IMRT vs. BRACHYTHERAPY FOR SOFT TISSUE SARCOMA. EXTERNAL RT IN STS NCI Trial (Yang JC et al, JCO 1998) Extremity / Superficial Trunk STS (n=141) LSS Alone.

Slides:

Advertisements

Similar presentations

Neoadjuvant therapy for Rectal cancer

Advertisements

Pulmonary Stereotactic Ablative Radiotherapy:

Post-operative Radiotherapy for Esophageal Cancer Parag Sanghvi, M.D., M.S.P.H. Department of Radiation Medicine Esophageal Care Conference 3/26/2007.

Management of locally advanced & metastatic prostate cancer Dr. Purvish. M. Parikh MD, DNB, PhD, FICP Professor & Head Department of Medical Oncology Tata.

Rectal Cancer: Advanced Technologies Chris Willett, M.D. Department of Radiation Oncology Duke University Medical Center Durham, NC.

CARBON ION THERAPY FOR SACRAL CHORDOMAS

IMRT, Designed with Evidence-Based Bone Avoidance Objectives, Reduces the risk of Bone Fracture in the management of Extremity Soft Tissue Sarcoma Colleen.

CTOS, Boca Raton, 2005 A Radiation Treatment Planning Comparison for Lower Extremity Soft Tissue Sarcoma: Can the Future Surgical Wound Be Spared? Anthony.

In-Depth Analysis of Wound Complications Following Preoperative Radiotherapy for Lower Extremity Soft Tissue Sarcoma Patients Colleen Dickie MSc, MRT(T)(MR)

Evaluation of Femur Fracture Risk in Soft-Tissue Sarcoma of the Thigh Treated with Intensity- Modulated Radiation Therapy (IMRT) Michael R. Folkert, MD.

NCI Workshop Advanced Technologies for Breast Cancer.

San Antonio Breast Cancer Symposium 2007 Highlights – Radiotherapy Kathleen C. Horst, M.D. Assistant Professor Department of Radiation Oncology Stanford.

Joint Hospital Surgical Grand Round Accelerated partial breast irradiation: where should we go? Dr Ma Kwok Kuen Queen Mary Hospital.

Impact of imaging on newer radiation techniques in Gynaecological cancer.

Postoperative Radiation for Oral Cavity Squamous Cell Carcinoma: The EP.

NCI Workshop on Advanced Technologies in Radiation Oncology: Cervix December 1, 2006 David Gaffney MDPhD Huntsman Cancer Hospital University of Utah.

Radiotherapy in Carcinoma of the Breast Patrick S Swift, MD Director, Radiation Oncology Alta Bates Comprehensive Cancer Center Berkeley, CA.

Thomas F. DeLaney MD, Aashish D. Bhatt MD, Alex Jacobson BS, Richard Y. Lee MD, PhD, Christine Giraud BS, Joseph H. Schwab MD, MS, Francis J. Hornicek.

Radiotherapy Planning for Esophageal Cancers Parag Sanghvi, MD, MSPH 9/12/07 Esophageal Cancer Tumor Board Part 1.

PREOPERATIVE HYPOFRACTIONED RADIOTHERAPY IN LOCALIZED EXTREMITY/TRUNK WALL SOFT TISSUE SARCOMAS EARLY STUDY RESULTS Hanna Kosela; Milena Kolodziejczyk;

Prof Ramesh S Bilimagga President AROI Group Medical Director - HCG.

Outcome Following Limb Salvage Surgery and External Beam Radiotherapy for High Grade Soft Tissue Sarcomas of the Groin and Axilla Rapin Phimolsarnti M.D.

Intra-Operative Radiation Therapy for Treatment of Early Stage Breast Cancer: Short Term Results from a Single Institution Clinical Trial Using Electronic.

Dr. Rico Liu Consultant, Department of Clinical Oncology, Queen Mary Hospital Honorary Clinical Associate Professor, Department of Clinical Oncology, The.

