Implications and opportunities for radiotherapy in soft tissue sarcomas treatment
Abstract
The belief about radioresistance of soft tissue sarcomas remained unchanged within several decades; however, recent data on heterogeneity of these tumors and radiotherapy effectiveness doubted that. Radiation therapy has been traditionally applied in the postoperative setting after R0 and, especially, R1 resection of tumors more than 5 cm in diameter, mostly for local control improvement. such approach appears to be standard and recommended by many oncological centers. however, preoperative irradiation of sarcomas may have firm theoretical advantages supported by experimental and clinical data. currently, the most promising therapeutic options with external beam radiotherapy are: combination with chemotherapy and targeted treatment; modern radiotherapy technique such as IMRT, intraoperative radiotherapy, brachytherapy; hadron therapy (protons, neutrons, heavy ions); combination with local hyperthermia.
About the Author
N. V. DenginaRussian Federation
Ulyanovsk
References
1. Jemal A., Siegel R., Ward E., Murray T., Xu J., Thun M.J. Cancer statistics, 2007. CA: A Cancer Journal for Clinicians. 2007, v. 57, No. 1, p. 43-66.
2. Grimer R., Judson I., Peake D., Seddon B. Guidelines for the Management of Soft Tissue Sarcomas. Hindawi Publishing Corporation Sarcoma. Volume 2010, Article ID 506182, 15 p.
3. Fertil B., Malaise E.P. Inherent radiosensitivity as a basic concept for human tumor radiotherapy. Int. J. Radiat. Oncol. Biol. Phys. 1981, v. 7, p. 621-629.
4. Deacon J., Peckham M.J., Steel G.G. The radioresponsiveness of human tumors and the initial slope of the cell survival curve. Radiother. Oncol. 1984, v. 2 (4), p. 317-323.
5. Friedman M., Egan J.W. Irradiation of liposarcoma. Acta radiol. 1960, v. 54, p. 225-239.
6. Edland R. Liposarcoma: retrospective study of fifteen cases, review of literature and discussion of radiosensitivity. Am. J. Roentgenol. Rad. Therapy & Nuclear Med. 1968, v. 103, p. 778-791.
7. Strander H., Turesson I., Cavallin-Ståhl E. A systematic overview of radiation therapy effects in soft tissue sarcomas. Acta Oncol. 2003, v. 42 (5-6), p. 516-531.
8. Rosenberg S.A., Tepper J., Glatstein E. et al. The treatment of soft tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann. Surg. 1982, v. 196, p. 305-315.
9. Ruka W., Taghian A., Gioioso D., Fletcher J.A., Preffer F., Suit H.D. Comparison between the in vitro intrinsic radiation sensitivity of human soft tissue sarcoma and breast cancer cell lines. J. Surg. Oncol. 1996, v. 61, p. 290-294.
10. Mundt A.J., Awan A., Sibley G.S. et al. Conservative surgery and adjuvant radiation therapy in the management of adult soft tissue sarcoma of the extremities: clinical and radiobiological results. Int. J. Radiat. Oncol. Biol. Phys. 1995, v. 32, p. 977-985.
11. Dahlberg W.K., Little J.B., Fletcher J.A. et al. Radiosensitivity of human soft tissue sarcoma cell lines and skin fibroblasts derived from the same patients. Int. J. Radiat. Oncol. Biol. Phys. 1993, v. 63, p. 191-198.
12. O’Sullivan B., Davis A.M., Turcotte R. et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomized trial. Lancet. 2002, v. 359, p. 2235-2241.
13. Sampath S., SchultheissT.E., HitchcockY.J. et al. Preoperative Versus Postoperative Radiotherapy in Soft-Tissue Sarcoma: Multi-Institutional Analysis of 821 Patients. Int. J. Radiat. Oncol. Biol. Phys. 2011, v. 81 (2), p. 498-505.
