High dose hyperfractionated radiotherapy in the treatment of extremity soft tissue sarcomas
Identifieur interne : 007178 ( Istex/Corpus ); précédent : 007177; suivant : 007179High dose hyperfractionated radiotherapy in the treatment of extremity soft tissue sarcomas
Auteurs : M. Robinson ; A. Cassoni ; C. Harmer ; C. Fisher ; J. Thomas ; G. WestburySource :
- Radiotherapy and Oncology [ 0167-8140 ] ; 1991.
Abstract
A hyperfractionated radiotherapy schedule has been evaluated in the treatment of 29 adults with limb or limb girdle soft tissue sarcomas. The objective was to increase the total administered dose and possibly improve local control, without increasing late normal tissue damage. Twice daily 1.25 Gy fractions (with a minimum interval of 6 h) have been given over 5 to 6 weeks to 12 patients pre-operatively, 10 post-operatively and 7 palliatively. Five patients received 62.5 Gy in 5 weeks pre-operatively and 3 palliatively. Nineteen of the remaining 21 patients received 75 Gy in 6 weeks with a field size reduction after 5 weeks. Sixteen of 29 tumours were situated in the thigh and only 2 were in the upper limb. Twenty were of high grade. The mean tumour size of those treated radically was 13.1 cm (range 5 to 40 cm). Sixteen patients (76%) given 75 Gy developed moderate or severe skin erythema maximal at 5 weeks. Despite the large field sizes used (mean phase one of 34.5 cm, and phase two of 22.8 cm) only 2 patients failed to complete the planned treatment because of the severity of these reactions. Two other patients developed partial wound breakdowns after the end of treatment — both healing spontaneously. Fourteen patients developed an area of moist desquamation — 11 mild, 2 moderate and one severe. There have been four late wound breakdowns requiring surgical intervention; all have since healed well. The median follow up is short at 556 days. Ten of 19 evaluable patients have developed moderate/severe induration, 5/19 mild and 4/19 none. There has been one local failure associated with regional node involvement and lung metastases. Although it was feasible to deliver the planned very high doses to these patients by the use of hyperfractionation, early results suggest that the late damage caused by this regime is greater than that from standard once daily 2 Gy fractionation to a total dose of 60 Gy in 6 weeks. A lower dose per fraction is now being evaluated.
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DOI: 10.1016/0167-8140(91)90007-4
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>High dose hyperfractionated radiotherapy in the treatment of extremity soft tissue sarcomas</title><author><name sortKey="Robinson, M" sort="Robinson, M" uniqKey="Robinson M" first="M." last="Robinson">M. Robinson</name><affiliation><mods:affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Cassoni, A" sort="Cassoni, A" uniqKey="Cassoni A" first="A." last="Cassoni">A. Cassoni</name><affiliation><mods:affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Harmer, C" sort="Harmer, C" uniqKey="Harmer C" first="C." last="Harmer">C. Harmer</name><affiliation><mods:affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Fisher, C" sort="Fisher, C" uniqKey="Fisher C" first="C." last="Fisher">C. Fisher</name><affiliation><mods:affiliation>Department of Histopathology, Sarcoma Unit, Royal Marsden Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Thomas, J" sort="Thomas, J" uniqKey="Thomas J" first="J." last="Thomas">J. Thomas</name><affiliation><mods:affiliation>Department of Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Westbury, G" sort="Westbury, G" uniqKey="Westbury G" first="G." last="Westbury">G. Westbury</name><affiliation><mods:affiliation>Institute of Cancer Research, 17A Onslow Gardens, London SW3, U.K.</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:F297E7432C17403F381DEFB0A489F350BFE21A32</idno><date when="1991" year="1991">1991</date><idno type="doi">10.1016/0167-8140(91)90007-4</idno><idno type="url">https://api.istex.fr/document/F297E7432C17403F381DEFB0A489F350BFE21A32/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">007178</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">007178</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">High dose hyperfractionated radiotherapy in the treatment of extremity soft tissue sarcomas</title><author><name sortKey="Robinson, M" sort="Robinson, M" uniqKey="Robinson M" first="M." last="Robinson">M. Robinson</name><affiliation><mods:affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Cassoni, A" sort="Cassoni, A" uniqKey="Cassoni A" first="A." last="Cassoni">A. Cassoni</name><affiliation><mods:affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Harmer, C" sort="Harmer, C" uniqKey="Harmer C" first="C." last="Harmer">C. Harmer</name><affiliation><mods:affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Fisher, C" sort="Fisher, C" uniqKey="Fisher C" first="C." last="Fisher">C. Fisher</name><affiliation><mods:affiliation>Department of Histopathology, Sarcoma Unit, Royal Marsden Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Thomas, J" sort="Thomas, J" uniqKey="Thomas J" first="J." last="Thomas">J. Thomas</name><affiliation><mods:affiliation>Department of Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Westbury, G" sort="Westbury, G" uniqKey="Westbury G" first="G." last="Westbury">G. Westbury</name><affiliation><mods:affiliation>Institute of Cancer Research, 17A Onslow Gardens, London SW3, U.K.