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
• Liposarcoma 20% of all malignancies in adults
• Localisation– extremities (75%)– retroperitoneal (10%)– trunk (10%)
Introduction
Introduction
• 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
• 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
• 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
• To investigate histopathological response to preoperative radiotherapy
Purpose
Introduction
• 70 yr male• Progressive circumference calf• No pain or neuro-vascular disability
Patiënt P.
Introduction
• 70 yr male• Progressive circumference calf• No pain or neuro-vascular disability
MLS
WLS-like
Patiënt P.
Introduction
Biopsy
Myxoid Liposarcoma intermediate grade
Pre-operative 50Gy radiotherapy
Introduction
Methods• All pre-operative irradiated sarcomas 2002 - 2006
• Intermediate/high grade sarcomas
• No prior therapy
• 50 Gy
Study pre-operative radiotherapy
Methods
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
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
• 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
MLS
WLS-like
Patiënt P.
Results
MLS pre and post radiotherapy
Results
Vascular changes
Results
Arteriolar damage
Thrombosis and arteriolar damage
Histology border MLS/WLS
Viable
Non-Viable
Results
• 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
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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