Open Access

Management of tumor volume changes during preoperative radiotherapy for extremity soft tissue sarcoma: a new strategy of adaptive radiotherapy

Marion Geneau De Lamarliere
Marion Geneau De Lamarliere
, 
Amélie Lusque
Amélie Lusque
, 
Justine Attal Khalifa
Justine Attal Khalifa
, 
Vincent Esteyrie
Vincent Esteyrie
, 
Christine Chevreau
Christine Chevreau
, 
Thibaud Valentin
Thibaud Valentin
, 
Dimitri Gangloff
Dimitri Gangloff
, 
Thomas Meresse
Thomas Meresse
, 
Louis Courtot
Louis Courtot
, 
Philippe Rochaix
Philippe Rochaix
, 
Bérénice Boulet
Bérénice Boulet
, 
Eliane Graulieres
Eliane Graulieres
 and 
Anne Ducassou
Anne Ducassou
   | Nov 30, 2023
Radiology and Oncology's Cover Image
About this article
Previous Article
Next Article
Cite
Article Category: Research Article
Published Online: Nov 30, 2023
Page range: 507 - 515
Received: Apr 13, 2023
Accepted: Sep 25, 2023
DOI: https://doi.org/10.2478/raon-2023-0056
Keywords
© 2023 Marion Geneau De Lamarliere et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

Percentage of maximal GTV changes during treatment: patients with significant gross tumor volume (GTV) increase (A), patients with significant GTV decrease (B)*. Day 0 corresponds to CTs1. Each color represents a different histology subtype; replanned patients appear as dotted line.DLS = dedifferentiated liposarcomas; MLS = myxoid liposarcomas; PRS = pleomorphic rhabdomyosarcoma; UPS = undifferentiated pleomorphic sarcomas* Only the largest variation is shown for patients who presented with both an increase and a decrease in tumor size during the course of treatment.
Percentage of maximal GTV changes during treatment: patients with significant gross tumor volume (GTV) increase (A), patients with significant GTV decrease (B)*. Day 0 corresponds to CTs1. Each color represents a different histology subtype; replanned patients appear as dotted line.DLS = dedifferentiated liposarcomas; MLS = myxoid liposarcomas; PRS = pleomorphic rhabdomyosarcoma; UPS = undifferentiated pleomorphic sarcomas* Only the largest variation is shown for patients who presented with both an increase and a decrease in tumor size during the course of treatment.

Patients, tumor and treatment characteristics

Characteristics: n (%)
Sex
  Male 12 (71)
  Female 5 (29.4)
Age at initial diagnosis, years
  Median (range) 69 (43–90)
Dimension, cm (diagnostic MRI)
  Median (range) 12.8 (6–30)
Pathology
  Undifferentiated pleomorphic sarcoma (UPS) 8 (47)
  Myxoid liposarcoma (MLS) 6 (35)
  Dedifferentiated liposarcoma (DLS) 2 (12)
  Pleomorphic rhabdomyosarcoma (PRS) 1 (6)
Grade
  1 6 (35)
  2 7 (41)
  3 4 (24)
RT schedule (total dose, dose fraction)
  50.4 Gy, 1.8Gy 5 (29)
  50 Gy, 2Gy 10 (59)
  45 Gy, 3 Gy 1 (6)
  70 Gy, 2 Gy* 1 (6)
GTV on CTs1 (ml)
  Median (range) 381 (84–2908)
PTV on CTs1 (ml)
  Median (range) 1373 (587–5793)
D95%PTV on CTs1 (%)
  Median (range) 97.1 (96–99.1)
Interval between CTs1 and MVCT 1 (days)
  Median (range) 13 (9–17)
Neoadjuvant CT**
  No CT 10 (59)
  Adriamycin ifosfamide ((doxorubicin 20 mg/m2 and ifosfamide 2500 mg/m2 day 1, 2 and 3 for 4 cycles (21-day cycle)) 6 (35)
  Adriamycin (doxorubicin 75 mg/m2 day 1 for 4 cycles (21-day cycle)) 1 (6)

Dosimetric and clinical data of patients with significant reductions in PTV coverage

Dosimetric data at first MVCT showing a variation of volume Concomitant volume changes Clinical dimension change* D95% PTV on last MVCT
D95% PTV on CTs1 Fraction n° Variation of D95 coverage (%) New D95% PTV D95% GTV GTV (%) PTV (%) Estimated GTV(%)
99%* 6* −11.8* 87.22%* 72.96%* +36.4* +22.8* +27.6* + 1.3 cm (ax)* 98.71%*
96.1% 6 −10.4 86.49% 98.03% +10.7 +6.2 +12.2 + 1 cm (sag) 77.07%
98.2% 1 −5.9 92.39% 98.91% +2.8 +3.3 +2 No 94.29%

