High-dose pre-operative helical tomotherapy (54 Gy) for retroperitoneal liposarcoma

• Published in: Radiation oncology (London, England) England), 2012-12, Vol.7 (1), p.214-214, Article 214
• Main Authors: Sargos, Paul, Dejean, Catherine, de Figueiredo, Bénédicte Henriques, Brouste, Véronique, Nguyen Bui, Binh, Italiano, Antoine, Stoeckle, Eberhard, Kantor, Guy
• Format: Article
• Language: English
• Subjects: Adult; Aged; Care and treatment; Comparative analysis; Feasibility Studies; Female; Helical tomotherapy; Humans; Intensity modulated radiotherapy; Liposarcoma; Liposarcoma - radiotherapy; Male; Metastasis; Middle Aged; Pre-operative radiotherapy; Preoperative Care; Radiometry - methods; Radiotherapy; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted - methods; Radiotherapy, Intensity-Modulated - methods; Retroperitoneal Neoplasms - radiotherapy; Retroperitoneal sarcoma; Sarcoma; Surgeons; Surgery; Treatment Outcome
• ISSN: 1748-717X; 1748-717X
• DOI: 10.1186/1748-717X-7-214

To evaluate the feasibility of pre-operative radiotherapy (54 Gy) with Helical Tomotherapy (HT) followed by surgery. Ten patients with non-metastatic resectable retroperitoneal liposarcomas were treated by pre-operative tomotherapy (54 Gy) and surgery. Clinical and biological toxicities were evaluated on the CTCAEV3.0 scale. For nine patients, delivered tomotherapy plans were compared with retrospectively-planned dynamic intensity-modulated radiotherapy (IMRT) dosimetric studies. No immediate or late Grade>2 toxicities were observed after radiotherapy. Post-operatively, one patient died and three patients experienced Grade 3 toxicity (two digestive and one metabolic). These toxicities disappeared and only two patients presented persistent Grade 1 paresthesia. R0 resection was obtained for four patients, R1 for four, and R2 resection for two. With a median follow-up of 26 months, no local or metastatic relapse was observed. Dosimetric comparisons between HT and retrospectively-planned IMRT demonstrate adequate target volume coverage for both techniques. Gastrointestinal sparing is higher with HT with a D200cc reduced by 5 Gy. Integral dose (ID) was increased in HT. High dose pre-operative radiotherapy (54 Gy) for retroperitoneal liposarcoma is feasible and mostly well tolerated. Cumulative toxicity and tolerance depend mainly on patient's general status. Image-guided radiation therapy (IGRT) is essential, irrespective of the IMRT technique used. Furthermore, HT offers the possibility of sparing selected areas in such complex volumes.