Radiotherapy for marginally resected, unresectable or recurrent giant cell tumor of the bone: a rare cancer network study

The role of radiotherapy for local control of marginally resected, unresectable, and recurrent giant cell tumors of bone (GCToB) has not been well defined. The number of patients affected by this rare disease is low. We present a series of 58 patients with biopsy proven GCToB who were treated with radiation therapy. A retrospective review of the role of radiotherapy in the treatment of GCToB was conducted in participating institutions of the Rare Cancer Network. Eligibility criteria consisted of the use of radiotherapy for marginally resected, unresectable, and recurrent GCToB. Fifty-eight patients with biopsy proven GCToB were analyzed from 9 participating North American and European institutions. Forty-five patients had a primary tumor and 13 patients had a recurrent tumor. Median radiation dose was 50 Gy in a median of 25 fractions. Indication for radiation therapy was marginal resection in 33 patients, unresectable tumor in 13 patients, recurrence in 9 patients and palliation in 2 patients. Median tumor size was 7.0 cm. A significant proportion of the tumors involved critical structures. Median follow-up was 8.0 years. Five year local control was 85% . Of the 7 local failures, 3 were treated successfully with salvage surgery. All patients who received palliation achieved symptom relief. Five year overall survival was 94%. None of the patients experienced grade 3 or higher acute toxicity. This study reports a large published experience in the treatment of GCToB with radiotherapy. Radiotherapy can provide excellent local control for incompletely resected, unresectable or recurrent GCToB with acceptable morbidity

Long-term outcome of soft tissue sarcomas of the foot treated with limb salvage surgery and radiotherapy Ekstremite koruyucu cerrahi ve radyoterapi uygulanan ayak yerleşimli yumuşak doku sarkomlarında uzun dönem takip souçları

Ekstremite Koruyucu Cerrahi ve Radyoterapi Uygulanan Ayak Yerleşimli Yumuşak Doku Sarkomlarında Uzun Dönem Takip Souçları Bu çalışmanın amacı; primer ayak yerleşimli yumuşak doku sarkomu tanısıyla ekstremite koruyucu cerrahi ve preoperatif veya postoperatif radyoterapi uygulanan hastalarda uzun dönem takip sonuçlarının değerlendirilmesidir. 1980-2008 yılları arasında, ekstremite koruyucu cerrahi ve radyoterapi uygulanan primer ayak yerleşimli yumuşak doku sarkomlu 11 olgu retrospektif olarak değerlendirildi. Tümör boyutu medyan 5.5 cm’dir (2-8 cm). Tüm olgulara ekstremite koruyucu cerrahi yapıldı. Beş olguda cerrahi sınır pozitif saptandı. En sık görülen histolojik grup sinovyal sarkom’dur (73%). Sekiz olguya postoperatif radyoterapi, 3 olguya preoperatif radyoterapi uygulandı. Yüksek grad ve büyük tümörü olan 6 olguya kemoterapi verildi. Medyan takip süresi 73 ay’dır (11-224 ay). 5 yıllık genel sağkalım %78.8’dir. Üç olguda medyan 12 ayda (6-13 ay) lokal nüks gelişti. Nüks gelişen tüm olguların histopatolojisi sinovyal sarkomdu ve sadece bir olguda cerrahi sınır pozitifti. İki olguya nüks nedeniyle amputasyon yapılırken, diğer olguya tekrar ekstremite koruyucu cerrahi yapıldı. Lokal nüks gelişen bu üç olguda akciğer metastazı gelişti ve 2’si hastalıktan dolayı kaybedildi. Lokal nüksü olmayan 8 olgu medyan 73 ay takip süresi içerisinde hastalıksız olarak takip edilmektedir. Primer ayak yumuşak doku sarkomlarında iyi onkolojik ve fonksiyonel tedavi sonucu elde edebilmek için diğer bölge yumuşak doku sarkomlarında olduğu gibi multidisipliner yaklaşım oldukça önemlidir. Radyoterapi iyi lokal kontrol oranı ile ektremite korunmasına olanak sağlamaktadır

Evaluation of Interfractional Movement of the Seminal Vesicle and Dose Variations with IGRT Throughout the Prostate Cancer Radiotherapy

To validate the actual cumulative doses delivered to the seminal vesicle (SV) depending on the organ movement using kV-Cone Beam CT (kV-CBCT) datasets acquired during prostate image-guided radiation therapy. Ten patients with intermediate risk prostate cancer treated with IMRT were included in this study. Both the prostate and the first 2 cm of the SV were included in the CTV. PTV margin was 8 mm in all directions except posterior, where it was 5 mm. Sixteen kV-CBCT scans per patient were used for assessments. After each kV-CBCT was matched with the planning CT based on prostate, the SV were recontoured as proximal, distal SV and both of them together (the whole SV). Actual delivered doses to the SV were assessed by means of DVH. The variations in certain dose-volume parameters were analyzed using the Student's test. Systematic and random errors of the SV and margins were assessed using the van-Herk formula. We observed that the SV movement in the anterior-posterior direction was significantly more compared to superior-inferior and left-right direction. The dose volume variations for the whole SV (D98%, D50%, D2%) and the distal SV (D98%, D95%, D50%) were significantly different than the planned doses. However, both the whole SV and the distal SV received the prescribed dose. Although it seems that there is a need to give larger margin to the SV in posterior direction, the actual cumulative doses delivered to SV throughout the treatment were within the prescribed dose

Radiotherapy in the treatment of extracranial hemangiopericytoma/solitary fibrous tumor: Study from the Rare Cancer Network

Background and purpose: The role of radiotherapy (RT) in the treatment of hemangiopericytoma/solitary fibrous tumor (HPC/SFT) is still under debate. We aimed at investigating whether radiotherapy can improve the results in patients operated for extracranial HPC/SFT. Materials and methods: Data from patients with HPC/SFT, treated from 1982 to 2012, were retrospectively reviewed within the Rare Cancer Network framework. Actuarial local control (LC), disease-free survival (DFS), metastasis-free survival (MFS) and overall survival (OS) were calculated with Kaplan-Meyer method. Patient and tumor parameters were analyzed by univariate and multivariate analysis. Results: Of 114 HPC/SFT, 58 (50.9%) occurred in the extremities/superficial trunk and 56 (49.1%) in intrathoracic/ retroperitoneum. Seventy-eight patients (68.4%) underwent surgery only (Sx), and 36 (31.6%) Sx and RT (Sx + RT). Median RT dose was 60 Gy (range 45\u201368.4 Gy) in 1.6\u20132.2 Gy fractions. In the extremities/ superficial trunk group of patients, actuarial 5-year LC rates were 50.4% after Sx and 91.6% after Sx + RT (p < 0.0001) for LC, and 50.4% after Sx and 83.1% after Sx + RT (p = 0.008) for DFS. In the intrathoracic/ retroperitoneum group of patients, actuarial 5-year rates were 89.3% after Sx and 77.8% after Sx + RT (p = 0.99) for LC, and 73.8% after Sx and 77.8% after Sx + RT (p = 0.93) for DFS. At multivariate analysis, the addition of RT resulted in better LC and DFS in the whole series. The advantage was confirmed for LC in the group of patients affected by extremity/superficial trunk tumors. Conclusion: Addition of RT to Sx could improve the prognosis, in terms of LC and DFS, essentially in patients with extremities/superficial trunk tumor locations