</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Radiotherapy and Oncology</title><title level="j" type="abbrev">RADION</title><idno type="ISSN">0167-8140</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1991">1991</date><biblScope unit="volume">22</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="118">118</biblScope><biblScope unit="page" to="126">126</biblScope></imprint><idno type="ISSN">0167-8140</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0167-8140</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">A hyperfractionated radiotherapy schedule has been evaluated in the treatment of 29 adults with limb or limb girdle soft tissue sarcomas. The objective was to increase the total administered dose and possibly improve local control, without increasing late normal tissue damage. Twice daily 1.25 Gy fractions (with a minimum interval of 6 h) have been given over 5 to 6 weeks to 12 patients pre-operatively, 10 post-operatively and 7 palliatively. Five patients received 62.5 Gy in 5 weeks pre-operatively and 3 palliatively. Nineteen of the remaining 21 patients received 75 Gy in 6 weeks with a field size reduction after 5 weeks. Sixteen of 29 tumours were situated in the thigh and only 2 were in the upper limb. Twenty were of high grade. The mean tumour size of those treated radically was 13.1 cm (range 5 to 40 cm). Sixteen patients (76%) given 75 Gy developed moderate or severe skin erythema maximal at 5 weeks. Despite the large field sizes used (mean phase one of 34.5 cm, and phase two of 22.8 cm) only 2 patients failed to complete the planned treatment because of the severity of these reactions. Two other patients developed partial wound breakdowns after the end of treatment — both healing spontaneously. Fourteen patients developed an area of moist desquamation — 11 mild, 2 moderate and one severe. There have been four late wound breakdowns requiring surgical intervention; all have since healed well. The median follow up is short at 556 days. Ten of 19 evaluable patients have developed moderate/severe induration, 5/19 mild and 4/19 none. There has been one local failure associated with regional node involvement and lung metastases. Although it was feasible to deliver the planned very high doses to these patients by the use of hyperfractionation, early results suggest that the late damage caused by this regime is greater than that from standard once daily 2 Gy fractionation to a total dose of 60 Gy in 6 weeks. A lower dose per fraction is now being evaluated.</div></front></TEI><istex><corpusName>elsevier</corpusName><keywords><teeft><json:string>sarcoma</json:string><json:string>radiotherapy</json:string><json:string>tumour</json:string><json:string>oncol</json:string><json:string>erythema</json:string><json:string>tissue sarcomas</json:string><json:string>soft tissue sarcomas</json:string><json:string>hyperfractionated</json:string><json:string>induration</json:string><json:string>radiat</json:string><json:string>phys</json:string><json:string>biol</json:string><json:string>resection</json:string><json:string>desquamation</json:string><json:string>field area</json:string><json:string>local control</json:string><json:string>soft tissue sarcoma</json:string><json:string>moist desquamation</json:string><json:string>standard fractionation</json:string><json:string>metastasis</json:string><json:string>evaluable</json:string><json:string>chemotherapy</json:string><json:string>surg</json:string><json:string>late damage</json:string><json:string>radiation therapy</json:string><json:string>tissue damage</json:string><json:string>high grade</json:string><json:string>neutron</json:string><json:string>palliative</json:string><json:string>wound complications</json:string><json:string>limb girdle</json:string><json:string>evaluable patients</json:string><json:string>median</json:string><json:string>local recurrence</json:string><json:string>conventional fractionation</json:string><json:string>total dose</json:string><json:string>hyperfractionated radiotherapy</json:string><json:string>effective