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@ARTICLE{Roohani:275749,
      author       = {S. Roohani and F. Ehret$^*$ and M. Kobus and A.
                      Flörcken$^*$ and S. Märdian and D. Rau and S. Wittenberg
                      and A. Jarosch and R. Öllinger and D. Zips$^*$ and D.
                      Kaul$^*$},
      title        = {{P}atterns of {F}ailure in {H}igh-grade {S}oft {T}issue
                      {S}arcomas of the {E}xtremities and {T}runk {W}all after
                      {P}re- or {P}ostoperative {R}adiotherapy},
      journal      = {Advances in radiation oncology},
      volume       = {8},
      number       = {4},
      issn         = {2452-1094},
      address      = {Amsterdam},
      publisher    = {Elsevier},
      reportid     = {DKFZ-2023-00848},
      pages        = {101224},
      year         = {2023},
      note         = {8(4), art. no. 101224},
      abstract     = {Purpose: Radiotherapy (RT) is a mainstay of treatment for
                      high-grade soft tissue sarcomas (STS). We sought to examine
                      the pattern of local recurrence (LR) with regard to target
                      volume, clinical course, and tumor characteristics in
                      extremity and trunk wall STS patients receiving pre- or
                      postoperative RT. Methods and Materials: In this
                      retrospective study, LR rates and patterns in 91 adult
                      patients with a primary diagnosis of localized high-grade
                      STS of the extremities and trunk wall treated with pre- or
                      postoperative RT at our institution between 2004 and 2021
                      were analyzed. Radiation treatment plans and imaging data
                      sets at diagnosis and LR were compared. Results: Seventeen
                      out of 91 (18.7 $\%)$ patients developed a LR after a median
                      time of 12.7 months. In 10 out of 13 LRs $(76.9\%)$ with
                      available treatment plans and radiographic imaging data at
                      the time of recurrence, the LR occurred within the planned
                      target volume (PTV), 2 LRs were marginal $(15.4\%,$ at the
                      edge of the PTV volume), and one relapsed out-of-field
                      $(7.7\%,$ outside the PTV volume). Positive surgical margins
                      (microscopic or macroscopic) were found in 5 out of 91
                      patients $(5.5\%),$ 1 of which was found in the 17 patients
                      with LRs $(5.9\%).$ Eleven of 13 LR patients $(84.6\%)$ with
                      available treatment plans and radiographic imaging data
                      received postoperative RT; the median total RT dose was 60
                      Gy. Volumetric-modulated arc therapy was used in 10
                      $(76.9\%),$ intensity-modulated RT in 2 $(15.4\%),$ and
                      3-dimensional conformal radiation therapy in 1 $(7.7\%)$ of
                      13 LRs. Conclusions: The majority of LRs occurred within the
                      PTV suggesting that LR is most likely not a consequence of
                      inadequate target volume definition, but rather of
                      radioresistant tumor biology. To further improve local tumor
                      control, future research on the potential of dose escalation
                      with normal tissue sparing, STS subtype-specific tumor
                      biology, radiosensitivity, and surgical technique is
                      indicated.},
      cin          = {BE01},
      ddc          = {610},
      cid          = {I:(DE-He78)BE01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      doi          = {10.1016/j.adro.2023.101224},
      url          = {https://inrepo02.dkfz.de/record/275749},
}