Dr. Catton on Omitting Radiation Therapy in Sarcoma

Charles Catton, MD, professor, Department of Radiation Oncology, University of Toronto, discusses the notion of omitting radiation therapy in the treatment of patients with extremity sarcomas.

According to Catton, oncologists in this space have long recognized that a combinatorial treatment involving surgery and radiation therapy for patients with extremity sarcomas is very beneficial, as it allows a high level of local control of the disease, and it provides excellent functional outcomes.

However, the problem is that, currently, the trials that have looked at this have had relatively few numbers of patients. It is highly possible, he says, that the majority of these patients don’t necessarily need the radiation therapy. This is particularly important because there can be very serious side effects with radiation, even though those side effects are very uncommon.

After investigating this more deeply, Catton says it appears that if one could achieve at least a 1 cm margin around the patient's tumor, then the value of radiation therapy decreases, making it not entirely necessary for that individual.

The opposite issue, he explains, is that the wider the margin around the tumor, the poorer the functional outcomes are for the patient. Thus, Catton proposed that patients who are at a higher risk of complications may be able to manage their disease without radiation. Such patients would include younger individuals who have smaller tumors located away from critical structures, like nerves and vessels.

The idea of omitting radiation therapy in this context is somewhat controversial, and it would have to be discussed with the patient, who should know that this would not be considered standard of care, he says.