Margin Reduction using IGRT For Soft-Tissue Sarcoma: Secondary Analysis of RTOG 0630 Dian Wang, MD., Ph.D. Rush University Medical Center CTOS October.

IMRT for the Treatment of Anal Cancer Kristen O’Donnell, MS3 December 12, 2007.

CTOS 2013 Radiation Oncology Session Discussion Elizabeth H Baldini, MD, MPH Associate Professor of Radiation Oncology Harvard Medical School Brigham and.

GIC Protocol Meeting Ca Stomach Presentor-Dr Richa Madhawi Moderator- Dr S. Pathy.

A phase I study on the combination of neoadjuvant radiotherapy plus pazopanib in patients with locally advanced soft tissue sarcoma of the extremities.

A Phase II Study to Evaluate the Safety and Toxicity of Sparing Radiation to the Pathologic N0 Side of the Neck in Squamous Cell.

Long-term follow-up of a prospective trial of pre-operative external-beam radiation and post-operative brachytherapy for retroperitoneal sarcoma LA Mikula,

Phase II Trial of Continuous Course Re- irradiation Concurrent with Weekly Cisplatinum and Cetuximab for Recurrent Squamous Cell Carcinoma of The Head.

CTOS Soft Tissue Sarcoma of the Extremity Comparison of Conformal Post-operative Radiotherapy (CRT) and Intensity Modulated Radiotherapy (IMRT)

Phase III Clinical Trials with Protons: Their importance for Patient Centered Care for: NCI Workshop on Advanced Technologies in Radiation Oncology: Examining.

Clinico-Dosimetric Correlation for Acute and Chronic Gastrointestinal Toxicity in Patients of Locally Advanced Carcinoma Cervix Treated With Conventional.

Radiation Breast Oncology Highlights of SABC 2006 Alison Bevan, MD PhD UCSF Radiation Oncology January, 2007.

Quantitative Dosimetric Analysis Of Patterns Of Local Relapse After IMRT For Primary Extremity Soft Tissue Sarcomas Ryan M. Lanning, Sean L. Berry, Michael.

Learn More At: CyberKnife Radiosurgery in the Treatment of Early and Advanced (Oligo-Metastases) Breast Cancer Sandra Vermeulen,

Targeted Intraoperative Radiotherapy versus Whole Breast Radiotherapy for Breast Cancer (TARGIT-A Trial): An International, Prospective, Randomised, Non-Inferiority.

Radiation Therapy in the Management of Cervical Carcinoma Patrick S Swift, MD Medical Director, Radiation Oncology Alta Bates Comprehensive Cancer Center.

Adductor Compartment STS - Does method of treatment affect outcome? Anup Pradhan, Yiu-Chung Cheung Birmingham Medical School, UK Supervisors: Mr Robert.

HCI Sarcoma Services Sequential Dependency of Radiotherapy for Soft-Tissue Sarcoma S Sampath TE Schultheiss YJ Hitchcock RL Randall DC Shrieve JYC Wong.

Quantifying the Morbidity of the Unplanned Sarcoma Excision

PROSTATE CANCER: RADIATION THERAPY APPROACHES ANDREW L. SALNER, MD FACR DIRECTOR HELEN & HARRY GRAY CANCER CENTER HARTFORD HOSPITAL, CT.

Adequate 3D Treatment Volume in Preoperative Radiotherapy in Extremity Soft Tissue Sarcoma Kim BK, Chen YL, Kirsch DG, Kobayashi W, Goldberg S, Wolfgang.

Five year results of a randomized Phase III trial of pre-operative vs post-operative radiotherapy in extremity soft tissue sarcoma Brian O'Sullivan, Aileen.

Principal Author, MD Second Author, MD PhD Third Author, MSc Institution, City, Country 23 January 2013.

Workshop on Advanced Technologies in Radiation Oncology Kian Ang.

Adjuvant chemotherapy in Rectal Cancer?. What is the evidence for adjuvant chemotherapy? Do patients achieving a pathological complete response need chemotherapy?

