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Case report
peer-reviewed

Excellent Pathologic Response and Atypical Clinical Course of High-Grade Extremity Sarcoma to Neoadjuvant Pencil Beam Scanning Proton Therapy



Abstract

Neoadjuvant radiation therapy, followed by definitive surgical resection, remains the standard of care for resectable high-grade and unresectable soft tissue sarcomas. Proton therapy offers the promise of highly conformal dose distributions with improved sparing of neighboring normal tissues as compared with conformal and intensity modulated photon techniques. It is unclear whether proton therapy may offer an improved tumoral response, especially with dose escalation, in this relatively radio-insensitive tumor type. We, herein, present a patient with an excellent pathologic response to preoperative pencil beam scanning proton therapy despite a complex treatment course.



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Case report
peer-reviewed

Excellent Pathologic Response and Atypical Clinical Course of High-Grade Extremity Sarcoma to Neoadjuvant Pencil Beam Scanning Proton Therapy


Author Information

Jill Remick

Radiation Oncology, University of Maryland School of Medicine

William Regine

Radiation Oncology, University of Maryland School of Medicine

Robert Malyapa

Radiation Oncology, University of Maryland School of Medicine

Vincent Ng

Department of Orthopaedics, University of Maryland School of Medicine

Melissa Vyfhuis

Radiation Oncology, University of Maryland School of Medicine

Tejan Diwanji

Radiation Oncology, University of Maryland School of Medicine

Susan Shyu

Department of Pathology, University of Maryland Medical Center

James W. Snider Corresponding Author

Radiation Oncology, University of Maryland School of Medicine


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Waived, retrospective case report. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Excellent Pathologic Response and Atypical Clinical Course of High-Grade Extremity Sarcoma to Neoadjuvant Pencil Beam Scanning Proton Therapy


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Case report
peer-reviewed

Excellent Pathologic Response and Atypical Clinical Course of High-Grade Extremity Sarcoma to Neoadjuvant Pencil Beam Scanning Proton Therapy

Jill Remick">Jill Remick, William Regine">William Regine, Robert Malyapa">Robert Malyapa, Vincent Ng">Vincent Ng, Melissa Vyfhuis">Melissa Vyfhuis, Tejan Diwanji">Tejan Diwanji, Susan Shyu">Susan Shyu, James W. Snider">James W. Snider

  • Author Information
    Jill Remick

    Radiation Oncology, University of Maryland School of Medicine

    William Regine

    Radiation Oncology, University of Maryland School of Medicine

    Robert Malyapa

    Radiation Oncology, University of Maryland School of Medicine

    Vincent Ng

    Department of Orthopaedics, University of Maryland School of Medicine

    Melissa Vyfhuis

    Radiation Oncology, University of Maryland School of Medicine

    Tejan Diwanji

    Radiation Oncology, University of Maryland School of Medicine

    Susan Shyu

    Department of Pathology, University of Maryland Medical Center

    James W. Snider Corresponding Author

    Radiation Oncology, University of Maryland School of Medicine


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Waived, retrospective case report. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: September 15, 2017

    DOI

    10.7759/cureus.1687

    Cite this article as:

    Remick J, Regine W, Malyapa R, et al. (September 15, 2017) Excellent Pathologic Response and Atypical Clinical Course of High-Grade Extremity Sarcoma to Neoadjuvant Pencil Beam Scanning Proton Therapy . Cureus 9(9): e1687. doi:10.7759/cureus.1687

    Publication history

    Received by Cureus: August 08, 2017
    Peer review began: August 23, 2017
    Peer review concluded: September 11, 2017
    Published: September 15, 2017

    Copyright

    © Copyright 2017
    Remick et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Neoadjuvant radiation therapy, followed by definitive surgical resection, remains the standard of care for resectable high-grade and unresectable soft tissue sarcomas. Proton therapy offers the promise of highly conformal dose distributions with improved sparing of neighboring normal tissues as compared with conformal and intensity modulated photon techniques. It is unclear whether proton therapy may offer an improved tumoral response, especially with dose escalation, in this relatively radio-insensitive tumor type. We, herein, present a patient with an excellent pathologic response to preoperative pencil beam scanning proton therapy despite a complex treatment course.



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Create a free account to continue reading this article.

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Jill Remick

Radiation Oncology, University of Maryland School of Medicine

William Regine, M.D., Professor

Radiation Oncology, University of Maryland School of Medicine

Robert Malyapa

Radiation Oncology, University of Maryland School of Medicine

Vincent Ng

Department of Orthopaedics, University of Maryland School of Medicine

Melissa Vyfhuis

Radiation Oncology, University of Maryland School of Medicine

Tejan Diwanji

Radiation Oncology, University of Maryland School of Medicine

Susan Shyu

Department of Pathology, University of Maryland Medical Center

James W. Snider

Radiation Oncology, University of Maryland School of Medicine

For correspondence:
jsnider@umm.edu

Jill Remick

Radiation Oncology, University of Maryland School of Medicine

William Regine, M.D., Professor

Radiation Oncology, University of Maryland School of Medicine

Robert Malyapa

Radiation Oncology, University of Maryland School of Medicine

Vincent Ng

Department of Orthopaedics, University of Maryland School of Medicine

Melissa Vyfhuis

Radiation Oncology, University of Maryland School of Medicine

Tejan Diwanji

Radiation Oncology, University of Maryland School of Medicine

Susan Shyu

Department of Pathology, University of Maryland Medical Center

James W. Snider

Radiation Oncology, University of Maryland School of Medicine

For correspondence:
jsnider@umm.edu