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Significant Reduction of Late Toxicities in Patients With Extremity Sarcoma Treated With Image-Guided Radiation Therapy to a Reduced Target Volume: Results of Radiation Therapy Oncology Group RTOG-0630 Trial

Identifieur interne : 001834 ( Main/Exploration ); précédent : 001833; suivant : 001835

Significant Reduction of Late Toxicities in Patients With Extremity Sarcoma Treated With Image-Guided Radiation Therapy to a Reduced Target Volume: Results of Radiation Therapy Oncology Group RTOG-0630 Trial

Auteurs : Dian Wang ; Qiang Zhang ; Burton L. Eisenberg ; John M. Kane ; X. Allen Li ; David Lucas ; Ivy A. Petersen ; Thomas F. Delaney ; Carolyn R. Freeman ; Steven E. Finkelstein ; Ying J. Hitchcock ; Manpreet Bedi ; Anurag K. Singh ; George Dundas ; David G. Kirsch

Source :

RBID : PMC:4486342

Abstract

Purpose

We performed a multi-institutional prospective phase II trial to assess late toxicities in patients with extremity soft tissue sarcoma (STS) treated with preoperative image-guided radiation therapy (IGRT) to a reduced target volume.

Patients and Methods

Patients with extremity STS received IGRT with (cohort A) or without (cohort B) chemotherapy followed by limb-sparing resection. Daily pretreatment images were coregistered with digitally reconstructed radiographs so that the patient position could be adjusted before each treatment. All patients received IGRT to reduced tumor volumes according to strict protocol guidelines. Late toxicities were assessed at 2 years.

Results

In all, 98 patients were accrued (cohort A, 12; cohort B, 86). Cohort A was closed prematurely because of poor accrual and is not reported. Seventy-nine eligible patients from cohort B form the basis of this report. At a median follow-up of 3.6 years, five patients did not have surgery because of disease progression. There were five local treatment failures, all of which were in field. Of the 57 patients assessed for late toxicities at 2 years, 10.5% experienced at least one grade ≥ 2 toxicity as compared with 37% of patients in the National Cancer Institute of Canada SR2 (CAN-NCIC-SR2: Phase III Randomized Study of Pre- vs Postoperative Radiotherapy in Curable Extremity Soft Tissue Sarcoma) trial receiving preoperative radiation therapy without IGRT (P < .001).

Conclusion

The significant reduction of late toxicities in patients with extremity STS who were treated with preoperative IGRT and absence of marginal-field recurrences suggest that the target volumes used in the Radiation Therapy Oncology Group RTOG-0630 (A Phase II Trial of Image-Guided Preoperative Radiotherapy for Primary Soft Tissue Sarcomas of the Extremity) study are appropriate for preoperative IGRT for extremity STS.


Url:
DOI: 10.1200/JCO.2014.58.5828
PubMed: 25667281
PubMed Central: 4486342


Affiliations:


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<name sortKey="Wang, Dian" sort="Wang, Dian" uniqKey="Wang D" first="Dian" last="Wang">Dian Wang</name>
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<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
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<name sortKey="Zhang, Qiang" sort="Zhang, Qiang" uniqKey="Zhang Q" first="Qiang" last="Zhang">Qiang Zhang</name>
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<name sortKey="Li, X Allen" sort="Li, X Allen" uniqKey="Li X" first="X. Allen" last="Li">X. Allen Li</name>
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<name sortKey="Lucas, David" sort="Lucas, David" uniqKey="Lucas D" first="David" last="Lucas">David Lucas</name>
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<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
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<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
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<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
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<name sortKey="Finkelstein, Steven E" sort="Finkelstein, Steven E" uniqKey="Finkelstein S" first="Steven E." last="Finkelstein">Steven E. Finkelstein</name>
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<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
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<name sortKey="Hitchcock, Ying J" sort="Hitchcock, Ying J" uniqKey="Hitchcock Y" first="Ying J." last="Hitchcock">Ying J. Hitchcock</name>
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<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
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<name sortKey="Bedi, Manpreet" sort="Bedi, Manpreet" uniqKey="Bedi M" first="Manpreet" last="Bedi">Manpreet Bedi</name>
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<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
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<name sortKey="Singh, Anurag K" sort="Singh, Anurag K" uniqKey="Singh A" first="Anurag K." last="Singh">Anurag K. Singh</name>
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<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
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<name sortKey="Dundas, George" sort="Dundas, George" uniqKey="Dundas G" first="George" last="Dundas">George Dundas</name>
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<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
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<name sortKey="Kirsch, David G" sort="Kirsch, David G" uniqKey="Kirsch D" first="David G." last="Kirsch">David G. Kirsch</name>
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<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
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<title xml:lang="en" level="a" type="main">Significant Reduction of Late Toxicities in Patients With Extremity Sarcoma Treated With Image-Guided Radiation Therapy to a Reduced Target Volume: Results of Radiation Therapy Oncology Group RTOG-0630 Trial</title>
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<name sortKey="Wang, Dian" sort="Wang, Dian" uniqKey="Wang D" first="Dian" last="Wang">Dian Wang</name>
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<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
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<name sortKey="Zhang, Qiang" sort="Zhang, Qiang" uniqKey="Zhang Q" first="Qiang" last="Zhang">Qiang Zhang</name>
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<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
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<name sortKey="Eisenberg, Burton L" sort="Eisenberg, Burton L" uniqKey="Eisenberg B" first="Burton L." last="Eisenberg">Burton L. Eisenberg</name>
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<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
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<name sortKey="Kane, John M" sort="Kane, John M" uniqKey="Kane J" first="John M." last="Kane">John M. Kane</name>
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<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
<wicri:noCountry code="subfield">NC.</wicri:noCountry>
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<author>
<name sortKey="Li, X Allen" sort="Li, X Allen" uniqKey="Li X" first="X. Allen" last="Li">X. Allen Li</name>
<affiliation>
<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
<wicri:noCountry code="subfield">NC.</wicri:noCountry>
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<name sortKey="Lucas, David" sort="Lucas, David" uniqKey="Lucas D" first="David" last="Lucas">David Lucas</name>
<affiliation>
<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
<wicri:noCountry code="subfield">NC.</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Petersen, Ivy A" sort="Petersen, Ivy A" uniqKey="Petersen I" first="Ivy A." last="Petersen">Ivy A. Petersen</name>
<affiliation>
<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
<wicri:noCountry code="subfield">NC.</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Delaney, Thomas F" sort="Delaney, Thomas F" uniqKey="Delaney T" first="Thomas F." last="Delaney">Thomas F. Delaney</name>
<affiliation>
<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
<wicri:noCountry code="subfield">NC.</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Freeman, Carolyn R" sort="Freeman, Carolyn R" uniqKey="Freeman C" first="Carolyn R." last="Freeman">Carolyn R. Freeman</name>
<affiliation>
<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
<wicri:noCountry code="subfield">NC.</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Finkelstein, Steven E" sort="Finkelstein, Steven E" uniqKey="Finkelstein S" first="Steven E." last="Finkelstein">Steven E. Finkelstein</name>
<affiliation>
<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
<wicri:noCountry code="subfield">NC.</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Hitchcock, Ying J" sort="Hitchcock, Ying J" uniqKey="Hitchcock Y" first="Ying J." last="Hitchcock">Ying J. Hitchcock</name>
<affiliation>
<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