14. Bishop A.J., Zagars G.K., Torres K.E. et al. Combined modality Management of retroperitoneal Sarcomas: a singleinstitution series of 121 patients. Int. J. Radiat. Oncol. Biol. Phys. 2015, v. 93 (1), p. 158-165.
15. Al-Absi E., Farrokhyar F., Sharma R. et al. A systematic review and meta-analysis of oncologic outcomes of pre- versus postoperative radiation in localized resectable soft-tissue sarcoma. Ann. Surg. Oncol. 2010, v. 17 (5), p. 1367-1374.
16. Roberge D., Skamene T., Nahal A. et al. Radiological and pathological response following pre-operative radiotherapy for soft-tissue sarcoma. Radiother. Oncol. 2010, v. 97, p. 404-407.
17. Stacchiotti S., Collini P., Messina A. et al. High-grade softtissue sarcomas: tumor response assessment-pilot study to assess the correlation between radiologic and pathologic response by using RECIST and Choi criteria. Radiology. 2009, v. 251, p. 447-456.
18. Eilber C., Rosen G., Eckardt J. et al. Treatment-Induced Pathologic Necrosis: A Predictor of Local Recurrence and Survival in Patients Receiving Neoadjuvant Therapy for HighGrade Extremity Soft Tissue Sarcomas. J. Clin. Oncol. 2001, v. 19 (13), p. 3203-3209.
19. Kraybill W.G., Harris J., Spiro I.J. et al. Phase II Study of Neoadjuvant Chemotherapy and Radiation Therapy in the Management of High-Risk, High-Grade, Soft Tissue Sarcomas of the Extremities and Body Wall: Radiation Therapy Oncology Group Trial 9514. J. Clin. Oncol. 2006, v. 24 (4), p. 619-625.
20. Look Hong N.J., Hornicek F.J., Harmon D.C. et al. Neoadjuvant chemoradiotherapy for patients with high-risk extremity and truncal sarcomas: A 10-year single institution retrospective study. Eur. J. Cancer. 2013, v. 49 (4), p. 875-883.
21. McDermed D., Miller L.M., Peabody T.D. et al. Primary Tumor Necrosis Predicts Distant Control in Locally Advanced Soft Tissue Sarcomas Following Preoperative Concurrent Chemoradiotherapy. Int. J. Radiat. Oncol. Biol. Phys. 2010, v. 15, 76 (4), p. 1147-1153.
22. Ryan C.W., Montag A.G., Hosenpud J.R. et al. Histologic Response of Dose-intense Chemotherapy With Preoperative Hypofractionated Radiotherapy for Patients With High-risk Soft Tissue Sarcomas. Cancer. 2008, v. 112 (11), p. 2432-2439.
23. Bedi M., King D.M., Shivakoti M. et al. Prognostic variables in patients with primary soft tissue sarcoma of the extremity and trunk treated with neoadjuvant radiotherapy or neoadjuvant sequential chemoradiotherapy. Radiation Oncology. 2013, v. 8, p. 60.
24. Toma S., Canavese G., Grimaldi A. et al. Concomitant chemo-radiotherapy in the treatment of locally advanced and/or metastatic soft tissue sarcomas: Experience of the National Cancer Institute of Genoa. Oncol. Rep. 2003, v. 10, p. 641-647.
25. Pisters P.W.T., Patel S.R., Prieto V.G. et al. Phase I trial of preoperative doxorubicin-based concurrent chemoradiation and surgical resection for localized extremity and body wall soft tissue sarcomas. J. Clin. Oncol. 2004, v. 22, p. 3375-3380.
26. Cormier J.N., Patel S.R., Herzog C.E. et al. Concurrent ifosfamide-based chemotherapy and irradiation. Analysis of treatment-related toxicity in 43 patients with sarcoma. Cancer. 2001, v. 92, p. 1550-1555.
27. Sanceau J., Truchet S., BauvoisB. Matrix metalloproteinase-9 silencing by RNA interference triggers the migratory adhesive switch in Ewing’s sarcoma cells. J. Biol. Chem. 2003, v. 278, p. 36537-36546.
