Franziska Eckert1,2, Lore Helene Braun1, Frank Traub2,3, Hans-Georg Kopp2,4, Bence Sipos2,5, Ulf Lamprecht1, Arndt-Christian Müller1, Frank Paulsen1,2, Daniel Zips1. 1. a Department of Radiation Oncology , Eberhard-Karls-University Tuebingen , Tuebingen , Germany. 2. b Center for Soft Tissue Sarcoma, GIST and bone tumors , Eberhard-Karls-University Tuebingen , Tuebingen , Germany. 3. c Department of Orthopaedic Surgery , Eberhard-Karls-University Tuebingen , Tuebingen , Germany. 4. d Department of Medical Oncology , Eberhard-Karls-University Tuebingen , Tuebingen , Germany. 5. e Institute for Pathology , Eberhard-Karls-University Tuebingen , Tuebingen , Germany.
Abstract
PURPOSE: Radiotherapy before or after resection is one of the pillars of treatment for localised high risk soft tissue sarcomas. Treatment intensification has been described with concurrent chemotherapy and hyperthermia. The aim of this study is to assess local control after multimodal treatment, focussing on the treatment of local recurrences after surgery only. PATIENTS AND METHODS: Of 42 patients treated in a prospective protocol with radiotherapy and hyperthermia, nine were treated for isolated local recurrences without metastatic spread. Most patients were treated with trimodal therapy including chemotherapy with ifosfamide and underwent resection whenever possible. Median follow-up was 1.4 years. RESULTS: The treatment was well tolerated. Estimated disease free survival, distant metastases free survival and local control for the whole cohort after 1.5 years were 66, 73 and 88%, respectively. Neoadjuvant vs. adjuvant treatment influenced local control with a trend to statistical significance. Resection status did not influence local control. The cohort of patients treated for local recurrence after surgery alone had a significantly impaired local control compared to multimodal treatment at primary diagnosis (100 vs. 52%, p < 0.001). CONCLUSIONS: With multimodal therapy including radiotherapy and hyperthermia local tumour control is achievable even in locally recurrent tumours. The clear-cut difference of the treatment of local recurrence in contrast to primary diagnosis might either reflect difficulties in diagnosis and treatment of local recurrences or biological aggressiveness of recurrent tumours. However, we recommend to consider multimodal treatment at primary diagnosis of high risk soft tissue sarcomas.
PURPOSE: Radiotherapy before or after resection is one of the pillars of treatment for localised high risk soft tissue sarcomas. Treatment intensification has been described with concurrent chemotherapy and hyperthermia. The aim of this study is to assess local control after multimodal treatment, focussing on the treatment of local recurrences after surgery only. PATIENTS AND METHODS: Of 42 patients treated in a prospective protocol with radiotherapy and hyperthermia, nine were treated for isolated local recurrences without metastatic spread. Most patients were treated with trimodal therapy including chemotherapy with ifosfamide and underwent resection whenever possible. Median follow-up was 1.4 years. RESULTS: The treatment was well tolerated. Estimated disease free survival, distant metastases free survival and local control for the whole cohort after 1.5 years were 66, 73 and 88%, respectively. Neoadjuvant vs. adjuvant treatment influenced local control with a trend to statistical significance. Resection status did not influence local control. The cohort of patients treated for local recurrence after surgery alone had a significantly impaired local control compared to multimodal treatment at primary diagnosis (100 vs. 52%, p < 0.001). CONCLUSIONS: With multimodal therapy including radiotherapy and hyperthermia local tumour control is achievable even in locally recurrent tumours. The clear-cut difference of the treatment of local recurrence in contrast to primary diagnosis might either reflect difficulties in diagnosis and treatment of local recurrences or biological aggressiveness of recurrent tumours. However, we recommend to consider multimodal treatment at primary diagnosis of high risk soft tissue sarcomas.
Entities:
Keywords:
Sarcoma; hyperthermia; local control; radiotherapy; recurrence
Authors: Vlatko Potkrajcic; Frank Traub; Barbara Hermes; Marcus Scharpf; Jonas Kolbenschlag; Daniel Zips; Frank Paulsen; Franziska Eckert Journal: Radiol Oncol Date: 2021-11-19 Impact factor: 2.991