<wicri:noCountry code="subfield">NC.</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Bedi, Manpreet" sort="Bedi, Manpreet" uniqKey="Bedi M" first="Manpreet" last="Bedi">Manpreet Bedi</name>
<affiliation>
<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
<wicri:noCountry code="subfield">NC.</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Singh, Anurag K" sort="Singh, Anurag K" uniqKey="Singh A" first="Anurag K." last="Singh">Anurag K. Singh</name>
<affiliation>
<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
<wicri:noCountry code="subfield">NC.</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Dundas, George" sort="Dundas, George" uniqKey="Dundas G" first="George" last="Dundas">George Dundas</name>
<affiliation>
<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
<wicri:noCountry code="subfield">NC.</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Kirsch, David G" sort="Kirsch, David G" uniqKey="Kirsch D" first="David G." last="Kirsch">David G. Kirsch</name>
<affiliation>
<nlm:aff id="aff1">Dian Wang, Rush University Medical Center, Chicago, IL; Qiang Zhang, NRG Oncology Statistics and Data Management Center, Philadelphia, PA; Burton L. Eisenberg, Hoag/University of Southern California Norris Cancer Center, Los Angeles, CA; John M. Kane and Anurag K. Singh, Roswell Park Cancer Institute, Buffalo, NY; X. Allen Li and Manpreet Bedi, Medical College of Wisconsin, Milwaukee, WI; David Lucas, University of Michigan, Ann Arbor, MI; Ivy A. Petersen, Mayo Clinic, Rochester, MN; Thomas F. DeLaney, Massachusetts General Hospital, Boston, MA; Carolyn R. Freeman, McGill University Health Centre, Montreal, Quebec; George Dundas, Cross Cancer Institute, Edmonton, Alberta, Canada; Steven E. Finkelstein, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Ying J. Hitchcock, University of Utah, Salt Lake City, UT; and David G. Kirsch, Duke University Medical Center, Durham, NC.</nlm:aff>
<wicri:noCountry code="subfield">NC.</wicri:noCountry>
</affiliation>
</author>
</analytic>
<series>
<title level="j">Journal of Clinical Oncology</title>
<idno type="ISSN">0732-183X</idno>
<idno type="eISSN">1527-7755</idno>
<imprint>
<date when="2015">2015</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc>
<textClass></textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<sec>
<title>Purpose</title>
<p>We performed a multi-institutional prospective phase II trial to assess late toxicities in patients with extremity soft tissue sarcoma (STS) treated with preoperative image-guided radiation therapy (IGRT) to a reduced target volume.</p>
</sec>
<sec>
<title>Patients and Methods</title>
<p>Patients with extremity STS received IGRT with (cohort A) or without (cohort B) chemotherapy followed by limb-sparing resection. Daily pretreatment images were coregistered with digitally reconstructed radiographs so that the patient position could be adjusted before each treatment. All patients received IGRT to reduced tumor volumes according to strict protocol guidelines. Late toxicities were assessed at 2 years.</p>
</sec>
<sec>
<title>Results</title>
<p>In all, 98 patients were accrued (cohort A, 12; cohort B, 86). Cohort A was closed prematurely because of poor accrual and is not reported. Seventy-nine eligible patients from cohort B form the basis of this report. At a median follow-up of 3.6 years, five patients did not have surgery because of disease progression. There were five local treatment failures, all of which were in field. Of the 57 patients assessed for late toxicities at 2 years, 10.5% experienced at least one grade ≥ 2 toxicity as compared with 37% of patients in the National Cancer Institute of Canada SR2 (CAN-NCIC-SR2: Phase III Randomized Study of Pre- vs Postoperative Radiotherapy in Curable Extremity Soft Tissue Sarcoma) trial receiving preoperative radiation therapy without IGRT (
<italic>P</italic>
< .001).</p>
</sec>
<sec>
<title>Conclusion</title>
<p>The significant reduction of late toxicities in patients with extremity STS who were treated with preoperative IGRT and absence of marginal-field recurrences suggest that the target volumes used in the Radiation Therapy Oncology Group RTOG-0630 (A Phase II Trial of Image-Guided Preoperative Radiotherapy for Primary Soft Tissue Sarcomas of the Extremity) study are appropriate for preoperative IGRT for extremity STS.</p>
</sec>
</div>
</front>
</TEI>
<affiliations>
<list></list>
<tree>
<noCountry>
<name sortKey="Bedi, Manpreet" sort="Bedi, Manpreet" uniqKey="Bedi M" first="Manpreet" last="Bedi">Manpreet Bedi</name>
<name sortKey="Delaney, Thomas F" sort="Delaney, Thomas F" uniqKey="Delaney T" first="Thomas F." last="Delaney">Thomas F. Delaney</name>
<name sortKey="Dundas, George" sort="Dundas, George" uniqKey="Dundas G" first="George" last="Dundas">George Dundas</name>
<name sortKey="Eisenberg, Burton L" sort="Eisenberg, Burton L" uniqKey="Eisenberg B" first="Burton L." last="Eisenberg">Burton L. Eisenberg</name>
<name sortKey="Finkelstein, Steven E" sort="Finkelstein, Steven E" uniqKey="Finkelstein S" first="Steven E." last="Finkelstein">Steven E. Finkelstein</name>
<name sortKey="Freeman, Carolyn R" sort="Freeman, Carolyn R" uniqKey="Freeman C" first="Carolyn R." last="Freeman">Carolyn R. Freeman</name>
<name sortKey="Hitchcock, Ying J" sort="Hitchcock, Ying J" uniqKey="Hitchcock Y" first="Ying J." last="Hitchcock">Ying J. Hitchcock</name>
<name sortKey="Kane, John M" sort="Kane, John M" uniqKey="Kane J" first="John M." last="Kane">John M. Kane</name>
<name sortKey="Kirsch, David G" sort="Kirsch, David G" uniqKey="Kirsch D" first="David G." last="Kirsch">David G. Kirsch</name>
<name sortKey="Li, X Allen" sort="Li, X Allen" uniqKey="Li X" first="X. Allen" last="Li">X. Allen Li</name>
<name sortKey="Lucas, David" sort="Lucas, David" uniqKey="Lucas D" first="David" last="Lucas">David Lucas</name>
<name sortKey="Petersen, Ivy A" sort="Petersen, Ivy A" uniqKey="Petersen I" first="Ivy A." last="Petersen">Ivy A. Petersen</name>
<name sortKey="Singh, Anurag K" sort="Singh, Anurag K" uniqKey="Singh A" first="Anurag K." last="Singh">Anurag K. Singh</name>
<name sortKey="Wang, Dian" sort="Wang, Dian" uniqKey="Wang D" first="Dian" last="Wang">Dian Wang</name>
<name sortKey="Zhang, Qiang" sort="Zhang, Qiang" uniqKey="Zhang Q" first="Qiang" last="Zhang">Qiang Zhang</name>
</noCountry>
</tree>
</affiliations>
</record>

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