Neoadjuvant sequential chemoradiotherapy versus radiotherapy alone for treatment of high-risk extremity soft tissue sarcoma: a single-institution experience

Aim of the study : Patients with large and high-grade extremity soft-tissue sarcoma are at significant risk for distant metastasis and sarcoma-related death. There is no randomized trial comparing chemoradiotherapy to radiotherapy in the neoadjuvant setting for high risk extremity soft-tissue sarcoma. The aim of this study is to evaluate the outcomes of patients treated with two different modalities (neoadjuvant sequential chemoradiotherapy vs. radiotherapy alone) in a single center. Material and methods : Data of 67 patients were analyzed retrospectively. Thirty-four patients received neoadjuvant sequential chemoradiotherapy (2–3 cycles of doxorubicin (75 mg/m 2 ) and ifosfamide (6 g/m 2 ) followed by radiotherapy of 28 Grays (Gy) administered as 8 fractions of 35 Gy) and 33 patients received radiotherapy alone. R0 resection rates and 3-year survival estimates were evaluated. Results : Median follow-up time was 37 months. The estimated 3-year overall and disease-free survival rates for the whole patient group were 79% (95% CI: 67.0–86.4) and 57.9% (95% CI: 46.3–69.0), respectively. The most common side effects were nausea and leucopenia. Three-year overall, disease-free, local recurrence-free and distant recurrence-free survival rates did not differ significantly. All patients except one underwent wide excision or compartmental resection. R0 resection rate for the whole patient group was 92.5% (n = 62). Sites of progression were similar across both treatment arms. Conclusions : Preoperative hypofractionated radiotherapy alone or sequentially with chemotherapy result in high rates of limb salvage and acceptable toxicity. Our study results did not show a statistically significant treatment effect regarding survival and patterns of failure

Dosimetric comparison of 3-dimensional conformal technique, intensity-modulated, volumetric arc modulation, and helical tomotherapy with radixact in patients with breast cancer

OBJECTIVE Adjuvant radiotherapy (RT) has been used often at breast cancer treatment. RT techniques differ from each other in terms of accessibility and applicability. We aimed to compare the dosimetric evaluations of four modern RT techniques through ten breast cancer patients that had been treated previously with intensity-modulated RT (IMRT) technique. METHODS A single-center dosimetric study was performed based on treatment plannings of left-sided breast cancer patients. The patient’s images, simulated at computed tomography with deep inspiration breath hold technique between March and June 2023, were used. Four different techniques, field-in-field (FinF), dynamic IMRT (dIMRT), volumetric modulated arc treatment (VMAT), and helical therapy (HT) were created on each patient image. Conformal index (CI) and homogeneity index (HI) were calculated. Mean doses of heart, contralateral breast, volume of doses 5 Grey (Gy) (V5) and 10 Gy (V10) of left lung and total lungs were also calculated for each plan and the descripted and comparisons analysis was performed. RESULTS The better results of CI and HI were reported with dIMRT, VMAT, and HT techniques. However, these approaches were expected with increased percentage of lower doses at organs at risk (OAR). The lowest of V5 of left and total lungs, mean heart, and contralateral breast doses were achieved with FinF tech-niques, HT values were observed similar to FinF by these factors at OAR. Particularly, the lowest V20 value was demonstrated at HT techniques. CONCLUSION Adjuvant RT techniques at breast cancer still carry controversial subtitles. New technologic improvements might be indispensable and treatment plannings should be based on the individual properties of patients