dose</json:string><json:string>local failure</json:string><json:string>palliative radiotherapy</json:string><json:string>palliative groups</json:string><json:string>hyperfractionated regime</json:string><json:string>field size</json:string><json:string>daily fractions</json:string><json:string>fractionation</json:string><json:string>daily fractionation</json:string><json:string>large volumes</json:string><json:string>acute reactions</json:string><json:string>upper limb</json:string><json:string>surgical intervention</json:string><json:string>lung metastases</json:string><json:string>maximum degree</json:string><json:string>extremity sarcoma</json:string><json:string>normal tissues</json:string><json:string>high dose radiotherapy</json:string><json:string>significant association</json:string><json:string>field length</json:string><json:string>maximum erythema score</json:string><json:string>high doses</json:string><json:string>sarcoma unit</json:string><json:string>preoperative irradiation</json:string><json:string>wound breakdowns</json:string><json:string>marginal resection</json:string><json:string>clear association</json:string><json:string>table viii</json:string><json:string>late effects</json:string><json:string>inoperable tumours</json:string><json:string>radical intent</json:string><json:string>human sarcoma cell lines</json:string><json:string>experimental tumours</json:string><json:string>dose response</json:string><json:string>major complications</json:string><json:string>wide resection</json:string><json:string>important factor</json:string><json:string>royal marsden hospital</json:string><json:string>partial wound breakdowns</json:string><json:string>adjuvant chemotherapy</json:string><json:string>acute reaction</json:string><json:string>wound breakdown</json:string><json:string>neutron therapy</json:string><json:string>functional impairment</json:string><json:string>synovial sarcomas</json:string><json:string>tissue sarcoma</json:string><json:string>progressive disease</json:string></teeft></keywords><author><json:item><name>M. Robinson</name><affiliations><json:string>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, London, UK</json:string></affiliations></json:item><json:item><name>A. Cassoni</name><affiliations><json:string>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, London, UK</json:string></affiliations></json:item><json:item><name>C. Harmer</name><affiliations><json:string>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, London, UK</json:string></affiliations></json:item><json:item><name>C. Fisher</name><affiliations><json:string>Department of Histopathology, Sarcoma Unit, Royal Marsden Hospital, London, UK</json:string></affiliations></json:item><json:item><name>J. Thomas</name><affiliations><json:string>Department of Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK</json:string></affiliations></json:item><json:item><name>G. Westbury</name><affiliations><json:string>Institute of Cancer Research, 17A Onslow Gardens, London SW3, U.K.</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Hyperfractionation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Extremity, sarcomas</value></json:item></subject><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>A hyperfractionated radiotherapy schedule has been evaluated in the treatment of 29 adults with limb or limb girdle soft tissue sarcomas. The objective was to increase the total administered dose and possibly improve local control, without increasing late normal tissue damage. Twice daily 1.25 Gy fractions (with a minimum interval of 6 h) have been given over 5 to 6 weeks to 12 patients pre-operatively, 10 post-operatively and 7 palliatively. Five patients received 62.5 Gy in 5 weeks pre-operatively and 3 palliatively. Nineteen of the remaining 21 patients received 75 Gy in 6 weeks with a field size reduction after 5 weeks. Sixteen of 29 tumours were situated in the thigh and only 2 were in the upper limb. Twenty were of high grade. The mean tumour size of those treated radically was 13.1 cm (range 5 to 40 cm). Sixteen patients (76%) given 75 Gy developed moderate or severe skin erythema maximal at 5 weeks. Despite the large field sizes used (mean phase one of 34.5 cm, and phase two of 22.8 cm) only 2 patients failed to complete the planned treatment because of the severity of these reactions. Two other patients developed partial wound breakdowns after the end of treatment — both healing spontaneously. Fourteen patients developed an area of moist desquamation — 11 mild, 2 moderate and one severe. There have been four late wound breakdowns requiring surgical intervention; all have since healed well. The median follow up is short at 556 days. Ten of 19 evaluable patients have developed moderate/severe induration, 5/19 mild and 4/19 none. There has been one local failure associated with regional node involvement and lung metastases. Although it was feasible to deliver the planned very high doses to these patients by the use of hyperfractionation, early results suggest that the late damage caused by this regime is greater than that from standard once daily 2 Gy fractionation to a total dose of 60 Gy in 6 weeks. 