Extremity and trunk tumors

PORT has been tested in a single-institution randomized trial of 141 patients with extremity sarcomas who were treated with limb-sparing surgery. Patients with high-grade tumors (n = 91) also received adjuvant chemotherapy (five 28-day cycles of doxorubicin and cyclophosphamide). Patients were randomly assigned to receive either radiation therapy (45 Gy to a wide field, plus a tumor-bed boost of 18 Gy over 6–7 weeks) concurrently with chemotherapy (in the case of high-grade tumors) or no radiation.[29][Level of evidence B1]

PORT has been tested in a single-institution randomized trial of 141 patients with extremity sarcomas who were treated with limb-sparing surgery. Patients with high-grade tumors (n = 91) also received adjuvant chemotherapy (five 28-day cycles of doxorubicin and cyclophosphamide). Patients were randomly assigned to receive either radiation therapy (45 Gy to a wide field, plus a tumor-bed boost of 18 Gy over 6–7 weeks) concurrently with chemotherapy (in the case of high-grade tumors) or no radiation.[29][Level of evidence B1]

At up to 12 years of follow-up, there was one local recurrence in the 70 patients randomly assigned to receive radiation therapy versus 17 recurrences in the 71 control patients (P = .0001). There was a similar reduction in risk of local recurrence for both high- and low-grade tumors.

PORT has been tested in a single-institution randomized trial of 141 patients with extremity sarcomas who were treated with limb-sparing surgery. Patients with high-grade tumors (n = 91) also received adjuvant chemotherapy (five 28-day cycles of doxorubicin and cyclophosphamide). Patients were randomly assigned to receive either radiation therapy (45 Gy to a wide field, plus a tumor-bed boost of 18 Gy over 6–7 weeks) concurrently with chemotherapy (in the case of high-grade tumors) or no radiation.[29][Level of evidence B1]

There was no difference in OS between the radiation therapy group and the control group.

PORT has been tested in a single-institution randomized trial of 141 patients with extremity sarcomas who were treated with limb-sparing surgery. Patients with high-grade tumors (n = 91) also received adjuvant chemotherapy (five 28-day cycles of doxorubicin and cyclophosphamide). Patients were randomly assigned to receive either radiation therapy (45 Gy to a wide field, plus a tumor-bed boost of 18 Gy over 6–7 weeks) concurrently with chemotherapy (in the case of high-grade tumors) or no radiation.[29][Level of evidence B1]

Global quality of life was similar in the two groups, but the radiation therapy group had substantially worse functional deficits resulting from reduced strength, reduced joint motion, and increased edema.

Though designed to include 266 patients, a trial was stopped after 190 patients were accrued because wound complications in the preRT group had increased. In the first phase of the trial, patients in the preRT group received wide-field radiation therapy of 50 Gy (in 2-Gy fractions). In the second phase of the trial, patients received an additional 16 Gy to 20 Gy to the tumor bed and a 2-cm margin (only if tumor cells were found at the surgical margins). Patients in the PORT group received radiation therapy during both phases of the trial.[30-32]

Though designed to include 266 patients, a trial was stopped after 190 patients were accrued because wound complications in the preRT group had increased. In the first phase of the trial, patients in the preRT group received wide-field radiation therapy of 50 Gy (in 2-Gy fractions). In the second phase of the trial, patients received an additional 16 Gy to 20 Gy to the tumor bed and a 2-cm margin (only if tumor cells were found at the surgical margins). Patients in the PORT group received radiation therapy during both phases of the trial.[30-32]

The wound complication rates were 35% in the preRT group and 17% in the PORT group (P = .01). In addition, limb function at 6 weeks after surgery was worse in the preRT group (P = .01).[30]

Though designed to include 266 patients, a trial was stopped after 190 patients were accrued because wound complications in the preRT group had increased. In the first phase of the trial, patients in the preRT group received wide-field radiation therapy of 50 Gy (in 2-Gy fractions). In the second phase of the trial, patients received an additional 16 Gy to 20 Gy to the tumor bed and a 2-cm margin (only if tumor cells were found at the surgical margins). Patients in the PORT group received radiation therapy during both phases of the trial.[30-32]

At 5 years, the two groups had similar local control rates (93% for the preRT group vs. 92% for the PORT group) and OS rates (73% for the preRT group vs. 67% for the PORT group; P = .48).[31]

Though designed to include 266 patients, a trial was stopped after 190 patients were accrued because wound complications in the preRT group had increased. In the first phase of the trial, patients in the preRT group received wide-field radiation therapy of 50 Gy (in 2-Gy fractions). In the second phase of the trial, patients received an additional 16 Gy to 20 Gy to the tumor bed and a 2-cm margin (only if tumor cells were found at the surgical margins). Patients in the PORT group received radiation therapy during both phases of the trial.[30-32]

Of the 129 patients evaluated for limb function at 21 to 27 months after surgery (n = 73 for preRT and n = 56 for PORT), limb function was similar in both groups, but there was a statistical trend for less fibrosis in the preRT group (P = .07).[32]

In a single-institution trial, 164 patients with sarcomas of the extremity or superficial trunk were randomly assigned during surgery (if all gross tumor could be excised) to receive an iridium Ir 192 implant delivering 42 Gy to 45 Gy over 4 to 6 days (78 patients) or to a control arm of no radiation (86 patients).[33,34] Thirty-four patients in each study arm with high-grade tumors who were believed to be at risk for metastasis received adjuvant doxorubicin-based chemotherapy.[33][Level of evidence B1]

In a single-institution trial, 164 patients with sarcomas of the extremity or superficial trunk were randomly assigned during surgery (if all gross tumor could be excised) to receive an iridium Ir 192 implant delivering 42 Gy to 45 Gy over 4 to 6 days (78 patients) or to a control arm of no radiation (86 patients).[33,34] Thirty-four patients in each study arm with high-grade tumors who were believed to be at risk for metastasis received adjuvant doxorubicin-based chemotherapy.[33][Level of evidence B1]

With a median follow-up of 76 months, the 5-year actuarial local recurrence rates were 18% in the brachytherapy arm and 31% in the control arm (P = .04). This difference was limited to patients with high-grade tumors.

In a single-institution trial, 164 patients with sarcomas of the extremity or superficial trunk were randomly assigned during surgery (if all gross tumor could be excised) to receive an iridium Ir 192 implant delivering 42 Gy to 45 Gy over 4 to 6 days (78 patients) or to a control arm of no radiation (86 patients).[33,34] Thirty-four patients in each study arm with high-grade tumors who were believed to be at risk for metastasis received adjuvant doxorubicin-based chemotherapy.[33][Level of evidence B1]

There was no discernible difference in sarcoma-specific survival rates between the brachytherapy arm (84%) and control arm (81%) (P = .65), and there was no difference in patients with high-grade tumors.

In a single-institution trial, 164 patients with sarcomas of the extremity or superficial trunk were randomly assigned during surgery (if all gross tumor could be excised) to receive an iridium Ir 192 implant delivering 42 Gy to 45 Gy over 4 to 6 days (78 patients) or to a control arm of no radiation (86 patients).[33,34] Thirty-four patients in each study arm with high-grade tumors who were believed to be at risk for metastasis received adjuvant doxorubicin-based chemotherapy.[33][Level of evidence B1]

The rates of clinically important wound complications (e.g., the need for operative revision or repeated seroma drainage, wound separation, large hematomas, or purulent infection) were 24% in the brachytherapy arm and 14% in the control arm (P = .13). The wound reoperation rates were 10% in the brachytherapy arm and 0% in the control arm (P = .006).[34]