A prospective study of proton reirradiation for recurrent and secondary soft tissue sarcoma

Radiother Oncol. 2017 Aug;124(2):271-276. doi: 10.1016/j.radonc.2017.06.024. Epub 2017 Jul 8.


Background and purpose: Proton reirradiation for sarcoma has not been previously described. We hypothesized that this strategy would provide favorable toxicity and survival outcomes.

Material and methods: Patients with soft tissue sarcoma in a previously-irradiated field were enrolled on a prospective trial of proton reirradiation. The primary endpoint was provider-reported acute toxicity. Secondary endpoints included late toxicities, local control, and overall survival.

Results: 23 patients underwent proton reirradiation. Median time between radiation courses was 40.7months (range 10-272). No grade 4-5 toxicities were observed. One patient (4%) experienced acute grade 3 dysphagia. Common grade 2 acute toxicities were fatigue (26%), anorexia (17%), and urinary incontinence (13%). There were two grade 3 late wound infections (10%) and one grade 3 late wound complication (5%). Grade 2 late complications included lymphedema (10%), fracture (5%), and fibrosis (5%). At a median follow-up of 36months, the 3-year cumulative incidence of local failure was 41% (95% CI [20-63%]). Median overall survival and progression-free survival were 44 and 29months, respectively. In extremity patients, amputation was spared in 7/10 (70%).

Conclusions: Proton reirradiation of recurrent/secondary soft tissue sarcomas is well tolerated. While longer follow-up is needed, early survival outcomes in this high-risk population are encouraging.

Keywords: Proton therapy; Reirradiation; Sarcoma.

Publication types

  • Clinical Trial

MeSH terms

  • Anorexia / etiology
  • Deglutition Disorders / etiology
  • Disease-Free Survival
  • Fatigue / etiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnostic imaging
  • Neoplasm Recurrence, Local / radiotherapy*
  • Prospective Studies
  • Proton Therapy / adverse effects
  • Proton Therapy / methods*
  • Radiation Injuries / etiology
  • Re-Irradiation / adverse effects
  • Re-Irradiation / methods
  • Sarcoma / diagnostic imaging
  • Sarcoma / radiotherapy*