Effectiveness of Radiotherapy in Myxoid Sarcomas is Associated with a Dense Vascular Pattern
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Transcript of Effectiveness of Radiotherapy in Myxoid Sarcomas is Associated with a Dense Vascular Pattern
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Effectiveness of Radiotherapy in Myxoid Sarcomas is Associated with a Dense
Vascular Pattern
• Ronald de Vreeze, research physician
• Daphne de Jong• Fiona Stewart• Rick Haas• Frits van Coevorden
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• Liposarcoma 20% of all malignancies in adults
• Localisation– extremities (75%)– retroperitoneal (10%)– trunk (10%)
Introduction
Introduction
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• Target area limitation easier• Lower dose• Canadian SR2 trial (Lancet 2002)
PrePost
Pre vs post operative radiotherapy 50 Gy 66 Gy
– comparable local control 93% 92%
– early complications 35%17%
– late complications 23% 36%
Pre operative radiotherapy
Introduction
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• Target area limitation easier• Lower dose• Canadian SR2 trial (Lancet 2002)
PrePost
Pre vs post operative radiotherapy 50 Gy 66 Gy
– comparable local control 93% 92%
– early complications 35%17%
– late complications 23% 36%
Pre operative radiotherapy
Introduction
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• 2 studies myxoid liposarcoma show volume reduction after pre-operative radiotherapy
– Pitson et al 2004– Engström et al 2007
• Mechanism is unknown
Pre operative radiotherapy
Introduction
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• To investigate histopathological response to preoperative radiotherapy
Purpose
Introduction
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• 70 yr male• Progressive circumference calf• No pain or neuro-vascular disability
Patiënt P.
Introduction
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• 70 yr male• Progressive circumference calf• No pain or neuro-vascular disability
MLS
WLS-like
Patiënt P.
Introduction
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Biopsy
Myxoid Liposarcoma intermediate grade
Pre-operative 50Gy radiotherapy
Introduction
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Methods• All pre-operative irradiated sarcomas 2002 - 2006
• Intermediate/high grade sarcomas
• No prior therapy
• 50 Gy
Study pre-operative radiotherapy
Methods
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Results• 31 Patiënts 15 ♂ / 16 ♀
• Localisation leg 24 (78%)
• Median tumor Ø 9 cm (3-18)
• Grade intermediate/high 19 / 12
• Early complications 2
Study pre-operative radiotherapy
Results
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Pt Histology Response
1234567891011121314151617181920
MLSMLSMLSMLSMLSMLSMLSMLSMLS/ALT-likePleomorphic MFHPleomorphic MFHPleomorphic MFHPleomorphic MFHPleomorphic MFHPleomorphic MFHSynovial sarcomaFibromyxo sarcomaPleomorphic MFHMPNSTPleomorfic liposarcoma
100 100100100100100100100100/09090909090909080808080
Pathologic respons after radiotherapy
Results
Pt Histology response
2122232425262728293031
MLS/RLSLeiomyosarcomaLeiomyosarcomaLeiomyosarcomaPleomorphic MFHSynovial sarcomaSynovial sarcomaSynovial sarcomaChondro sarcomaClear cell sarcomaClear cell sarcoma
66/665050505050505040100
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• All pure MLS 100% pathologic response
• 20 of 31 sarcomas > 80% pathologic response
• Arteriolar vascular damage in areas of response
• Similar MLS-like vascular damage in allresponding sarcomas
Results
Results
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MLS
WLS-like
Patiënt P.
Results
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MLS pre and post radiotherapy
Results
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Vascular changes
Results
Arteriolar damage
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Thrombosis and arteriolar damage
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Histology border MLS/WLS
Viable
Non-Viable
Results
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• Pre-operative radiotherapy in vascular sarcomas results in effective pathologic response
• MLS is a radio sensitive sarcoma– All MLS-like sarcomas are sensitive
• The sensitivity seems associated to vascular structure of sarcomas
Conclusions
Conclusions
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1) O'Sullivan B, Davis AM, Turcotte R, Bell R, Catton C, Chabot P, Wunder J, Kandel R, Goddard K, Sadura A, Pater J, Zee B. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet 2002 June 29;359(9325):2235-41.
2) Pitson G, Robinson P, Wilke D, Kandel RA, White L, Griffin AM, Bell RS, Catton CN, Wunder JS, O'Sullivan B. Radiation response: an additional unique signature of myxoid liposarcoma. Int J Radiat Oncol Biol Phys 2004 October 1;60(2):522-6.
3) Engstrom K, Bergh P, Cederlund CG, Hultborn R, Willen H, Aman P, Kindblom LG, Meis-Kindblom JM. Irradiation of myxoid/round cell liposarcoma induces volume reduction and lipoma-like morphology. Acta Oncol 2007;46(6):838-45.
References
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Extra Figures