The use of radiation therapy in combination treatment of soft tissue sarcomas of the extremities with involvement of long tubular bones

«Radiation and Risk», 2021, vol. 30, No. 3, pp.124-133

DOI: 10.21870/0131-3878-2021-30-3-124-133

Authors

Zubarev A.L. – Physician, C. Sc., Med.
Kurilchik A.A. – Head of Dep., C. Sc., Med. Contacts: 4 Korolyov str., Obninsk, Kaluga region, Russia, 249035. Tel.: 7 (484) 399-33-86; 9-31-21: e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. .
Ivanov V.E. – Researcher
Starodubtsev A.L. – Researcher
Shitareva V.N. – Medical Resident. A. Tsyb MRRC.
A. Tsyb MRRC, Obninsk

Abstract

Soft tissue sarcomas (STS) are rare malignant tumors of mesenchymal origin. They account for about 1% of all malignant neoplasms. Haematogenous spread is the most common route of metastasis for STS and bone metastases occur in 9.4% of cases. When creating treatment plan for STS, it is nec-essary to consider a multimodal approach. Combination treatment can include preoperative or post-operative radiation therapy (RT), chemotherapy (CT), and local hyperthermia (LHT). Surgery for STS should be radical. This paper presents 9 STS clinical cases and treatment outcomes in patients with secondary bone disease. Four patients underwent chemotherapy and surgery. Two patients received chemoradiotherapy (CRT) and surgery. Three patients received thermo-chemo-radiotherapy (TCHRT) followed by surgery. Accelerated fractionation radiotherapy was given using a single tumor dose of 3 Gy, twice a day with interval of 4 hours between sessions, 3 times a week to a total tumor dose (TTD) of 30 Gy (isoeffective TTD – 42 Gy, TDF – 69 Gy). Local hyperthermia for soft tissue tumor treatment was performed over 6 sessions: 2 sessions were combined with CHT courses before and after RT, and 4 sessions were combined with RT. The follow up period for 6 patients varied from 12 to 1.5 months, for 3 patients it varied from 6 to 8 months, for 1 patient it lasted 3 months and for 1 patient – 2 years. According to the RECIST criteria, more than half of the patients had tumor stabilization and 22% of patients had a partial response. Grade III-IV the rapeutic pathomorphosis was observed in 70% of patients after preoperative combination treatment. The use of CT, CRT or TCHRT in combination treatment of STS with secondary bone disease enabled us to achieve a pronounced therapeutic pathomorphosis of tumors and to perform organ preservation surgery with endoprosthetic replacement.

Key words
soft tissue sarcomas, combination treatment, radiation therapy, chemotherapy, thermo-chemo-therapy, endoprosthetic replacement, allotransplantation, local hyperthermia, thermo-chemoradiotherapy, chemoradiotherapy.

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