28. Hieken T.J., Das Gupta T.K. Mutant p53 expression: a marker of diminished survival in well-differentiated soft tissue sarcoma. Clin. Cancer Res. 1996, v. 2, p. 1391-1395.
29. Hong L., Alektiar K.M., Hunt M., Venkatraman E., Leibel S.A. Intensity-modulated radiotherapy for soft tissue sarcoma of the thigh. Int. J. Radiat. Oncol. Biol. Phys. 2004, v. 59 (3), p. 752-759.
30. Shiu M.H., Turnbull A.D., Nori D., Hajdu S., Hilaris B. Control of locally advanced extremity soft tissue sarcomas by function-saving resection and brachytherapy. Cancer. 1984, v. 53, p. 1385-1392.
31. Fuller B.G. The Role of Radiotherapy in the Treatment of Bone and Soft-tissue Sarcomas. Chapter 5 in Musculoskeletal Cancer Surgery Treatment of Sarcomas and Allied Diseases (by Malawer M.M. and Sugarbaker P.H.). Kluwer Academic Publishers. 2001.
32. Ormsby M.V., Hilaris B.S., Nori D., Brennan M.F. Wound complications of adjuvant radiation therapy in patients with soft-tissue sarcomas. Ann. Surg. 1989, v. 210, p. 93-99.
33. Pisters P.W.T., Harrison L.B., Leung D.H.Y., Woodruf J.M., Casper E.S., Brennan M.F. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J. Clin. Oncol. 1996, v. 14, p. 859-868.
34. Harrison L.B., Franzse F., Gaynor J.J., Brennan M.F. Longterm results of a prospective randomized trial of adjuvant brachytherapy in the management of completely resected soft tissue sarcomas of the extremity and superficial trunk. Radiat. Oncol. Biol. Phys. 1993, v. 27, p. 259-265.
35. Alekhteyar K.M., Leung D.H., Brennan M.F., Harrison L.B. The effect of combined external beam radiotherapy and brachytherapy on local control and wound complications in patients with high-grade soft tissue sarcomas of the extremity with positive microscopic margin. Int. J. Radiat. Oncol. Biol. Phys. 1996, v. 36, p. 321-324.
36. Sindelar W.F., Kinsella T.J., Chen P.W. et al. Intraoperative radiotherapy in retroperitoneal sarcomas: final results of a prospective, randomized, clinical trial. Arch. Surg. 1993, v. 128, p. 402-410.
37. Oleson J.R. Preoperative hyperthermia and radiation for soft tissue sarcomas: Advantage of two versus one hyperthermia treatments per week. Int. J. Radiat. Oncol. Biol. Phys. 1989, v. 16, p. 107-115.
38. Scully S.P., Oleson J.R., Leopold K.A. et al. Clinical outcome after neoadjuvant thermoradiotherapy in high grade soft tissue sarcomas. J. Surg. Oncol. 1994, v. 57, p. 143-151.
39. Brizel D.M., Scully S.P., Harrelson J.M. et al. Radiation Therapy and Hyperthermia Improve the Oxygenation of Human Soft Tissue Sarcomas. Cancer. Research. 1996, v. 56, p. 5347-5350.
40. Issels R.D., Lindner L.H., Wust P. et al. Regional hyperthermia (RHT) improves response and survival when combined with systemic chemotherapy in the management of locally advanced, high grade soft tissue sarcomas (STS) of the extremities, the body wall and the abdomen: A phase III randomized prospective trial (EORTC-ESHO intergroup trial). Proc. Am. Soc. Clin. Oncol. 2007, v. 25 (18 suppl.), p. 547.
Review
For citations:
Dengina N.V. Implications and opportunities for radiotherapy in soft tissue sarcomas treatment. Bone and soft tissue sarcomas, tumors of the skin. 2015;(4):52-62. (In Russ.)