ASTRO issues guideline on use of radiation therapy for adults with soft tissue sarcoma
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American Society for Radiation Oncology issued its first clinical guideline for sarcoma.
The guideline — published in Practical Radiation Oncology — addresses use of radiation therapy for adults with operable, localized soft tissue sarcoma of the extremities and trunk, including optimal dosing, techniques and recommendations for treatment planning.
“Management of soft tissue sarcoma can be complicated, with the potential for poor outcomes and significant morbidity if treated suboptimally. The addition of radiation therapy to surgery reduces the chance of local recurrence,” Killian E. Salerno, MD, radiation oncologist at NCI and vice chair of the guideline task force, said in an ASTRO press release. “This guideline [emphasizes] the importance of multidisciplinary input prior to initiation of treatment and provides detailed recommendations on indications for radiation therapy, dose and planning techniques.”
Patients for whom radiation therapy is recommended include those with primary, localized extremity and truncal soft tissue sarcoma deemed at increased risk for local recurrence as determined by multidisciplinary evaluation of factors such as tumor location, pathology and size, as well as expected or final surgical margins.
Preoperative radiation therapy is recommended when surgery and radiation are indicated, with postoperative radiation therapy reserved for specific clinical circumstances. These include when unexpected adverse pathologic features are discovered after initial resection or unplanned excision, or when risk for complications of wound healing outweighs that of late toxicity.
“When radiation is indicated, it generally should be given before surgery because the long-term side effects are less severe,” B. Ashleigh Guadagnolo, MD, MPH, chair of the guideline task force and professor of radiation oncology at The University of Texas MD Anderson Cancer Center, said in the press release. “The side effects of preoperative radiation therapy can be serious, but they are reversible. Postoperative radiation therapy side effects, however, are, in many cases, permanent because more radiation dose is required when given after surgery, and it often needs to be given to a larger area of the body.”
The guideline outlines dose-fractionation schemes and target volumes for external beam radiation therapy for adults with extremity and truncal soft tissue sarcoma. Recommendations are 5,000 cGy administered in 25 once-daily fractions for preoperative radiation therapy and, for postoperative therapy, 5,000 cGy in 25 once-daily fractions or 5,040 cGy in 28 once-daily fractions to clinical target volume 1 and another dose to a reduced volume clinical target volume 2, as defined in the guideline.
Target delineation and delivery techniques — including recommendations for patient positioning and image guidance — also are provided, with a focus on long-term functional outcomes.
The guideline conditionally does not recommend routine use of radiation therapy in addition to oncologic resection for patients with primary localized retroperitoneal sarcoma. Selective use of preoperative radiation may be considered for these patients if they are at high risk for local recurrence, according to the guideline.
“Research on patterns of care in the U.S. indicates that most radiation therapy for [soft tissue sarcoma] continues to be given postoperatively,” Guadagnolo said in the press release. “Therefore, there is a need for clear clinical guidance on modern treatment approaches that can have less impact on patients’ long-term quality of life.”
References:
ASTRO. ASTRO issues clinical guideline on radiation therapy for soft tissue sarcoma in adults. Available at: www.astro.org/News-and-Publications/News-and-Media-Center/News-Releases/2021/ASTRO-issues-clinical-guideline-on-radiation-thera. Accessed Aug. 1, 2021.
Salerno KE, et al. Pract Radiat Oncol. 2021;doi:10.1016/j.prro.2021.04.005.
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