open access

Vol 24, No 3 (2019)
Original research articles
Published online: 2019-05-01
Submitted: 2018-09-12
Get Citation

Adaptive radiotherapy in patients receiving neoadjuvant radiation for soft tissue sarcoma

Ramiz Abu-Hijlih, Sara Mheid, Fawzi Abuhijla, Wafa Asha, Issa Mohamad, Abdullah Alrashdan, Samer Alheet, Haitham Kana’an, Mohammad Abd Al-Raheem, Abdelatif Almousa
DOI: 10.1016/j.rpor.2019.02.007
·
Rep Pract Oncol Radiother 2019;24(3):263-268.

open access

Vol 24, No 3 (2019)
Original research articles
Published online: 2019-05-01
Submitted: 2018-09-12

Abstract

Aim

The aim of this study is to evaluate tumor volume changes during preoperative radiotherapy and to assess the role of adaptive radiation.

Background

Contemporary neoadjuvant radiotherapy utilizes image guidance for precise treatment delivery. Moreover, it may depict changes in tumor size and shape.

Materials and methods

Between 2016 and 2018, 23 patients aged ≥18 years with soft tissue sarcoma were treated with neoadjuvant radiation followed by surgical resection. The tumor volumes (cc) were measured using the Pinnacle planning system prior to starting radiotherapy and during treatment, the changes in volume and absolute differences were estimated. Moreover, patient's position on the machine was evaluated to assess setup offsets. The triggers for plan adaptation were >1cm expansion or unacceptable setup offsets.

Results

The mean tumors volume at presentation was 810 cc (range, 55–4000). At last cone beam CT the tumor volume had changed in 14 patients (61%); it was stable in nine patients (39%). Disease regression was documented in eight patients (35%), with median shrinkage of −20.5% (range, −2 to −29%), while tumor progression was observed in six cases (26%), the median change was 12.5% (range, +10 to +25%).

Adaptive radiation was required in four patients (17%). For the remaining 19 cases (83%), the dose distribution was adequate to cover target volumes.

Conclusions

Change in soft tissue sarcoma volume during radiation is not uncommon. Image guidance should be used to reduce setup errors and to detect differences in tumor volume. Image guidance and adaptive radiation are paramount to ensure optimal radiation delivery.

Abstract

Aim

The aim of this study is to evaluate tumor volume changes during preoperative radiotherapy and to assess the role of adaptive radiation.

Background

Contemporary neoadjuvant radiotherapy utilizes image guidance for precise treatment delivery. Moreover, it may depict changes in tumor size and shape.

Materials and methods

Between 2016 and 2018, 23 patients aged ≥18 years with soft tissue sarcoma were treated with neoadjuvant radiation followed by surgical resection. The tumor volumes (cc) were measured using the Pinnacle planning system prior to starting radiotherapy and during treatment, the changes in volume and absolute differences were estimated. Moreover, patient's position on the machine was evaluated to assess setup offsets. The triggers for plan adaptation were >1cm expansion or unacceptable setup offsets.

Results

The mean tumors volume at presentation was 810 cc (range, 55–4000). At last cone beam CT the tumor volume had changed in 14 patients (61%); it was stable in nine patients (39%). Disease regression was documented in eight patients (35%), with median shrinkage of −20.5% (range, −2 to −29%), while tumor progression was observed in six cases (26%), the median change was 12.5% (range, +10 to +25%).

Adaptive radiation was required in four patients (17%). For the remaining 19 cases (83%), the dose distribution was adequate to cover target volumes.

Conclusions

Change in soft tissue sarcoma volume during radiation is not uncommon. Image guidance should be used to reduce setup errors and to detect differences in tumor volume. Image guidance and adaptive radiation are paramount to ensure optimal radiation delivery.

Get Citation

Keywords

Radiotherapy; Soft tissue sarcoma; Neoadjuvant radiation; Adaptive radiation; Image-guided radiation

About this article
Title

Adaptive radiotherapy in patients receiving neoadjuvant radiation for soft tissue sarcoma

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 24, No 3 (2019)

Pages

263-268

Published online

2019-05-01

DOI

10.1016/j.rpor.2019.02.007

Bibliographic record

Rep Pract Oncol Radiother 2019;24(3):263-268.

Keywords

Radiotherapy
Soft tissue sarcoma
Neoadjuvant radiation
Adaptive radiation
Image-guided radiation

Authors

Ramiz Abu-Hijlih
Sara Mheid
Fawzi Abuhijla
Wafa Asha
Issa Mohamad
Abdullah Alrashdan
Samer Alheet
Haitham Kana’an
Mohammad Abd Al-Raheem
Abdelatif Almousa

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: journals@viamedica.pl