CTOS, Berlin 2014 The influence of time interval between preoperative radiation and surgical resection on the development of wound healing complications.

The Influence of Age on Morbidity in Primary High Grade Sarcoma of the Extremity K. Alektiar, M. Brennan, S. Singer Memorial Sloan-Kettering Cancer Center.

Preliminary Results of the MRC CR07 / NCIC CO16 Randomized Trial Short course pre-op vs selective post-op chemo-RT for rectal cancer Local Recurrence after.

UK Clinical Sarcoma Research. Changes in UK Appointment of Cancer Tsar Use of NICE to evaluate care pathways and technology/drugs Minimum datasets established.

Breast Cancer Surgery: Can I still keep my breast? By Dr. Khudair Al-Rawaq.

Debra Freeman, MD – Naples Christopher King, MD, PhD - Stanford.

PHASE II TRIAL OF HYPOFRACTIONATED BREAST IRRADIATION WITH VMAT-SIB TECHNIQUE: TOXICITY AND EARLY CLINICAL ASSESSMENT IN 270 PATIENTS F. De Rose¹, F. Alongi¹,

방사선종양학과 - 혈액종양내과 Joint Conference 경희의료원 방사선종양학과 R4 공 문 규.

ACOSOG Sarcoma Committee Chair: Peter W.T. Pisters, MD Vice Chairs: Edward Cheng, MD (Orthopedic Oncology) Robert Maki, MD, PhD (Medical Oncology) Brian.

Emily Tanzler, MD Waseet Vance, MD

Locally Recurrent Head and Neck Cancer (Salvage IMRT - Dose, fractionation, volumes) Eddy S. Yang, MD, PhD Professor and Vice Chair of Translational Sciences.

Radiation therapy for Early Stage Prostate Cancer

Feasibility of hippocampal sparing radiation therapy for glioblastoma using helical Tomotherapy Dr Kamalram THIPPU JAYAPRAKASH1,2,3, Dr Raj JENA1,4 and.

นายแพทย์ธราธร ตุงคะสมิต นายแพทย์ชำนาญการพิเศษ โรงพยาบาลมะเร็งอุดรธานี

IMRT delivery of preoperative, high dose radiotherapy to a large volume, with Simultaneous Integrated Boost (SIB) in retroperitoneal sarcomas: The Ottawa.

A U.S. GI INTERGROUP TRIAL

Radiotherapy for Metastatic Spinal Cord Compression

Rarer Bone Tumors Thomas F. DeLaney, M.D. Co-Director: Sarcoma Program

Presentation transcript:

IMRT vs. BRACHYTHERAPY FOR SOFT TISSUE SARCOMA

EXTERNAL RT IN STS NCI Trial (Yang JC et al, JCO 1998) Extremity / Superficial Trunk STS (n=141) LSS Alone (n=71) LSS + External Radiotherapy (n=70) Ext. Radiotherapy: 45Gy (WF) + 18Gy (Boost) Median FU: 115mths Local Control LSS Alone: 76% LSS + External Radiotherapy: 98% p= ve impact in high grade as well as low grade sts Level I Evidence

MSKCC Trial (Pisters PWT et al, JCO 1996) Extremity / Superficial Trunk STS (n=164) LSS Alone (n=86) LSS + Interstitial Brachytherapy (n=78) Brachytherapy: 42-45Gy in 4-6 days Median FU: 76mths Local Control LSS Alone: 69% LSS + Interstitial Brachytherapy: 82% p=0.04 +ve impact in 119 pts. with high grade sts only no improvement in 45 pts. with low grade sts Level I Evidence BRACHYTHERAPY FOR STS

Three prospective trials investigating the impact of limited radiation volumes on toxicity rates and local control RTOG 0630 United Kingdom VORTEX trial COG ARST 0332 trial Radiation volume reduction aims at sparing healthy surrounding tissues to potentially decrease treatment toxicities Lymphedema Subcutaneous Fibrosis Joint Stiffness TRIALS ADRESSING TARGET VOLUME

