Radiotherapy for Soft Tissue Sarcoma of the Proximal Lower Extremity
Identifieur interne : 003255 ( Pmc/Checkpoint ); précédent : 003254; suivant : 003256Radiotherapy for Soft Tissue Sarcoma of the Proximal Lower Extremity
Auteurs : Brendan Prendergast [États-Unis] ; John B. Fiveash [États-Unis] ; C. Parker Gibbs [États-Unis] ; Mark T. Scarborough [États-Unis] ; Daniel J. IndelicatoSource :
- Sarcoma [ 1357-714X ] ; 2010.
Abstract
Soft-tissue sarcoma (STS) is a histopathologically diverse group of tumors accounting for approximately 10,000 new malignancies in the US each year. The proximal lower extremity is the most common site for STS, accounting for approximately one-third of all cases. Coordinated multimodality management in the form of surgery and radiation is often critical to local control, limb preservation, and functional outcome. Based on a review of currently available Medline literature and professional experience, this paper provides an overview of the treatment of STS of the lower extremity with a particular focus on the modern role of radiotherapy.
Url:
DOI: 10.1155/2010/829498
PubMed: 20981344
PubMed Central: 2957855
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Radiotherapy for Soft Tissue Sarcoma of the Proximal Lower Extremity</title><author><name sortKey="Prendergast, Brendan" sort="Prendergast, Brendan" uniqKey="Prendergast B" first="Brendan" last="Prendergast">Brendan Prendergast</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35294-1150, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35294-1150</wicri:regionArea><wicri:noRegion>AL 35294-1150</wicri:noRegion></affiliation></author><author><name sortKey="Fiveash, John B" sort="Fiveash, John B" uniqKey="Fiveash J" first="John B." last="Fiveash">John B. Fiveash</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35294-1150, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35294-1150</wicri:regionArea><wicri:noRegion>AL 35294-1150</wicri:noRegion></affiliation></author><author><name sortKey="Gibbs, C Parker" sort="Gibbs, C Parker" uniqKey="Gibbs C" first="C. Parker" last="Gibbs">C. Parker Gibbs</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Orthopedics, College of Medicine, University of Florida, Gainesville, FL 32610, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Orthopedics, College of Medicine, University of Florida, Gainesville, FL 32610</wicri:regionArea><wicri:noRegion>FL 32610</wicri:noRegion></affiliation></author><author><name sortKey="Scarborough, Mark T" sort="Scarborough, Mark T" uniqKey="Scarborough M" first="Mark T." last="Scarborough">Mark T. Scarborough</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Orthopedics, College of Medicine, University of Florida, Gainesville, FL 32610, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Orthopedics, College of Medicine, University of Florida, Gainesville, FL 32610</wicri:regionArea><wicri:noRegion>FL 32610</wicri:noRegion></affiliation></author><author><name sortKey="Indelicato, Daniel J" sort="Indelicato, Daniel J" uniqKey="Indelicato D" first="Daniel J." last="Indelicato">Daniel J. Indelicato</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">20981344</idno><idno type="pmc">2957855</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957855</idno><idno type="RBID">PMC:2957855</idno><idno type="doi">10.1155/2010/829498</idno><date when="2010">2010</date><idno type="wicri:Area/Pmc/Corpus">004B74</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004B74</idno><idno type="wicri:Area/Pmc/Curation">004B73</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">004B73</idno><idno type="wicri:Area/Pmc/Checkpoint">003255</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">003255</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Radiotherapy for Soft Tissue Sarcoma of the Proximal Lower Extremity</title><author><name sortKey="Prendergast, Brendan" sort="Prendergast, Brendan" uniqKey="Prendergast B" first="Brendan" last="Prendergast">Brendan Prendergast</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35294-1150, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35294-1150</wicri:regionArea><wicri:noRegion>AL 