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Robinson, Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital Fulham Rd., London SW3 6JJ, U.K.</affiliation><affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, London, UK</affiliation></author><author xml:id="author-0001"><persName><forename type="first">A.</forename><surname>Cassoni</surname></persName><affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, London, UK</affiliation></author><author xml:id="author-0002"><persName><forename type="first">C.</forename><surname>Harmer</surname></persName><affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, London, UK</affiliation></author><author xml:id="author-0003"><persName><forename type="first">C.</forename><surname>Fisher</surname></persName><affiliation>Department of Histopathology, Sarcoma Unit, Royal Marsden Hospital, London, UK</affiliation></author><author xml:id="author-0004"><persName><forename type="first">J.</forename><surname>Thomas</surname></persName><affiliation>Department of Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK</affiliation></author><author xml:id="author-0005"><persName><forename type="first">G.</forename><surname>Westbury</surname></persName><affiliation>Institute of Cancer Research, 17A Onslow Gardens, London SW3, U.K.</affiliation></author><idno type="istex">F297E7432C17403F381DEFB0A489F350BFE21A32</idno><idno type="DOI">10.1016/0167-8140(91)90007-4</idno><idno type="PII">0167-8140(91)90007-4</idno></analytic><monogr><title level="j">Radiotherapy and Oncology</title><title level="j" type="abbrev">RADION</title><idno type="pISSN">0167-8140</idno><idno type="PII">S0167-8140(00)X0123-5</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1991"></date><biblScope unit="volume">22</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="118">118</biblScope><biblScope unit="page" to="126">126</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1991</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>A hyperfractionated radiotherapy schedule has been evaluated in the treatment of 29 adults with limb or limb girdle soft tissue sarcomas. The objective was to increase the total administered dose and possibly improve local control, without increasing late normal tissue damage. Twice daily 1.25 Gy fractions (with a minimum interval of 6 h) have been given over 5 to 6 weeks to 12 patients pre-operatively, 10 post-operatively and 7 palliatively. Five patients received 62.5 Gy in 5 weeks pre-operatively and 3 palliatively. Nineteen of the remaining 21 patients received 75 Gy in 6 weeks with a field size reduction after 5 weeks. Sixteen of 29 tumours were situated in the thigh and only 2 were in the upper limb. Twenty were of high grade. The mean tumour size of those treated radically was 13.1 cm (range 5 to 40 cm). Sixteen patients (76%) given 75 Gy developed moderate or severe skin erythema maximal at 5 weeks. Despite the large field sizes used (mean phase one of 34.5 cm, and phase two of 22.8 cm) only 2 patients failed to complete the planned treatment because of the severity of these reactions. Two other patients developed partial wound breakdowns after the end of treatment — both healing spontaneously. Fourteen patients developed an area of moist desquamation — 11 mild, 2 moderate and one severe. There have been four late wound breakdowns requiring surgical intervention; all have since healed well. The median follow up is short at 556 days. Ten of 19 evaluable patients have developed moderate/severe induration, 5/19 mild and 4/19 none. There has been one local failure associated with regional node involvement and lung metastases. Although it was feasible to deliver the planned very high doses to these patients by the use of hyperfractionation, early results suggest that the late damage caused by this regime is greater than that from standard once daily 2 Gy fractionation to a total dose of 60 Gy in 6 weeks. A lower dose per fraction is now being evaluated.