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Treatment of pelvic sarcomas with intensive combined modality therapy
Radiation
134
Oncology
??
November
Biology . Physics
1986, Volume 12, Sup. 1
Immediate RT was given per protocol design (35 cases) or for advanced parameningeal tumors (4). Control was noted in 51% with immediate RT and 71% with RT delayed 1-8 (median = 2) months post-surgery (p =.05). Data supports use of RT at doses of approximately 40 Gy for microscopic disease, continuous RT whenever feasible, and further trials of pre-RT chemotherapy.
84 TREATMENT
OF PELVIC
SARCOMAS
B. Stea+, J. Miser*, Radiation
Oncology
WITH
INTENSIVE
E. Glatsteini,
Branch+,
COMBINED
R. SteisO,
Pediatric
Branch*,
MODALITY
0. LongoO,
THERAPY
T. Kinsella+
and Medicine
Branch',
COP, DCT, NCI, NIH, Bethesda,
Maryland
The location of the primary tumor and the presence of metastatic disease are the major prognostic variables for patients with pediatric and adolescent sarcomas. Pelvic primaries usually have a larger size and their local failure rate has been reported to be as high as 35%. Furthermore, the proportion of patients with pelvic primaries who present with overt metastatic disease approaches 50%. For these high risk patients, the goals of therapy are both improvement in local control and eradication of either gross or microscopic metastatic disease. To achieve these goals, we have devised a regimen that utilizes intensive chemotherapy in conjunction with aggressive radiation therapy to the primary as well as to sites of gross metastatic disease. Patients receive 5 cycles of induction chemotherapy (Vincristine, Adriamycin and Cytoxan). Following cycle 3, patients are assessed for tumor response. Two additional cycles of chemotherapy are given with concomitant radiation therapy. The primary receives 55-60 Gy and metastatic (non-pulmonary) sites receive 45-50 Gy using conventional fractionation. CT-assisted treatment planning is used. Patients are then completely restaged which includes rebiopsy of any persistent soft tissue abnormality. If a complete response is achieved, consolidation therapy consisting of total body irradiation (8 Gy in 2 fractions/2 days), high dose chemotherapy, and autologous bone marrow transplant is given. 23 patients with pelvic sarcomas were treated since l/83. 15 of 23 patients had metastatic disease at presentation. All 23 patients experienced >50% tumor response of measurable disease (excluding bone scans) following the initial 3 cycles of chemotherapy. Of the 19 patients who have completed all treatment, 18 (93%) have achieved a complete response (CR). The median disease-free interval for this group of 19 patients is 19.5 months. There have been 8 relapses among the 18 patients who achieved a CR, but no local failures have been observed. There have been six relapses among the 11 patients who presented with metastatic disease, but only 2 of 8 patients with localized disease had a relapse. Disease-free survival is 49% at 18 months. Thirteen of the 19 patients who have completed treatment remain alive with a follow-up of lo-36 months. This preliminary report shows that with an intensive chemo-radiotherapeutic regimen it is possible to achieve a CR in a very high proportion (93%) of patients with pelvic sarcomas even in the presence of overt metastatic disease. Furthermore, no local failures have been observed so far with this regimen, despite the large size (110 cm) of these tumors at presentation. Although late failures are possible, they are unlikely since most of the local failures occur within 12-18 months from treatment. Acute and late toxicity has been acceptable using this aggressive combined modality approach.
85 TOTAL
LYMPHOID
IRRADIATION,
Julia E. Blum, Shari Departments
DeSilva,
of Radiation
AN IMMUNOSUPPRESSANT Daniel
Oncology
B. Drachman,
and Neurology,
IN GRAFT TOLERANCE: Stanley Johns
CONVENTIONAL
VS. LOW-DOSE-RATE
IRRADIATION
E. Order
Hopkins
University
School
of Medicine,
Baltimore,
Md.
Total Lymphoid Irradiation (TLI) in conventional dose-rates has been successful in inducing immunosuppression in Lewis rats. Conventional dose-rate TLI requires a prolonged course of therapy (> 3 weeks in rats); low-dose-rate TLI has the potential of reducing treatment time. The immunosuppressant activity of low-dose-rate TLI was compared with conventional dose-rate TLI in prolonging the survival of skin grafts taken from Brown-Norway rats. Lewis rats were given TLI with Co60. One group was treated with conventional dose-rates (ranging from 80-180 rad/min) and received total doses of 3400 rad in 17 equally divided fractions on a 5 day/week schedule. A second group was treated with low-dose-rates (< 7 rad/min) and received total doses of 800, Each method of treatment was tolerated 1200, 1800, and 2400 rad in up to 4 consecutive days of treatment. well.
TLI
The mean survival of Brown-Norway skin grafts in untreated (control) rats was 15 days. Conventional (17 fractions x 200 rad/day) prolonged skin graft survival to 60 days. Low-dose-rate TLI given as
134
Oncology
??
