David M Guttmann1, Melissa A Frick2, Ruben Carmona2, Curtiland Deville3, William P Levin2, Abigail T Berman2, Chidambaram Chinniah2, Stephen M Hahn4, John P Plastaras2, Charles B Simone5. 1. Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, United States. Electronic address: david.guttmann@uphs.upenn.edu. 2. Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, United States. 3. Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, United States. 4. Division of Radiation Oncology, MD Anderson Cancer Center, Houston, United States. 5. Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, United States.
Abstract
BACKGROUND AND PURPOSE: Proton reirradiation for sarcoma has not been previously described. We hypothesized that this strategy would provide favorable toxicity and survival outcomes. MATERIAL AND METHODS: Patients with soft tissue sarcoma in a previously-irradiated field were enrolled on a prospective trial of proton reirradiation. The primary endpoint was provider-reported acute toxicity. Secondary endpoints included late toxicities, local control, and overall survival. RESULTS: 23 patients underwent proton reirradiation. Median time between radiation courses was 40.7months (range 10-272). No grade 4-5 toxicities were observed. One patient (4%) experienced acute grade 3 dysphagia. Common grade 2 acute toxicities were fatigue (26%), anorexia (17%), and urinary incontinence (13%). There were two grade 3 late wound infections (10%) and one grade 3 late wound complication (5%). Grade 2 late complications included lymphedema (10%), fracture (5%), and fibrosis (5%). At a median follow-up of 36months, the 3-year cumulative incidence of local failure was 41% (95% CI [20-63%]). Median overall survival and progression-free survival were 44 and 29months, respectively. In extremity patients, amputation was spared in 7/10 (70%). CONCLUSIONS: Proton reirradiation of recurrent/secondary soft tissue sarcomas is well tolerated. While longer follow-up is needed, early survival outcomes in this high-risk population are encouraging.
BACKGROUND AND PURPOSE: Proton reirradiation for sarcoma has not been previously described. We hypothesized that this strategy would provide favorable toxicity and survival outcomes. MATERIAL AND METHODS:Patients with soft tissue sarcoma in a previously-irradiated field were enrolled on a prospective trial of proton reirradiation. The primary endpoint was provider-reported acute toxicity. Secondary endpoints included late toxicities, local control, and overall survival. RESULTS: 23 patients underwent proton reirradiation. Median time between radiation courses was 40.7months (range 10-272). No grade 4-5 toxicities were observed. One patient (4%) experienced acute grade 3 dysphagia. Common grade 2 acute toxicities were fatigue (26%), anorexia (17%), and urinary incontinence (13%). There were two grade 3 late wound infections (10%) and one grade 3 late wound complication (5%). Grade 2 late complications included lymphedema (10%), fracture (5%), and fibrosis (5%). At a median follow-up of 36months, the 3-year cumulative incidence of local failure was 41% (95% CI [20-63%]). Median overall survival and progression-free survival were 44 and 29months, respectively. In extremity patients, amputation was spared in 7/10 (70%). CONCLUSIONS: Proton reirradiation of recurrent/secondary soft tissue sarcomas is well tolerated. While longer follow-up is needed, early survival outcomes in this high-risk population are encouraging.
Authors: Brady S Laughlin; Michael A Golafshar; Safia Ahmed; Matthew Prince; Justin D Anderson; Tamara Vern-Gross; Mahesh Seetharam; Krista Goulding; Ivy Petersen; Todd DeWees; Jonathan B Ashman Journal: Int J Part Ther Date: 2022-05-06
Authors: Anna Lee; Jung J Kang; Havah Bernstein; Kathryn E Marqueen; Brian Neal; Ciara M Kelly; Mark A Dickson; Chiaojung Jillian Tsai; William Tap; Samuel Singer; Kaled Alektiar; Nancy Y Lee Journal: Cancer Med Date: 2021-06-04 Impact factor: 4.711
Authors: D Brügemann; B Lehner; M Kieser; J Krisam; A Hommertgen; C Jaekel; S B Harrabi; K Herfarth; G Mechtesheimer; O Sedlaczek; G Egerer; A Geisbüsch; M Uhl; J Debus; K Seidensaal Journal: BMC Cancer Date: 2022-05-12 Impact factor: 4.638
Authors: Jill Remick; William Regine; Robert Malyapa; Vincent Ng; Melissa Vyfhuis; Tejan Diwanji; Susan Shyu; James W Snider Journal: Cureus Date: 2017-09-15