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Radiotherapy And Sarcomas
- 1. Radiotherapy and Sarcomas Wendy Ella University College London Hospitals NHS Foundation Trust
- 5. Heterogenous group of tumours
- 6. Heterogenous group of tumours
- 7. Heterogenous group of tumours
- 8. Heterogenous group of tumours
- 9. Principles of management: soft tissue sarcomas Surgery +/- Radiotherapy +/- Chemotherapy
- 26. Systematic/Random errors Margin = (2.5 X SD of group systematic error) + (0.7 X SD of random error) - Van Herk, 2004 4.4 mm +/- 0.8mm 0.3 mm +/- 1.5 SD A–P on Lat 5.3 mm +/- 1.7mm -0.2 mm +/- 1.7 SD S-I on AP 4.3 mm +/- 1.1mm 0.2 mm +/- 1.4 SD L-R on AP Margins calculated Group SD of random error Group systematic error
- 28. MRI Scan
- 29. Planning
- 30. Planning
- 32. Questions? University College London Hospitals NHS Foundation Trust
Notas del editor
- Sarcomas are rare malignant tumours that arise from mesenchymal tissue at any body site. Represents <15 of new malignant tumours diasgnosed. Heterogenous group of tumours including more than 40 subtypes. The tumours appear to arise from malignant precursor cells which can differentiate along one or several linaeges syuch as muscle, adipose, fibrous, cartilage or vascular tissue. Subtypes differ in clinical behaviour and aggressiveness, dissemination pattern and sensitivity.
- Except for small peak in incidence in early childhood (accounted for primarily by embryonal RMS) STS as a whole increases in frequency with advancing age and is most common in patients over the age of 50. Anatomic distribution of soft tissue sarcomas in 4508 adults reviewed by American Colege of Surgery was as follows
- RCT Phase III – Yang et al, JCO, 1998
- Study was not powered to look at local control, PFS or OS, these were all secondary endpoints
- If you had a small lesion that had been widely excised you may not give radiotherapy but this decision needs to on individual basis
- In Canada all patients receive pre-op radiotherapy, UK standard treatment is post op If we give it pre op they receive 50gy then have 4-6 weeks gap prior to surgery and then recive 16Gy boost if positive margins
- Hard when dry and placed in water to soften Optimum position - ? Other leg abducted, flexed out of way?
- Allowing 5-10 mm for set-up error Vortex study suggest 5 mm enough for immobilised patients and 10mm for non-immobilised patients
- Lymphoedema is common even with sparing a corridor so the more limb that can be spared the less risk Caused by fibrosis of skin and muscle
- Smaller margins in Craniocaudal direction, set-up variability will become increasingly important 0.5 To assess if a reduced volume of post-operative radiotherapy increases limb function without compromising local control Suggests that majority of local recurrences occur within the high dose volume
- To ensure that on average 99% target volume receives 95% of prescribed dose
- On anterior images
- Informed consent Follow up on treatment Usually seen week 4 in OPD, weekly by nurses in floor clinic
- Tumour extended distally so leg was externally rotated for treatment and planning