Local Control Complications Functional Outcomes QOL Duration of Treatment Cost of Treatment

Dept of Radiation Onology, MSKCC, USA Cancer July 2011

PATIENTS & METHODS January 1995 – December Adult Patients Inclusion Criteria: Primary Presentation Extremity High Grade Limb Sparing Surgery at MSKCC Adj. Brachyherapy / IMRT at MSKCC Brachytherapy (Jan 1995 – Nov. 2003), n = 71 (53%) IMRT (Feb 2002 – Dec 2006), n = 63 (47%)

BRACHYTHERAPY LDR Brachytherapy: Dose Rate – 0.41Gy / Hour Total Dose – 45Gy Started – Post op Day ≥ 5

Intensity Modulated Radiation Therapy Pre – Operative N = 10 Dose : 50Gy/ 25 2Gy/# WLE : 4-6 wks after RT CTV : Gross Tumor + 3cm long 0.5cm bone 1.5cm Radial PTV : CTV + 2cm Post – Operative N = 53 Dose : 63Gy (Median) Started 4–6 wks after Sx CTV : Sx bed + 3cm expansion 0.5cm bone 1.5cm Radial PTV : CTV + 2cm

PROGNOSTIC FACTORS

5 YEAR LOCAL CONTROL (Actuarial) Median FU: 46 mths Whole Group: 86% IMRT: 92% BRT: 81% Significant Wound Complications IMRT: 19% BRT: 11%p=0.6

AUTHORS INFERENCE Post-op adjuvant RT using IMRT technique results in Superior outcomes compared to Brachytherapy for Local Disease Control Should be considered the treatment of choice for extremity sts

PRE-OP VS. POST-OP RADIOTHERAPY Randomized Trial O’Sullivan et al, Lancet 2002 Extremity STS (n=190) Pre-op RT + LSS (n=94) LSS + Post-op Ext. RT(n=96) Pre-op Ext. RT Dose: 50Gy/ 25# Post-op Ext. RT Dose: 66Gy/ 33# Primary endpoint: Complication rate within 120 days Median FU: 3.3 years Pre-opPost-op Wound Complications 35%17% p=0.011 Local Control91%(3yr)90%(3yr) p=0.711 Overall Survival84%(3yr)74%(3yr) p=0.048 Level I Evidence

O’Sullivan Cancer 2013

Local Control: 65 – 89% Complications: 1 – 50% RESULTS WITH LDR BRACHY ALONE

RESULTS WITH HDR BRACHY ALONE Local Control: 50 – 100% Adverse Effects: 0 – 50%

Laskar et al, Ann Surg Oncology 2007

RESULTS

TOXICITIES S Laskar Annals of Surgical Oncolog 2007

CENTERPTSBRACHYLC(%) MSKCC (Pister et al.)164LDR/HDR89 Tata Memorial Hosp. ( )151LDR71 Fox Chase130LDR/HDR82 MSKCC (Harrison et al.)126LDR82 Inst. Claudius Regaud112LDR/HDR89 MSKCC (Alekhteyar et al.)105LDR86 Institute Gustave Roussy50LDR62 Tata Memorial Hospital ( )155LDR/HDR71 LITERATURE REVIEW

10 year local control % LONG TERM DATA TMH (TMH – UNPUBLISHED 2012)

Laskar et al, Pediatric Blood & Cancer 2007

RESULTS

INTERSTITIAL BRACHYTHERAPY IN THE ERA of IMRT / IGRT / DOSE PAINTING WITH NUMBERS Hong et al., IJROBP 2004 Lancet Oncology 2006

IMAGE GUIDED BRACHYTHERAPY

2500 INR = 40 USD 300INR – 6 USD Brachy: 450 USD (At TMH) IMRT: 1400 USD (At TMH) Protons: ,000 USD

IMRTBRTVerdict Local Control***** Complications***** Functional Outcome ** QOLNo Data Treatment Duration***** Treatment Cost***** Similar BRT Randomised Clinical Trial: IMRT vs. BRT SUMMARY