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Radiation Therapy Connective Tissue Oncology Society 2005

Radiation Therapy Connective Tissue Oncology Society 2005. Thomas F. DeLaney, M.D. Samarium-153 for Osteosarcoma. Anderson PM (Mayo Clinic) 14 patients High dose samarium 30 mCi/kg + gemcitabine 1500 mg/m2 Stem cells reinfused 2 weeks later

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Radiation Therapy Connective Tissue Oncology Society 2005

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  1. Radiation TherapyConnective Tissue Oncology Society 2005 Thomas F. DeLaney, M.D.

  2. Samarium-153 for Osteosarcoma • Anderson PM (Mayo Clinic) • 14 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 • Toxicity • Modest cytopenias • Responses • 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

  3. STS-Results of Limb Sparing Therapy • Merimsky O et al (Tel Aviv Medical Center) • 133 patients • Intermediate and high grade sarcomas • Limb sparing surgery + post-op XRT • Results • 23 LR; 35 systemic spread +/- LR • 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

  4. Retroperitoneal STS: Surgery + XRT +/- Chemotherapy • Ballo et al (MD Ancerson Cancer Center) • 84 patients (1965-2003) with primary (61)/LR (23) STS • G1 13 G2 19 G3 52 • Margins Positive/Uncertain 40 Negative 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% DMFS 66% LC 51% • 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 for positive/uncertain margins 34% vs. 69% for (-) margins • Not improved with  dose, IORT, concurrent chemoRx, XRT timing • Complications • 11% at 5 years ; these patients received post-op XRT

  5. Radio-Hyperthermo-ChemoRx for MFH • Marsushita Y et al (Nagoya City Univ. Medical School) • 34 pts with MFH (1992-2000) • XRT: 32 Gy/16 fx of 2 Gy q.d. • Hyperthermia Weekly x 5 sessions: 42.5° for > 60 min • Cisplatin 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 2nd degree burns • 8 delayed wound healing

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

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