Radiation Therapy to Treat Musculoskeletal Tumors

• Cumulative incidence of local control, pattern of failure (local or metastatic) [ Time Frame: Time to local failure (local control) over 5 years follow-up after completion of therapy ] [ Designated as safety issue: No ]
  To estimate local control rates with image guided radiation therapy as defined in this study for patients with primary musculoskeletal tumors (MST).
  
  
• Cumulative incidence of local control, pattern of failure (local or metastatic) [ Time Frame: Time to local failure (local control) over 10 years follow-up after completion of therapy ] [ Designated as safety issue: No ]
  To estimate local control rates with image guided radiation therapy as defined in this study for patients with primary musculoskeletal tumors (MST).
  
  

• Changes in growth rate and length of bone, bone density, development of muscle (muscle function, e.g. range of motion), occurrence of organ specific (e.g. lung, skin) CTC measured toxicities. [ Time Frame: Time to local failure (local control) over 5 years follow-up after completion of therapy ] [ Designated as safety issue: No ]
  Investigate the dose and volume relationship for the developing physis and cortical bone using physical measures and imaging evaluations.
  
  
• Changes in growth rate and length of bone, bone density, development of muscle (muscle function, e.g. range of motion), occurrence of organ specific (e.g. lung, skin) CTC measured toxicities. [ Time Frame: Time to local failure (local control) over 10 years follow-up after completion of therapy ] [ Designated as safety issue: No ]
  Investigate the dose and volume relationship for the develop8ing physis and cortical bone using physical measures and imaging evaluations.
  
  
• Muscle function over time, PET, DCE-MR, T2* MR quantitative parameters. [ Time Frame: Change from baseline as well as comparison to non-treated side (when available) during the first 5 years after completion of therapy. ] [ Designated as safety issue: No ]
  Describe the severity and time course of radiation-induced changes in the soft tissues and adjacent organs, including muscle and subcutaneous tissues.
  
  

The study focuses on the following primary Objectives:

• To estimate local control rates with image guided radiation therapy as defined in this study for patients with primary musculoskeletal tumors (MST).

  • Prospectively establish a baseline estimate of local control for patients with MST (Ewing's sarcoma family of tumors (ESFT), rhabdomyosarcoma (RMS) and non-rhabdomyosarcoma soft tissue sarcoma (STS)) treated with image guided radiation therapy.
  • Demonstrate that the increased level of conformality afforded by image guided radiation therapy does not reduce its efficacy relative to previously utilized non-image guided radiation therapy techniques in patients with Ewing's sarcoma family of tumors, resected soft tissue sarcomas, and group III rhabdomyosarcomas.
  • Assess local and regional patterns of failure for patients with MST treated with image guided radiation therapy relative to their targeted volumes.
  • Provide a long term (>5 year) estimate of local disease control for patients with MST (Ewing's sarcoma family of tumors (ESFT)), rhabdomyosarcoma (RMS), and non-rhabdomyosarcoma soft tissue sarcoma (STS) treated with image guided radiation therapy.

The study focuses on the following secondary objectives:

• Establish a quantitative baseline estimate of radiation dose-related changes in normal tissues using novel objective measures of somatic change, musculoskeletal function, tissue biochemistry and physiology.

  o Investigate the dose and volume relationship for the developing physis and cortical bone using physical measures and imaging evaluations including:

  • Prospectively investigate whether an age based radiotherapeutic threshold of dose and volume that will induce premature physis closure and alter long bone length can be quantitatively identified.
  • Quantitatively explore the impact of radiation on cortical bone thinning and long bone curvature.
  • Relate radiation dose and volume to late (10+ year) alterations in bone integrity.

• Describe the severity and time course of radiation-induced changes in the soft tissues including muscle and subcutaneous tissues.

  • Delineate sequential changes in muscular volume, muscle function and organ function (delineated by imaging and measures of physical function) following image guided radiation for specific muscular groups.
  • Correlate the temporal changes in muscular volume and function with changes in vascularity and metabolism defined by imaging studies.
  • Relate prospectively documented changes in subcutaneous tissues (by physical measure and imaging) to dosimetric parameters.