November
Biology . Physics
1986, Volume 12, Sup. 1
Immediate RT was given per protocol design (35 cases) or for advanced parameningeal tumors (4). Control was noted in 51% with immediate RT and 71% with RT delayed 1-8 (median = 2) months post-surgery (p =.05). Data supports use of RT at doses of approximately 40 Gy for microscopic disease, continuous RT whenever feasible, and further trials of pre-RT chemotherapy.
84 TREATMENT
OF PELVIC
SARCOMAS
B. Stea+, J. Miser*, Radiation
Oncology
WITH
INTENSIVE
E. Glatsteini,
Branch+,
COMBINED
R. SteisO,
Pediatric
Branch*,
MODALITY
0. LongoO,
THERAPY
T. Kinsella+
and Medicine
Branch',
COP, DCT, NCI, NIH, Bethesda,
Maryland
The location of the primary tumor and the presence of metastatic disease are the major prognostic variables for patients with pediatric and adolescent sarcomas. Pelvic primaries usually have a larger size and their local failure rate has been reported to be as high as 35%. Furthermore, the proportion of patients with pelvic primaries who present with overt metastatic disease approaches 50%. For these high risk patients, the goals of therapy are both improvement in local control and eradication of either gross or microscopic metastatic disease. To achieve these goals, we have devised a regimen that utilizes intensive chemotherapy in conjunction with aggressive radiation therapy to the primary as well as to sites of gross metastatic disease. Patients receive 5 cycles of induction chemotherapy (Vincristine, Adriamycin and Cytoxan). Following cycle 3, patients are assessed for tumor response. Two additional cycles of chemotherapy are given with concomitant radiation therapy. The primary receives 55-60 Gy and metastatic (non-pulmonary) sites receive 45-50 Gy using conventional fractionation. CT-assisted treatment planning is used. Patients are then completely restaged which includes rebiopsy of any persistent soft tissue abnormality. If a complete response is achieved, consolidation therapy consisting of total body irradiation (8 Gy in 2 fractions/2 days), high dose chemotherapy, and autologous bone marrow transplant is given. 23 patients with pelvic sarcomas were treated since l/83. 15 of 23 patients had metastatic disease at presentation. All 23 patients experienced >50% tumor response of measurable disease (excluding bone scans) following the initial 3 cycles of chemotherapy. Of the 19 patients who have completed all treatment, 18 (93%) have achieved a complete response (CR). The median disease-free interval for this group of 19 patients is 19.5 months. There have been 8 relapses among the 18 patients who achieved a CR, but no local failures have been observed. There have been six relapses among the 11 patients who presented with metastatic disease, but only 2 of 8 patients with localized disease had a relapse. Disease-free survival is 49% at 18 months. Thirteen of the 19 patients who have completed treatment remain alive with a follow-up of lo-36 months. This preliminary report shows that with an intensive chemo-radiotherapeutic regimen it is possible to achieve a CR in a very high proportion (93%) of patients with pelvic sarcomas even in the presence of overt metastatic disease. Furthermore, no local failures have been observed so far with this regimen, despite the large size (110 cm) of these tumors at presentation. Although late failures are possible, they are unlikely since most of the local failures occur within 12-18 months from treatment. Acute and late toxicity has been acceptable using this aggressive combined modality approach.
85 TOTAL
LYMPHOID
IRRADIATION,
Julia E. Blum, Shari Departments
DeSilva,
of Radiation
AN IMMUNOSUPPRESSANT Daniel
Oncology
B. Drachman,
and Neurology,
IN GRAFT TOLERANCE: Stanley Johns
CONVENTIONAL
VS. LOW-DOSE-RATE
IRRADIATION
E. Order
Hopkins
University
School
of Medicine,
Baltimore,
Md.
Total Lymphoid Irradiation (TLI) in conventional dose-rates has been successful in inducing immunosuppression in Lewis rats. Conventional dose-rate TLI requires a prolonged course of therapy (> 3 weeks in rats); low-dose-rate TLI has the potential of reducing treatment time. The immunosuppressant activity of low-dose-rate TLI was compared with conventional dose-rate TLI in prolonging the survival of skin grafts taken from Brown-Norway rats. Lewis rats were given TLI with Co60. One group was treated with conventional dose-rates (ranging from 80-180 rad/min) and received total doses of 3400 rad in 17 equally divided fractions on a 5 day/week schedule. A second group was treated with low-dose-rates (< 7 rad/min) and received total doses of 800, Each method of treatment was tolerated 1200, 1800, and 2400 rad in up to 4 consecutive days of treatment. well.
TLI
The mean survival of Brown-Norway skin grafts in untreated (control) rats was 15 days. Conventional (17 fractions x 200 rad/day) prolonged skin graft survival to 60 days. Low-dose-rate TLI given as