</p></abstract><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>Hyperfractionation</term></item><item><term>Extremity, sarcomas</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="1991-07-25">Modified</change><change when="1991">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/F297E7432C17403F381DEFB0A489F350BFE21A32/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: tail"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla"><item-info><jid>RADION</jid><aid>91900074</aid><ce:pii>0167-8140(91)90007-4</ce:pii><ce:doi>10.1016/0167-8140(91)90007-4</ce:doi><ce:copyright type="unknown" year="1991"></ce:copyright></item-info><head><ce:dochead><ce:textfn>Original paper</ce:textfn></ce:dochead><ce:title>High dose hyperfractionated radiotherapy in the treatment of extremity soft tissue sarcomas</ce:title><ce:author-group><ce:author><ce:given-name>M.</ce:given-name><ce:surname>Robinson</ce:surname><ce:cross-ref refid="COR1"><ce:sup>∗</ce:sup></ce:cross-ref><ce:cross-ref refid="AFF1"><ce:sup>1</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>A.</ce:given-name><ce:surname>Cassoni</ce:surname><ce:cross-ref refid="AFF1"><ce:sup>1</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>C.</ce:given-name><ce:surname>Harmer</ce:surname><ce:cross-ref refid="AFF1"><ce:sup>1</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>C.</ce:given-name><ce:surname>Fisher</ce:surname><ce:cross-ref refid="AFF2"><ce:sup>2</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>J.</ce:given-name><ce:surname>Thomas</ce:surname><ce:cross-ref refid="AFF3"><ce:sup>3</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>G.</ce:given-name><ce:surname>Westbury</ce:surname><ce:cross-ref refid="AFF4"><ce:sup>4</ce:sup></ce:cross-ref></ce:author><ce:affiliation id="AFF1"><ce:label>a</ce:label><ce:textfn>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, London, UK</ce:textfn></ce:affiliation><ce:affiliation id="AFF2"><ce:label>b</ce:label><ce:textfn>Department of Histopathology, Sarcoma Unit, Royal Marsden Hospital, London, UK</ce:textfn></ce:affiliation><ce:affiliation id="AFF3"><ce:label>c</ce:label><ce:textfn>Department of Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK</ce:textfn></ce:affiliation><ce:affiliation id="AFF4"><ce:label>d</ce:label><ce:textfn>Institute of Cancer Research, 17A Onslow Gardens, London SW3, U.K.</ce:textfn></ce:affiliation><ce:correspondence id="COR1"><ce:label>∗</ce:label><ce:text>Address for correspondence: M. Robinson, Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital Fulham Rd., London SW3 6JJ, U.K.</ce:text></ce:correspondence></ce:author-group><ce:date-received day="15" month="10" year="1990"></ce:date-received><ce:date-revised day="25" month="7" year="1991"></ce:date-revised><ce:date-accepted day="5" month="8" year="1991"></ce:date-accepted><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para>A hyperfractionated radiotherapy schedule has been evaluated in the treatment of 29 adults with limb or limb girdle soft tissue sarcomas. The objective was to increase the total administered dose and possibly improve local control, without increasing late normal tissue damage. Twice daily 1.25 Gy fractions (with a minimum interval of 6 h) have been given over 5 to 6 weeks to 12 patients pre-operatively, 10 post-operatively and 7 palliatively. Five patients received 62.5 Gy in 5 weeks pre-operatively and 3 palliatively. Nineteen of the remaining 21 patients received 75 Gy in 6 weeks with a field size reduction after 5 weeks. Sixteen of 29 tumours were situated in the thigh and only 2 were in the upper limb. Twenty were of high grade. The mean tumour size of those treated radically was 13.1 cm (range 5 to 40 cm). Sixteen patients (76%) given 75 Gy developed moderate or severe skin erythema maximal at 5 weeks. Despite the large field sizes used (mean phase one of 34.5 cm, and phase two of 22.8 cm) only 2 patients failed to complete the planned treatment because of the severity of these reactions. Two other patients developed partial wound breakdowns after the end of treatment — both healing spontaneously. Fourteen patients developed an area of moist desquamation — 11 mild, 2 moderate and one severe. There have been four late wound breakdowns requiring surgical intervention; all have since healed well. The median follow up is short at 556 days. Ten of 19 evaluable patients have developed moderate/severe induration, 5/19 mild and 4/19 none. There has been one local failure associated with regional node involvement and lung metastases. Although it was feasible to deliver the planned very high doses to these patients by the use of hyperfractionation, early results suggest that the late damage caused by this regime is greater than that from standard once daily 2 Gy fractionation to a total dose of 60 Gy in 6 weeks. A lower dose per fraction is now being evaluated.