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. 2024 Nov 28;10(2):101689.
doi: 10.1016/j.adro.2024.101689. eCollection 2025 Feb.

Response to Central Boost Radiation Therapy in Unresectable Retroperitoneal Sarcoma: A Case Series

Danielle N Burner  1 , Peter G Hendrickson  2 , Diana M Cardona  3 , Dan G Blazer 3rd  4 , James B Mullins  2 , David G Kirsch  1   2   5   6   7
Affiliations

Response to Central Boost Radiation Therapy in Unresectable Retroperitoneal Sarcoma: A Case Series

Danielle N Burner et al. Adv Radiat Oncol. .

Abstract

Purpose: Optimal treatment of retroperitoneal sarcoma (RPS) remains undefined. Here, we report the feasibility of using high-dose boost radiation (3-4 Gy) to the central part of the tumor in patients with unresectable RPS.

Methods and materials: Five patients with unresectable RPS were treated with radiation therapy using a central boost technique with intensity modulated radiation therapy. On average, doses of 25 Gy to 45 Gy were delivered to the outer part of the tumor (planning target volume 1), while the central part of the tumor (planning target volume 2) received a 56 Gy to 75 Gy physical dose, which translates to a 62.67 Gy to 87.5 Gy equivalent dose in 2 Gy fractions (EQD2). To minimize radiation toxicity to the adjacent bowel and other organs, we used sequential, interdigitated, or simultaneous integrated boost (SIB) techniques.

Results: In this case series of variable RPS histology, the median survival postradiation therapy was 30 months. Three of the 5 patients had clinically stable local disease on follow-up scans, and none of the patients experienced clinically significant toxicity.

Conclusions: In summary, in this small case series of 5 patients, treatment was tolerated well, and excellent local responses were observed regardless of the timing of the central boost. Given the high rates of metastatic disease that developed in responding patients, effective systemic therapy will likely be needed for unresectable RPS treated with aggressive radiation therapy to the central part of the tumor.

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Conflict of interest statement

David G. Kirsch is a cofounder and stockholder of XRAD Therapeutics, which develops radiosensitizers. David G. Kirsch is a member of the scientific advisory board and owns stock in Lumicell Inc, a company commercializing intraoperative imaging technology. None of these affiliations represent a conflict of interest with respect to the work described in this manuscript. David G. Kirsch is a coinventor on a patent for a handheld imaging device and is a coinventor on a patent for radiosensitizers. XRAD Therapeutics, Merck, Bristol Myers Squibb, and Varian Medical Systems have provided research support to David G. Kirsch, but this did not support the research described in this manuscript. The other authors have no conflicting financial interests.

Figures

Figure 1
Figure 1
Baseline patient imaging, pathology, and simulation scanning. (A) Cross-sectional computed tomography images showing the retroperitoneal sarcoma for each patient described in this case series. (B) Histology with hematoxylin and eosin-stained slides of the biopsy from each retroperitoneal sarcoma. Case 5 inset shows desmin immunohistochemistry. (C) Planning target volume (PTV) 1 and central boost PTV2 for each case. (D) Radiation dose distribution of the central boost (PTV2) and surrounding tumor (PTV1) and normal tissues. Abbreviations: NA = not available.
See this image and copyright information in PMC

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