Abstract
BackgroundNeoadjuvant or adjuvant radiotherapy (RT) for extremity soft tissue sarcoma (STS) confers significant local control benefit. To determine patterns of practice, a survey of RT planning practices was undertaken.MethodMembers of the Connective Tissue Oncology Society and Canadian Association of Radiation Oncology participated in this survey pertaining to general practice patterns of RT for extremity STS, patterns of contouring and planning, and use of quality control measures such as guidelines, tumor boards, and quality assurance rounds.ResultsA total of 58 radiation oncologists treating extremity STS from 12 countries responded. 89.7% work in academically affiliated centres, and 55.2% saw at least 20 cases of extremity STS per year. Most (96.7%) had access to multidisciplinary sarcoma boards (85.5% of those discussed every referred sarcoma case). 78.6% held quality assurance rounds. Most (92.9%) used planning guidelines. Pre-operative RT was used nearly twice as much as post-operative RT. CT simulation with MR fusion was used by 94.6%. Patterns of clinical target volume (CTV) contouring for both superficial and deep STS were variable. 69.8% contoured a normal soft tissue strip for extremity sarcoma, 13.5% without routine constraints and the remainder with various constraints. Most (91.1%) used 50 Gy in 25 fractions pre-operatively and 39.6% reported using post-operative RT boost for positive margins. Post-operative dose was more variable from 59.4 Gy to 70 Gy.ConclusionMajor aspects of RT planning for extremity STS were similar among the responders, and most were academically affiliated. Over twice as many employed pre-operative as opposed to post-operative RT. There was considerable heterogeneity in use of: margins for contouring, normal soft tissue strip as an avoidance structure, and boost for positive margins. This survey shows variable patterns of practice and identifies areas that may require further research.
Highlights
Soft tissue sarcomas (STS) are neoplasms arising from mesenchymal cells in the adipose, muscle and connective tissues
Since several important studies that showed the similar magnitude of local control benefits between pre- and post-operative RT, there has been a shift favouring pre-operative RT as it has a lesser chance of severe long-term toxicities compared to postoperative RT [9,10,11,12]
Consistent with the technological improvements seen within radiation oncology, the results show that newer RT techniques such as volumetric-modulated arc therapy (VMAT), intensity-modulated radiotherapy (IMRT), and simulation with MR fusion and MR simulation are widely implemented for treatment of soft tissue sarcoma (STS) of the extremities
Summary
Soft tissue sarcomas (STS) are neoplasms arising from mesenchymal cells in the adipose, muscle and connective tissues. The rate of local control for combined surgery and radiotherapy is significantly improved compared to that with surgery alone [2, 3]. Both preoperative and post-operative RT confer similar local control, progression-free and overall survival benefits, pre-operative RT has been associated with a lower total dose, smaller area of treatment, and lower risk of late toxicities such as edema, subcutaneous fibrosis, and joint stiffness [4, 5]. Neoadjuvant or adjuvant radiotherapy (RT) for extremity soft tissue sarcoma (STS) confers significant local control benefit. To determine patterns of practice, a survey of RT planning practices was undertaken
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