy may represent a promising strategy in patients with extra-pulmonary sites and/or in occasions where surgical morbidity is considered too high. Author Disclosure: A. Falk: None. L. Moureau-Zabotto: None. N. Penel: None. A. Italiano: None. J. Bay: None. M. Sunyach: None. M. Ducassou: None. T. Olivier: None. A. Thyss: None. J. Thariat: None.
3075 Improved Outcomes With Iterative Local Treatments of Oligometastases in Sarcomas: A French Sarcoma Group Study A. Falk,1,2 L. Moureau-Zabotto,3 N. Penel,4 A. Italiano,5 J. Bay,6 M. Sunyach,7 M. Ducassou,8 T. Olivier,9 A. Thyss,1 and J. Thariat1; 1 Centre Antoine Lacassagne, Nice, France, 2Faculty of Medicine University of Nice-Sophia Antipolis, Nice, France, 3Institut Paoli Calmette, Marseille, France, 4Centre Oscar Lambret, Lille, France, 5Institut Bergonie´, Bordeaux, France, 6Centre Hospitalier Universitaire Estaing, Clermont-Ferrand, France, 7Centre Le´on Berard, Lyon, France, 8Centre Claudius Re´gaud, Toulouse, France, 9Centre Val d’Aure´lie, Montpellier, France Purpose/Objective(s): About 50% of sarcomas become metastatic during their history. Median overall survival (OS) for metastatic sarcomas went from 12 months in the nineties to 18 months in recent studies. A new concept of oligometastases and oligo-recurrence has been proposed in the cancer metastasis natural history. Local treatment could improve OS and has been widely used in the last years with the emergence of ablative techniques: stereotactic radiation therapy, radiofrequency and aggressive surgical attitude. Our objective was to assess repeated local treatments on OS from diagnosis of metastases of oligometastatic sarcomas. Materials/Methods: A retrospective multicentric study was conducted. Inclusion criteria were patients presenting: 1-5 synchronous/metachronous metastases between 20002012 in the French Sarcoma Group (FSG) participating centers. Results: Three hundred twenty-six patients were included. 24 had uncontrolled primary, a criteria influencing the delivery of metastatic ablation (p < .001). Two hundred twenty-nine received local treatment. No difference was found for age, sex, performance status, histology and grade between patients with locally treated metastasis versus not treated. Patients with local treatment had fewer metastases. Median follow-up was 22.9 months. Median OS for the local treatment group was 90 months (CI 61.4 -120) since diagnosis of primary cancer and 45.6 months (CI 31.5-59.6) since diagnosis of metastases. In univariate analysis, patients that benefited from local treatment had a controlled primary [HR Z 2.4 (95% CI, 1.63.5)], a lower grade [HR Z 1.7 (95% CI, 1.2-2.3)] and were treated by surgery [HR Z 2.5 (95% CI, 1.8-3.5)] (with p < .001). Only 22 of 86 patients undergoing irradiation had doses over 50 Gy in 2 Gy equivalent doses and had better OS (p Z 0.021). Of these 22 patients, 6 only had lung metastases; other sites included soft tissue, bone, nodal metastases. The more iterative local treatments (with a maximum over 6 [HR Z 9.6 (95% CI, 1.3-69.8) p Z .004]), the higher benefit on survival. Median OS since diagnosis of metastasis were: 52.7 months (95% CI, 42-63.4) for patients
3076 Perioperative High-Dose-Rate Interstitial Brachytherapy in Patients With Soft Tissue Sarcomas D. Sharma,1 S. Deo,2 G.K. Rath,1 A.K. Gandhi,1 S. Bakhshi,3 P. Julka,1 K. Haresh,1 and S. Gupta1; 1Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India, 2Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India, 3 Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India Purpose/Objective(s): Interstitial brachytherapy with or without external beam radiation therapy (EBRT) has an established role in adjuvant treatment of soft tissue sarcomas (STS). Most experience is based on low dose rate brachytherapy and there is limited data on high-dose-rate (HDR) brachytherapy. The aim of our study was to evaluate the clinical results of perioperative high-dose-rate interstitial brachytherapy (PHDRIBT) combined with EBRT in adult patients with STS. Materials/Methods: From year 2004-2010, 52 patients with STS were treated with wide local excision plus PHDIBT followed by EBRT. There were 33 males and 19 females with a median age of 43 years (range, 18-75 years). Distribution of patients according to site was: thigh 40; arm; 6; shoulder 3; pelvis 2; breast 1. Median size of the tumor was 8 cm (range, 4-19 cm). Liposarcoma was the commonest histopathology observed in 10 patients. Majority of patients (75%) had high grade tumor. The brachytherapy implant (single plane with average of 9 catheters) was performed during the surgical procedure. The PHDIBT was started on 3rd postoperative day to deliver a HDR dose of 16 Gy in 4 fractions over 2 days. After an interval of 3-4 weeks, EBRT was started for a prescription dose of 45-50 Gy by conventional fractionation. Subsequently, adjuvant chemotherapy was given to patients with high risk features for distant metastases. Local control, survival and toxicity were studied. Results: At a median follow-up of 46 months (range, 3-84 months), no patient developed local recurrence but 12 patients developed distant metastases. The 5-year overall survival and disease free survival were 67% and 63% respectively. Main acute toxicity was delayed wound healing observed in 3 patients (5.7%). Commonest late toxicity was chronic skin/ subcutaneous fibrosis noticed in 5 patients (9.6%). No significant prognostic factor affecting the survival could be identified. Conclusions: PHDRIBT combined with EBRT provides excellent local control and acceptable acute and chronic toxicity in patients with STS. Author Disclosure: D. Sharma: None. S. Deo: None. G.K. Rath: None. A.K. Gandhi: None. S. Bakhshi: None. P. Julka: None. K. Haresh: None. S. Gupta: None.
3077 Reproducibility Evaluation of Tissue Expander in Patients With Retroperitoneal Sarcomas Treated by Postoperative Radiation Therapy Y. Kim,1 B. Kim,1 D. Lim,1 and S. Kim2; 1Department of Radiation Oncology, Samsung Medical Center, Seoul, Korea, Republic of Korea, 2 Department of Surgery, Samsung Medical Center, Seoul, Korea, Republic of Korea