Kilian E Salerno1, Kaled M Alektiar2, Elizabeth H Baldini3, Manpreet Bedi4, Andrew J Bishop5, Lisa Bradfield6, Peter Chung7, Thomas F DeLaney8, Andrew Folpe9, John M Kane10, X Allen Li4, Ivy Petersen11, John Powell12, Michael Stolten13, Steven Thorpe14, Jonathan C Trent15, Maria Voermans16, B Ashleigh Guadagnolo5. 1. Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland. Electronic address: kilian.salerno@nih.gov. 2. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York. 3. Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts. 4. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin. 5. Department of Radiation Oncology, UT-MD Anderson Cancer Center, Houston, Texas. 6. American Society for Radiation Oncology, Arlington, Virginia. 7. Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Center, Toronto, Ontario, Canada. 8. Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts. 9. Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota. 10. Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York. 11. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. 12. Department of Radiation Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York. 13. Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York. 14. Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, California. 15. Division of Medical Oncology, Sylvester Comprehensive Cancer Center, The University of Miami Health System, Miami, Florida. 16. Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin.
Abstract
PURPOSE: This guideline provides evidence-based recommendations addressing the indications for radiation therapy (RT), sequencing of local therapies, and appropriate dose and planning techniques for management of primary, operable, localized, soft tissue sarcoma (STS) in adults. METHODS: The American Society for Radiation Oncology convened a task force to address 5 key questions focused on the use of RT for management of STS. These questions included indications for RT for STS of the extremity and superficial trunk; considerations for sequencing of RT with respect to surgery, dose of RT, appropriate treatment volumes and techniques; and the role of RT in management of retroperitoneal sarcoma. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS: Multidisciplinary evaluation and decision making are recommended for all cases of STS. RT is recommended for patients in whom there is increased risk of local recurrence of resected STS, particularly if close or microscopically positive margins are anticipated or have occurred. When RT is indicated, preoperative RT is strongly recommended over postoperative RT. Postoperative RT is conditionally recommended in specific clinical circumstances (eg, uncontrolled pain or bleeding) or when the risk of wound complications outweighs that of late toxicity from RT. Routine use of RT in addition to oncologic resection for retroperitoneal sarcoma is conditionally not recommended. When RT is used for retroperitoneal sarcoma, preoperative RT is recommended, whereas postoperative RT is not recommended. CONCLUSIONS: Based on currently published data, the American Society for Radiation Oncology task force has proposed evidence-based recommendations regarding the use of RT for STS in adults. Future studies will ascertain whether alterations in dosing and sequencing may optimize outcomes and quality of life.
PURPOSE: This guideline provides evidence-based recommendations addressing the indications for radiation therapy (RT), sequencing of local therapies, and appropriate dose and planning techniques for management of primary, operable, localized, soft tissue sarcoma (STS) in adults. METHODS: The American Society for Radiation Oncology convened a task force to address 5 key questions focused on the use of RT for management of STS. These questions included indications for RT for STS of the extremity and superficial trunk; considerations for sequencing of RT with respect to surgery, dose of RT, appropriate treatment volumes and techniques; and the role of RT in management of retroperitoneal sarcoma. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS: Multidisciplinary evaluation and decision making are recommended for all cases of STS. RT is recommended for patients in whom there is increased risk of local recurrence of resected STS, particularly if close or microscopically positive margins are anticipated or have occurred. When RT is indicated, preoperative RT is strongly recommended over postoperative RT. Postoperative RT is conditionally recommended in specific clinical circumstances (eg, uncontrolled pain or bleeding) or when the risk of wound complications outweighs that of late toxicity from RT. Routine use of RT in addition to oncologic resection for retroperitoneal sarcoma is conditionally not recommended. When RT is used for retroperitoneal sarcoma, preoperative RT is recommended, whereas postoperative RT is not recommended. CONCLUSIONS: Based on currently published data, the American Society for Radiation Oncology task force has proposed evidence-based recommendations regarding the use of RT for STS in adults. Future studies will ascertain whether alterations in dosing and sequencing may optimize outcomes and quality of life.
Authors: Siyer Roohani; Felix Ehret; Marta Kobus; Anne Flörcken; Sven Märdian; Jana Käthe Striefler; Daniel Rau; Robert Öllinger; Armin Jarosch; Volker Budach; David Kaul Journal: Radiat Oncol Date: 2022-09-14 Impact factor: 4.309
Authors: Sean S Mahase; Bhuvanesh Singh; Richard J Wong; Ian Ganly; Jay O Boyle; Snehal G Patel; Nancy Y Lee Journal: Cancer Rep (Hoboken) Date: 2022-05-10
Authors: Marta Kobus; Siyer Roohani; Felix Ehret; Anne Flörcken; Jana Käthe Striefler; Franziska Brandes; Sven Märdian; Daniel Rau; Silvan Wittenberg; Robert Öllinger; David Kaul Journal: Radiat Oncol Date: 2022-08-08 Impact factor: 4.309