9 / 90
T
reatment
of
bone
and
soft
tissue
tumors
of
the
limbs
with
conformal
radiotherapy
and
intensity
-
modulated
radiotherapy
(IMRT)
R
ev
A
ssoc
M
ed
B
ras
2017; 63(6):477-480
477
GUIDELINES IN FOCUS
Treatment of bone and soft tissue tumors of the limbs with conformal
radiotherapy and intensity-modulated radiotherapy (IMRT)
T
ratamento
de
tumores
ósseos
e
de
partes moles
de membros
com
radioterapia
externa
conformada
e
com
intensidade modulada
(IMRT)
Authorship:
Brazilian Society of Radiotherapy (SBR)
Participants:
Marcus Simões Castilho
1
, Robson Ferrigno
1
, Helena Baraldi
1
,
Paulo Eduardo Ribeiro dos Santos Novaes
1
1
Sociedade Brasileira de Radioterapia (SBR)
http://dx.doi.org/10.1590/1806-9282.63.06.477The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize
procedures to assist the reasoning and decision-making of doctors.
The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending
on the conditions and the clinical status of each patient.
G
rades
of
recommendation
and
levels
of
evidence
•
•
A:
Experimental or observational studies of higher
consistency.
•
•
B:
Experimental or observational studies of lower
consistency.
•
•
C:
Cases reports (non-controlled studies).
•
•
D:
Opinion without critical evaluation, based on con-
sensus, physiological studies or animal models.
D
escription
of
evidence
collection method
Through the elaboration of three relevant clinical ques-
tions related to the proposed theme, we sought to present
the main evidences regarding safety, toxicity and effective-
ness of the presented radiotherapy techniques. The study
population consisted of male and female patients of all
ages with bone and soft tissue tumors in the upper and
lower limbs, regardless of histological type, staging, treat-
ment context (neoadjuvant, radical or adjuvant) or the
presence of comorbidities. For this, a systematic review
of the literature was carried out in primary scientific da-
tabases (MEDLINE – PubMed; Embase – Elsevier; LILACS
– BIREME; Cochrane Library – Record of Controlled Trials).
All articles available through May 31, 2015 were considered.
The search terms used in the research were: (conformal
radiotherapies [MeSH Terms]) OR radiotherapies, con-
formal [MeSH Terms]) OR conformal radiotherapy [MeSH
Terms]) OR radiotherapy, intensity-modulated [MeSH
Terms]) OR conformal radiotherapy) OR conformal
radiotherapies) OR conventional radiotherapy) OR IMRT)
OR 3D conformal radiotherapy) OR VMAT)) AND (sar-
comas [MeSH Terms]) OR sarcoma, soft tissue [MeSH
Terms]) OR sarcomas, soft tissue[MeSH Terms]) OR soft
tissue sarcoma [MeSH Terms]) OR sarcoma) OR sarcomas).
The articles were selected based on critical evaluation
using the instruments (scores) proposed by Jadad and
Oxford. The references with greater degree of evidence
were used. The recommendations were elaborated after
discussion with the elaboration group composed by four
members of the Brazilian Society of Radiotherapy.
O
bjective
To evaluate the most appropriate technique of radio-
therapy for the treatment of patients with bone and soft
tissue tumors of the limbs.
I
ntroduction
The therapeutic strategy of bone and soft tissue tumors
of the limbs should be performed through multidisci-
plinary decision to better associate surgery, radiotherapy
and chemotherapy. The decision on the best combination
and sequence is based on factors such as tumor type and
histological grade, clinical staging, primary tumor loca-
tion and volume, proposed type of surgery, and general
patient conditions. External radiotherapy can be used
preoperatively (neoadjuvant) or postoperative (adjuvant)
and aims to ensure local control of the primary tumor
before or after surgery.
Although there are no viscera or vital organs in the
limbs, the joints and soft tissues are susceptible to severe
complications of radiotherapy, such as lymphedema, joint
stiffness, soft tissue fibrosis, and necrosis of bones and
soft tissues. If an irradiated bone fractures, there is no
consolidation of this fracture due to changes in the mi-