UCLA Journal of Radiation Oncology January 1, 2022 - Flipbook - Page 37
UCLA RADIATION ONCOLOGY JOURNAL
Optimizing Preoperative
Radiation Therapy in High
Risk Sarcoma
in April 2020.
Here, Savjani presents updated findings with
longer follow-up and additional patients
from an expansion cohort.
With five-day preoperative treatment instead
MATERIALS AND METHODS
of five-week course, UCLA researchers find
similar results with less burden on patients
The initial cohort accrued between April
2016 and May 2018 and included 52 patients
FINDINGS
with histologically confirmed extremity or
trunk soft tissue sarcoma (STS) planning to
In updated results of a phase 2 singleundergo preoperative radiation therapy (RT)
institution study of over 100 patients,
followed by surgery. The primary endpoint
researchers from the UCLA Jonsson
of the initial cohort was the rate of grade ≥2
Comprehensive Cancer Center Sarcoma
radiation morbidity (fibrosis, lymphedema,
Program found that preoperative radiation
or joint stiffness) at two years.
therapy for soft tissue sarcoma delivered in
five days rather than the conventional five
An expansion cohort opened in October
weeks continues to produce excellent patient 2018 to compare wound complication rates
outcomes.
between patients with preoperative RT
alone versus chemoRT and has enrolled an
additional 47 patients. Patients received 30
Gy (RT alone) or 25 Gy (chemoRT) over five
daily fractions to the primary tumor with
standard margins.
Dr. Ricky R. Savjani, a resident physician
in the Radiation Oncology Residency
Program at UCLA and a researcher at UCLA
Jonsson Comprehensive Cancer Center,
presented updated findings at ASTRO, the
annual meeting of the American Society for
Radiation Oncology. Dr. Anusha Kalbasi,
assistant professor in the Division of
Molecular and Cellular Oncology of the
Department of Radiation Oncology, and a
UCLA Jonsson Comprehensive Cancer Center
researcher, is the abstract’s senior author.
“Preoperative radiation therapy is a key
component of treatment for soft tissue
sarcoma. It enables the treatment team to
provide good local disease control, and the
radiation side effects – fibrosis, lymphedema
or joint stiffness – are generally manageable
and well tolerated. But the standard five-week
preoperative radiation course is a burden
affecting patient quality of life,” Savjani said.
“We’ve found that a five-day course provides
excellent local control, and the rates of side
effects and wound complications remain
acceptable, with 52 patients followed for at
least two years.”
BACKGROUND
Results from the initial cohort of 52 patients
were published in Clinical Cancer Research
Here we report on patients with primary
localized STS who completed preoperative
RT and surgery in the initial and expansion
cohorts (N=79; chemoRT excluded). We
assessed disease outcomes (local control
and distant metastasis) and toxicity (grade
≥2 fibrosis, lymphedema, or joint stiffness)
after two-year follow-up (N=93). Fibrosis
and joint stiffness were graded using RTOG/
EORTC criteria, and lymphedema by Stern’s
scale. We also updated the major wound
complication rate (defined per established
criteria) after one-year follow-up.
CONCLUSIONS AND IMPACT
Of the 52 patients with minimum two-year
follow-up, predominant histologic subtypes
included undifferentiated pleomorphic
sarcoma, spindle cell sarcoma or sarcoma
NOS (N=24), myxofibrosarcoma (N=8), and
myxoid liposarcoma (N=12). Median tumor
size was 6.9 cm, and 15 pts had tumors ≥10
cm. At a median follow-up of two years, the
local recurrence and distant metastasis rates
were 6.4% and 24.7%, respectively. The rate
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