{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T15:35:49Z","timestamp":1788104149838,"version":"build-2803163510"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"1102","license":[{"start":{"date-parts":[[2019,7,25]],"date-time":"2019-07-25T00:00:00Z","timestamp":1564012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective:<\/jats:title>\n                  <jats:p>To assess the impact of adjuvant volumetric modulated arc therapy (VMAT) compared with three-dimensional conformal radiation therapy (3DCRT) in terms of toxicity and local control (LC) in patients with soft tissue sarcoma of the extremities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods:<\/jats:title>\n                  <jats:p>From 2004 to 2016, 109 patients were treated, initially using 3DCRT and subsequently with VMAT. Clinical outcome was evaluated by contrast-enhanced MRI, thoracic and abdominal CT 3 months after treatments and then every 6 months. Toxicity was evaluated with Common Terminology Criteria for Adverse Events scale v. 4.3.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results:<\/jats:title>\n                  <jats:p>Patients presented Stage III soft tissue sarcoma disease (77%), localized tumor (95%) at the lower extremity (87%), adipocytic histotype (46%). Surgical resection was performed in all patients, followed by adjuvant 3DCRT in 38, and VMAT in 71. The median total dose was 66\u2009Gy\/33 fractions (range 60\u201370\u2009Gy;25\u201335 fractions). More successful bone sparing was recorded using VMAT (p &amp;lt; 0.001). Median follow-up was 61 months, 93 and 58 months for 3DCRT and VMAT group, respectively. The 2- and 5\u2009year LC were 95.3\u00b12.1%, and 87.4\u00b13.4% for the whole cohort, 92.0\u00b14.5%, 82.9\u00b16.4% for 3DCRT, 97.1\u00b12.0%, 89.6\u00b14.1% for VMAT (p = 0.150). On univariate and multivariate analysis the factors recorded as conditioning LC were the status of the surgical resection margins (p = 0.028) and the total dose delivered (p = 0.013).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion:<\/jats:title>\n                  <jats:p>The availability of modern radiotherapy technique permit a better conformity on the target with maximum sparing of normal tissue and acceptable side-effects. VMAT is a safe and feasible treatment with limited rate of toxicity, compared to 3DCRT. Results on LC of VMAT are encouraging.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Advances in knowledge:<\/jats:title>\n                  <jats:p>Soft tissue sarcoma of the extremities can benefit from the use of VMAT, with a reduction of the high dose to bones to avoid radiation osteonecrosis. An adequate total dose of at least 66\u2009Gy and a radical surgical margin allow a good local control.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1259\/bjr.20190252","type":"journal-article","created":{"date-parts":[[2019,7,19]],"date-time":"2019-07-19T16:44:53Z","timestamp":1563554693000},"source":"Crossref","is-referenced-by-count":12,"title":["Adjuvant volumetric modulated arc therapy compared to 3D conformal radiation therapy for newly diagnosed soft tissue sarcoma of the extremities: outcome and toxicity evaluation"],"prefix":"10.1093","volume":"92","author":[{"given":"Lucia","family":"Di Brina","sequence":"first","affiliation":[{"name":"Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center \u2013 IRCCS, Rozzano - Milano \u2013 Italy ,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2282-9894","authenticated-orcid":false,"given":"Antonella","family":"Fogliata","sequence":"additional","affiliation":[{"name":"Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center \u2013 IRCCS, Rozzano - Milano \u2013 Italy ,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierina","family":"Navarria","sequence":"additional","affiliation":[{"name":"Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center \u2013 IRCCS, Rozzano - Milano \u2013 Italy ,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"D'Agostino","sequence":"additional","affiliation":[{"name":"Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center \u2013 IRCCS, Rozzano - Milano \u2013 Italy ,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciro","family":"Franzese","sequence":"additional","affiliation":[{"name":"Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center \u2013 IRCCS, Rozzano - Milano \u2013 Italy ,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Franceschini","sequence":"additional","affiliation":[{"name":"Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center \u2013 IRCCS, Rozzano - Milano \u2013 Italy ,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiorenza","family":"De Rose","sequence":"additional","affiliation":[{"name":"Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center \u2013 IRCCS, Rozzano - Milano \u2013 Italy ,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziana","family":"Comito","sequence":"additional","affiliation":[{"name":"Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center \u2013 IRCCS, Rozzano - Milano \u2013 Italy ,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexia","family":"Bertuzzi","sequence":"additional","affiliation":[{"name":"Medical Oncology Department, Humanitas Clinical and Research Center \u2013 IRCCS, Rozzano - Milano \u2013 Italy ,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Marrari","sequence":"additional","affiliation":[{"name":"Medical Oncology Department, Humanitas Clinical and Research Center \u2013 IRCCS, Rozzano - 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