Gross tumor volume (GTV) and planned target volume (PTV) volumes variations, the largest GTV and D95% PTV changes during the course of treatment

Pathology Vol GTV CTs1 (ml) Vol PTV CTs1 (ml) Vol GTV last MVCT Vol PTV last MVCT Largest GTV vol change % (week) Largest D95%PTV change % (week)
UPS 674 1373 560 1150 +36.4 (2) −12 (2)*
PRS 239 1037 238 966 +33.7 (2) −3.1 (1)
UPS 381 1432 486 1706 +32.3 (5) −20.1 (6)*
UPS 2546 5292 3243 6263 +27.4 (6) + 1 (4)
DLS 2908 5793 3444 6628 +18.9 (4) −4.6 (3)
UPS 1356 3534 1319 3446 +11 (1) −2.1 (1)
UPS 234 999 246 1086 +7.9 (2) −14.1 (4)*
UPS 140 587 144 598 −7.2 (5) −3.4 (2)
UPS 826 2073 781 2031 −9.2 (1) −7.6 (4)
DLS 531 1679 461 1509 −13.2 (6) −1.3 (3)
MLS 258 952 184 805 −28.9 (6) −1.3 (2)
MLS 415 1514 233 1098 −43.8 (6) + 1.6 (6)
MLS 192 816 104 630 −46.2 (6) −2 (6)
MLS 228 629 122 398 −46.4 (6) +0.4 (4)
MLS 1062 3084 568 2158 −46.5 (6) + 1.14 (5)
UPS 208 961 96 602 −52 (6) −0.9 (1)
MLS 84 606 44 548 −52 (5) −7 (3)

Correlations between GTV volume variations and dosimetric and clinical characteristics

Maximal GTV change
Decrease (n=10) Increase (n=7)
GTV largest axial axis* Decrease 7 (70%) 0
Stable 3 (30%) 3 (43%)
Increase 0 4 (57%)
GTV largest sagittal axis* Decrease 8 (80%) 0
Stable 2 (20%) 3 (43%)
Increase 0 4 (57%)
Estimated GTV volume Decrease 9 (90%) 0
Stable 1 (10%) 0
Increase 0 7 (100%)
PTV volume Decrease 8 (80%) 0
Stable 2 (20%) 0
Increase 0 7 (100%)
D95% PTV Decrease 0 3 (43%)
Stable 10 (100%) 4 (57%)
Surgical complications** Yes 3 (33%) 4 (80%)
No 6 (67%) 1 (20%)
Histology subtypes UPS 3 (30%) 5 (71%)
DLS 1 (10%) 1 (14%)
MLS 6 (60%) 0
PRS 0 1 (14%)
Histology grade 1 6 (60%) 0
2 2 (20%) 5 (71%)
3 2 (20%) 2 (29%)
Neoadjuvant CT Yes 3 (30%) 4 (57%)
No 7(70%) 3 (43%)

Dosimetric and clinical data of patients with a plan adaptation

Dosimetric data just before plan adaptation Evolution of D95%PTV
Clinical Reason* Fr n° % GTV vol change %PTV vol change OAR constraints At CTs1 Before re-planning At CTs2
Ax. increase (+ 1.3 cm) 13 + 33 + 22 Better 99.1% 88% 97.5%
Ax. increase (+ 0.9 cm) 4* + 9 + 9 Better 98.1% 93.5% 96%
Sag. increase (+ 1.2 cm) 1 + 23 + 10 Better 96.8% 93.7% 95.9%
Sag. increase (+ 1 cm) 11 + 17 + 12 NA 96.9% 97.6% 97.6%
Ax. decrease (− 1.8 cm) 13 − 36 − 21 Bone Dm + 1.8% 96.9% 97.2% 98.7%
Sag. decrease (− 2 cm) 17 − 28 − 17 Bone Dm + 1% 96.4% 97.5% 96.5%
Weight loss 21** − 13 − 10 Bone Dm + 30.7% 96.4% 97.1% 96.9%
eISSN:
1581-3207
Language:
English
Publication timeframe:
4 times per year
Journal Subjects:
Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
Journal RSS Feed