35294-1150</wicri:noRegion></affiliation></author><author><name sortKey="Fiveash, John B" sort="Fiveash, John B" uniqKey="Fiveash J" first="John B." last="Fiveash">John B. Fiveash</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35294-1150, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35294-1150</wicri:regionArea><wicri:noRegion>AL 35294-1150</wicri:noRegion></affiliation></author><author><name sortKey="Gibbs, C Parker" sort="Gibbs, C Parker" uniqKey="Gibbs C" first="C. Parker" last="Gibbs">C. Parker Gibbs</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Orthopedics, College of Medicine, University of Florida, Gainesville, FL 32610, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Orthopedics, College of Medicine, University of Florida, Gainesville, FL 32610</wicri:regionArea><wicri:noRegion>FL 32610</wicri:noRegion></affiliation></author><author><name sortKey="Scarborough, Mark T" sort="Scarborough, Mark T" uniqKey="Scarborough M" first="Mark T." last="Scarborough">Mark T. Scarborough</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Orthopedics, College of Medicine, University of Florida, Gainesville, FL 32610, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Orthopedics, College of Medicine, University of Florida, Gainesville, FL 32610</wicri:regionArea><wicri:noRegion>FL 32610</wicri:noRegion></affiliation></author><author><name sortKey="Indelicato, Daniel J" sort="Indelicato, Daniel J" uniqKey="Indelicato D" first="Daniel J." last="Indelicato">Daniel J. Indelicato</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></analytic><series><title level="j">Sarcoma</title><idno type="ISSN">1357-714X</idno><idno type="eISSN">1369-1643</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Soft-tissue sarcoma (STS) is a histopathologically diverse group of tumors accounting for approximately 10,000 new malignancies in the US each year. The proximal lower extremity is the most common site for STS, accounting for approximately one-third of all cases. Coordinated multimodality management in the form of surgery and radiation is often critical to local control, limb preservation, and functional outcome. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Sarcoma</journal-id><journal-id journal-id-type="iso-abbrev">Sarcoma</journal-id><journal-id journal-id-type="publisher-id">SRCM</journal-id><journal-title-group><journal-title>Sarcoma</journal-title></journal-title-group><issn pub-type="ppub">1357-714X</issn><issn pub-type="epub">1369-1643</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">20981344</article-id><article-id pub-id-type="pmc">2957855</article-id><article-id pub-id-type="doi">10.1155/2010/829498</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review Article</subject></subj-group></article-categories><title-group><article-title>Radiotherapy for Soft Tissue Sarcoma of the Proximal Lower Extremity</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Prendergast</surname><given-names>Brendan</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Fiveash</surname><given-names>John B.</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gibbs</surname><given-names>C. Parker</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Scarborough</surname><given-names>Mark T.</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Indelicato</surname><given-names>Daniel J.</given-names></name><xref ref-type="aff" rid="I3"><sup>3, 4</sup></xref><xref ref-type="aff" rid="I4"></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35294-1150, USA</aff><aff id="I2"><sup>2</sup>Department of Orthopedics, College of Medicine, University of Florida, Gainesville, FL 32610, USA</aff><aff id="I3"><sup>3</sup>Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, FL 32610, USA</aff><aff id="I4"><sup>4</sup>University of Florida Proton Therapy Institute, Jacksonville, FL 32206, USA</aff><author-notes><corresp id="cor1">*Daniel J. Indelicato: <email>dindelicato@floridaproton.org</email></corresp><fn fn-type="other"><p>Academic Editor: Alberto Pappo</p></fn></author-notes><pub-date pub-type="ppub"><year>2010</year></pub-date><pub-date pub-type="epub"><day>14</day><month>10</month><year>2010</year></pub-date><volume>2010</volume><elocation-id>829498</elocation-id><history><date date-type="received"><day>28</day><month>4</month><year>2010</year></date><date date-type="accepted"><day>28</day><month>7</month><year>2010</year></date></history><permissions><copyright-statement>Copyright © 2010 Brendan Prendergast et al.