</ce:simple-para></ce:abstract-sec></ce:abstract><ce:keywords><ce:section-title>Keywords</ce:section-title><ce:keyword><ce:text>Hyperfractionation</ce:text></ce:keyword><ce:keyword><ce:text>Extremity, sarcomas</ce:text></ce:keyword></ce:keywords></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>High dose hyperfractionated radiotherapy in the treatment of extremity soft tissue sarcomas</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>High dose hyperfractionated radiotherapy in the treatment of extremity soft tissue sarcomas</title></titleInfo><name type="personal"><namePart type="given">M.</namePart><namePart type="family">Robinson</namePart><affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, London, UK</affiliation><description>Address for correspondence: M. Robinson, Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital Fulham Rd., London SW3 6JJ, U.K.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A.</namePart><namePart type="family">Cassoni</namePart><affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C.</namePart><namePart type="family">Harmer</namePart><affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C.</namePart><namePart type="family">Fisher</namePart><affiliation>Department of Histopathology, Sarcoma Unit, Royal Marsden Hospital, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.</namePart><namePart type="family">Thomas</namePart><affiliation>Department of Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">G.</namePart><namePart type="family">Westbury</namePart><affiliation>Institute of Cancer Research, 17A Onslow Gardens, London SW3, U.K.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1991</dateIssued><dateModified encoding="w3cdtf">1991-07-25</dateModified><copyrightDate encoding="w3cdtf">1991</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">A hyperfractionated radiotherapy schedule has been evaluated in the treatment of 29 adults with limb or limb girdle soft tissue sarcomas. The objective was to increase the total administered dose and possibly improve local control, without increasing late normal tissue damage. Twice daily 1.25 Gy fractions (with a minimum interval of 6 h) have been given over 5 to 6 weeks to 12 patients pre-operatively, 10 post-operatively and 7 palliatively. Five patients received 62.5 Gy in 5 weeks pre-operatively and 3 palliatively. Nineteen of the remaining 21 patients received 75 Gy in 6 weeks with a field size reduction after 5 weeks. Sixteen of 29 tumours were situated in the thigh and only 2 were in the upper limb. Twenty were of high grade. The mean tumour size of those treated radically was 13.1 cm (range 5 to 40 cm). Sixteen patients (76%) given 75 Gy developed moderate or severe skin erythema maximal at 5 weeks. Despite the large field sizes used (mean phase one of 34.5 cm, and phase two of 22.8 cm) only 2 patients failed to complete the planned treatment because of the severity of these reactions. Two other patients developed partial wound breakdowns after the end of treatment — both healing spontaneously. Fourteen patients developed an area of moist desquamation — 11 mild, 2 moderate and one severe. There have been four late wound breakdowns requiring surgical intervention; all have since healed well. The median follow up is short at 556 days. Ten of 19 evaluable patients have developed moderate/severe induration, 5/19 mild and 4/19 none. There has been one local failure associated with regional node involvement and lung metastases. Although it was feasible to deliver the planned very high doses to these patients by the use of hyperfractionation, early results suggest that the late damage caused by this regime is greater than that from standard once daily 2 Gy fractionation to a total dose of 60 Gy in 6 weeks. A lower dose per fraction is now being evaluated.</abstract><note type="content">Section title: Original paper</note><subject><genre>Keywords</genre><topic>Hyperfractionation</topic><topic>Extremity, sarcomas</topic></subject><relatedItem type="host"><titleInfo><title>Radiotherapy and Oncology</title></titleInfo><titleInfo type="abbreviated"><title>RADION</title></titleInfo><genre type="journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">199110</dateIssued></originInfo><identifier type="ISSN">0167-8140</identifier><identifier type="PII">S0167-8140(00)X0123-5</identifier><part><date>199110</date><detail type="volume"><number>22</number><caption>vol.</caption></detail><detail type="issue"><number>2</number><caption>no.</caption></detail><extent unit="issue pages"><start>79</start><end>151</end></extent><extent unit="pages"><start>118</start><end>126</end></extent></part></relatedItem><identifier type="istex">F297E7432C17403F381DEFB0A489F350BFE21A32</identifier><identifier type="DOI">10.1016/0167-8140(91)90007-4</identifier><identifier type="PII">0167-8140(91)90007-4</identifier><recordInfo><recordContentSource>ELSEVIER</recordContentSource></recordInfo></mods></metadata></istex></record>Pour manipuler ce document sous Unix (Dilib)
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