Radiation Therapy Connective Tissue Oncology Society 2005 Thomas F. DeLaney, M.D.

Samarium-153 for Osteosarcoma Anderson PM (Mayo Clinic)Anderson PM (Mayo Clinic) 14 patients14 patients –High dose samarium 30 mCi/kg + gemcitabine 1500 mg/m2 –Stem cells reinfused 2 weeks later –Standard dose samarium 1 mCi/kg + gemcitabine 1000 mg/m2 repeated in respondersa ToxicityToxicity –Modest cytopenias ResponsesResponses –6 PR, 2 mixed, 6 progressive –All relapsed or had new metastases within a year ? Use standard dose samarium + gemcitabine for multiple cycles and combine with external beam, avastin, HDMTX? Use standard dose samarium + gemcitabine for multiple cycles and combine with external beam, avastin, HDMTX

STS-Results of Limb Sparing Therapy Merimsky O et al (Tel Aviv Medical Center)Merimsky O et al (Tel Aviv Medical Center) 133 patients133 patients –Intermediate and high grade sarcomas –Limb sparing surgery + post-op XRT ResultsResults –23 LR; 35 systemic spread +/- LR DFS/OS influenced by:DFS/OS influenced by: –Stage I (A or B) vs Stage II –Upper vs lower limb –Resection margins: adequate vs marginal/positive margins –Good vs bad histologic response to induction therapy –If diagnostic biopsy at outside facility, fare worse –MFH : 10 y RFS: 62%- relapses occur in first 3 years –Liposarcoma: 10 Y RFS 52%; relapses occurring out to 8 years

Retroperitoneal STS: Surgery + XRT +/- Chemotherapy Ballo et al (MD Ancerson Cancer Center)Ballo et al (MD Ancerson Cancer Center) –84 patients ( ) with primary (61)/LR (23) STS –G1 13G2 19G3 52 –Margins Positive/Uncertain40Negative 44 –EBRT only 64 pts (40-66 Gy; Median 50 Gy) Post-op 33 pts –EBRT + IORT 18 pts; IORT (10-15 Gy; Median 15 Gy) –DSS 47%DMFS66%LC51% –LF: 29/33 in field; 2/33 marginal; 2 /33 outside –Multivariate: G3 : inferior DFS 36 % vs 64% –Local control Inferior in pts presenting with recurrent disease : 35% vs 58%Inferior in pts presenting with recurrent disease : 35% vs 58% Inferior for positive/uncertain margins 34% vs. 69% for (-) marginsInferior for positive/uncertain margins 34% vs. 69% for (-) margins Not improved with  dose, IORT, concurrent chemoRx, XRT timingNot improved with  dose, IORT, concurrent chemoRx, XRT timing –Complications 11% at 5 years ; these patients received post-op XRT11% at 5 years ; these patients received post-op XRT

Radio-Hyperthermo-ChemoRx for MFH Marsushita Y et al (Nagoya City Univ. Medical School)Marsushita Y et al (Nagoya City Univ. Medical School) –34 pts with MFH ( ) XRT: 32 Gy/16 fx of 2 Gy q.d.XRT: 32 Gy/16 fx of 2 Gy q.d. Hyperthermia Weekly x 5 sessions: 42.5° for > 60 minHyperthermia Weekly x 5 sessions: 42.5° for > 60 min Cisplatin 90 mg/m2 and Pinorubin 25 mg/m2 i.a. q week x 3Cisplatin 90 mg/m2 and Pinorubin 25 mg/m2 i.a. q week x 3 –Surgical margin: wide 12 pts; marginal 20 pts: 2 LR –21 pts CDF; 5 NED; 5 DOD; 1 AWD; 3 DID –Complications: Deaths: 1 septicemia, 1 PE 2 2 nd degree burns2 2 nd degree burns 8 delayed wound healing8 delayed wound healing

Complications of Combined Modality Therapy for Lower Extremity STS Cannon et al (MD Anderson Cancer Center)Cannon et al (MD Anderson Cancer Center) –412 pts with primary LE STS Pre-op XRT 268 (65%): median dose of 50 GyPre-op XRT 268 (65%): median dose of 50 Gy Post-op XRT 144 (35%): median dose of 60 GyPost-op XRT 144 (35%): median dose of 60 Gy –Complications Acute wound: 15%: no difference pre vs post-op XRTAcute wound: 15%: no difference pre vs post-op XRT –Medial thigh vs non medial: 21% vs 8 % Chronic complications: 6%Chronic complications: 6% –Post-op 16% vs Pre-op 6% p=0.02 –Thigh fractures: Peri-osteal stripping 10% vs. no stripping 1%