</copyright-statement><copyright-year>2010</copyright-year><license xlink:href="https://creativecommons.org/licenses/by/3.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Soft-tissue sarcoma (STS) is a histopathologically diverse group of tumors accounting for approximately 10,000 new malignancies in the US each year. The proximal lower extremity is the most common site for STS, accounting for approximately one-third of all cases. Coordinated multimodality management in the form of surgery and radiation is often critical to local control, limb preservation, and functional outcome. Based on a review of currently available Medline literature and professional experience, this paper provides an overview of the treatment of STS of the lower extremity with a particular focus on the modern role of radiotherapy.</p></abstract></article-meta></front><floats-group><fig id="fig1" position="float"><label>Figure 1</label><caption><p>Axial (a) and coronal (b) magnetic resonance imaging scans of soft tissue sarcoma arising from the adductor muscle and invading the periosteum of the femur.</p></caption><graphic xlink:href="SRCM2010-829498.001"></graphic></fig><fig id="fig2" position="float"><label>Figure 2</label><caption><p>Comparison of preoperative proton (a) and photon (b) dosimetry for soft tissue sarcoma of the thigh shown in <xref ref-type="fig" rid="fig1">Figure 1</xref>. The tumor target volume is outlined in yellow and the anus is outlined in aqua blue. Note how the proton plan spares the perineal region and lymphatic drainage of uninvolved soft tissue.</p></caption><graphic xlink:href="SRCM2010-829498.002"></graphic></fig><table-wrap id="tab1" position="float"><label>Table 1</label><caption><p>Selected outcomes for proximal lower-extremity soft tissue sarcoma.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Author</th><th align="center" rowspan="1" colspan="1">Date</th><th align="center" rowspan="1" colspan="1">Number of proximal lower extremity tumors</th><th align="center" rowspan="1" colspan="1">Treatment type (%)</th><th align="center" rowspan="1" colspan="1">Median follow up (months)</th><th align="center" rowspan="1" colspan="1">Local recurrences (%)</th><th align="center" rowspan="1" colspan="1">Complications (rate)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Enneking et al. [<xref rid="B8" ref-type="bibr">8</xref>] <break></break>University of Florida</td><td align="center" rowspan="1" colspan="1">1981</td><td align="center" rowspan="1" colspan="1">40</td><td align="center" rowspan="1" colspan="1">Surgery alone</td><td align="center" rowspan="1" colspan="1">48</td><td align="center" rowspan="1" colspan="1">6 (15%)</td><td align="center" rowspan="1" colspan="1">NR</td></tr><tr><td align="center" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Karakousis et al. [<xref rid="B13" ref-type="bibr">13</xref>]<break></break>Roswell Park</td><td align="center" rowspan="1" colspan="1">1998</td><td align="center" rowspan="1" colspan="1">44</td><td align="center" rowspan="1" colspan="1">Compartment resection—29 (66%)<break></break>Wide excision—15 (34%)<break></break>Radiotherapy—6 (14%)</td><td align="center" rowspan="1" colspan="1">49</td><td align="center" rowspan="1" colspan="1">6 (14%)</td><td align="center" rowspan="1" colspan="1">NR</td></tr><tr><td align="center" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Yang et al. [<xref rid="B4" ref-type="bibr">4</xref>] National Cancer Institute</td><td align="center" rowspan="1" colspan="1">1998</td><td align="center" rowspan="1" colspan="1">73</td><td align="center" rowspan="1" colspan="1">Post-op RT—33 (45%)<break></break>Surgery alone—40 (55%)</td><td