Efficacy of neoadjuvant hypofractionated radiotherapy in patients with locally advanced myxoid liposarcoma.

BACKGROUND: Myxoid liposarcoma (MLPS) has been reported to be more radiosensitive compared with other soft tissue sarcomas (STS). The use of preoperative hypofractionated radiotherapy 5 × 5 Gy for five consecutive days, and then immediate surgery in patients with locally advanced STS showed a good local control rate. The main objective of our work was to assess the efficacy of hypofractionated radiotherapy in preoperative setting in patients with locally advanced primary MLPS. METHODS: From February 1999 to March 2014, 32 patients with primary MLPS were treated with preoperative hypofractionated radiotherapy for 5 consecutive days followed by immediate surgery (median dose 5 × 5 Gy). Median size of the tumor 10.5 cm. In one patient the tumor was located on the upper extremity, the other (31 patients) had their tumors located on the lower extremity. RESULTS: In 90% patients histologically negative surgical margins (R0) were obtained. 34% patients had distant recurrence of the disease, local recurrence was found in 9.3% of the patients. 5-year local relapse-free survival rate was 90% and overall survival was 68%. In all analyzed surgical specimens the radiotherapy response features (hyalinization, fibrosis, paucicelularity, hemorrhages, dilatation of vessels) were detected. We have not found statistically significant differences in terms of OS and LRFS for RCC component, tumor grade, BCL2, TP53, postsurgery necrosis and tumor size. In postradiotherapy specimens significantly higher positivity of TP53 expression was detected as compared to primary biopsies. CONCLUSION: Combined therapy with hypofractionated radiotherapy followed by immediate surgery seems to be effective therapy in MLPS demonstrating good local control and pathological response to therapy.

Preoperative hypofractionated radiotherapy in the treatment of localized soft tissue sarcomas.

BACKGROUND: The primary treatment of soft tissue sarcomas (STS) is a radical resection of the tumor with adjuvant radiotherapy. Conventional fractionation of preoperative radiotherapy is 50 Gy in fraction of 2 Gy a day. The purpose of the conducted study was to assess the efficacy and safety of hypofractionated radiotherapy in preoperative setting in STS patients. METHODS: 272 patients participated in this prospective study conducted from 2006 till 2011. Tumors were localized on the extremities or trunk wall. Median tumor size was 8.5 cm, 42% of the patients had tumor larger than 10 cm, whereas 170 patients (64.6%) had high grade (G3) tumors. 167 patients (61.4%) had primary tumors. Patients were treated with preoperative radiotherapy for five consecutive days in 5 Gy per fraction, with an immediate surgery. Median follow up is 35 months. RESULTS: 79 patients died at the time of the analysis, the 3-year overall survival was 72%. Local recurrences were observed in 19.1 % of the patients. Factors that had a significant adverse impact on local recurrence were tumor size of 10 cm or more and G3 grade. 114 patients (42%) had any kind of treatment toxicity, vast majority with tumors located on lower limbs. 7% (21) of the patients required surgery for treatment of the complications. CONCLUSION: In this non-selected group of locally advanced STS use of hypofractionated preoperative radiotherapy was associated with similar local control (81%) when compared to previously published studies. The early toxicity is tolerable, with small rate of late complications. Presented results warrant further evaluation.

Preoperative radiotherapy combined with resection of squamous cell carcinoma of the mid-thoracic oesophagus. Does a histopathological malignancy grading system assess actual survival?

The aim of our study was to assess the reproducibility of the findings of Hambraeus et al. In their group of patients with squamous cell carcinoma of the oesophagus who underwent preoperative radiotherapy and resection, the histopathological malignancy grading score system was found to predict survival. We studied nine patients with squamous cell cancer of the mid-thoracic oesophagus, who had received radiotherapy followed by surgery and survived over 12 months. We did not confirm the prognostic value of the histopathological malignancy grading score system.

Preoperative concurrent chemotherapy and radiotherapy for local-regional and advanced squamous cell carcinoma of the thoracic oesophagus: preliminary results of a pilot study.

Preliminary experience based on the results of a pilot study on preoperative concurrent continuous i.v. infusion chemotherapy and radiotherapy for squamous cell carcinoma of the oesophagus in eight consecutive patients is presented. Chemotherapy consisted of 5-fluorouracil and cisplatin. Radiotherapy (Co-60) was delivered to a total dose of 3000 cGy. Clinical tolerance was good in four of eight patients, but poor in the remaining four, including three septic deaths. Oesophagectomy was performed in five patients with no postoperative deaths. Postoperative complications (Horner syndrome, hydrothorax, abdominal wound dehiscence) were observed in three cases. The response was categorized as complete (CR), partial (PR) or stable disease (SD), based on a comparison of the initial and immediate preoperative imaging studies and on the presence of tumour degeneration and/or necrosis in pathological examination of operative specimens. CR was observed in 1/8 patients, PR in 4/8 and SD in 3/8. Concurrent preoperative chemo- and radiotherapy may be effective as a neo-adjuvant or remission-inducing modality in the combined treatment of oesophageal carcinoma, however, it may also lead to fatal complications.