align="center" rowspan="1" colspan="1">115/118**</td><td align="center" rowspan="1" colspan="1">6 (13%)/5 (19%)**</td><td align="center" rowspan="1" colspan="1">NR</td></tr><tr><td align="center" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Fabrizio et al. [<xref rid="B25" ref-type="bibr">25</xref>] <break></break>Mayo Clinic</td><td align="center" rowspan="1" colspan="1">2000</td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">Wide local excision (100%)</td><td align="center" rowspan="1" colspan="1">55</td><td align="center" rowspan="1" colspan="1">0 (0%)</td><td align="center" rowspan="1" colspan="1">NR</td></tr><tr><td align="center" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Vraa et al. [<xref rid="B17" ref-type="bibr">17</xref>] Denmark</td><td align="center" rowspan="1" colspan="1">2001</td><td align="center" rowspan="1" colspan="1">152</td><td align="center" rowspan="1" colspan="1">Amputation (18%)<break></break>Wide local excision (82%)<break></break>RT (21%)</td><td align="center" rowspan="1" colspan="1">52</td><td align="center" rowspan="1" colspan="1">14 (9%)</td><td align="center" rowspan="1" colspan="1">NR</td></tr><tr><td align="center" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">O'Sullivan et al. [<xref rid="B30" ref-type="bibr">30</xref>] <break></break>Princess <break></break>Margaret Hospital</td><td align="center" rowspan="1" colspan="1">2002</td><td align="center" rowspan="1" colspan="1">98</td><td align="center" rowspan="1" colspan="1">Pre-op RT (45%)<break></break> Post-op RT (55%)</td><td align="center" rowspan="1" colspan="1">39</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">Wound complication:<break></break>Pre-op—20 (45%)<break></break>Post-op—15 (28%)</td></tr><tr><td align="center" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Virkus et al. [<xref rid="B34" ref-type="bibr">34</xref>] <break></break>University of Florida</td><td align="center" rowspan="1" colspan="1">2002</td><td align="center" rowspan="1" colspan="1">130</td><td align="center" rowspan="1" colspan="1">Pre-op RT</td><td align="center" rowspan="1" colspan="1">71</td><td align="center" rowspan="1" colspan="1">10 (11%)*</td><td align="center" rowspan="1" colspan="1">Wound complication: 41 (26%)*</td></tr><tr><td align="center" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Rimner et al. [<xref rid="B10" ref-type="bibr">10</xref>] <break></break>Memorial Sloan Kettering</td><td align="center" rowspan="1" colspan="1">2009</td><td align="center" rowspan="1" colspan="1">255</td><td align="center" rowspan="1" colspan="1">Post-op RT<break></break>(BRT alone 63%, EBRT alone 31%, both modalities 6%)</td><td align="center" rowspan="1" colspan="1">71</td><td align="center" rowspan="1" colspan="1">24 (9%)</td><td align="center" rowspan="1" colspan="1">Wound reoperation—24 (9%)<break></break>Edema—34 (13%)<break></break>Joint stiffness—32 (13%)<break></break>Nerve damage—20 (9%)<break></break>Fracture—15 (6%)</td></tr></tbody></table><table-wrap-foot><fn><p>*For all lower-extremity cases (both proximal and distal).</p></fn><fn><p>**For high/lowgrade, respectively. NR: not reported; RT: radiotherapy; EBRT: external-beam radiotherapy; BRT: Brachytherapy.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list><country><li>États-Unis</li></country></list><tree><noCountry><name sortKey="Indelicato, Daniel J" sort="Indelicato, Daniel J" uniqKey="Indelicato D" first="Daniel J." last="Indelicato">Daniel J. Indelicato</name></noCountry><country name="États-Unis"><noRegion><name sortKey="Prendergast, Brendan" sort="Prendergast, Brendan" uniqKey="Prendergast B" first="Brendan" last="Prendergast">Brendan Prendergast</name></noRegion><name sortKey="Fiveash, John B" sort="Fiveash, John B" uniqKey="Fiveash J" first="John B." last="Fiveash">John B. Fiveash</name><name sortKey="Gibbs, C Parker" sort="Gibbs, C Parker" uniqKey="Gibbs C" first="C. Parker" last="Gibbs">C. Parker Gibbs</name><name sortKey="Scarborough, Mark T" sort="Scarborough, Mark T" uniqKey="Scarborough M" first="Mark T." last="Scarborough">Mark T. 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