{"doi":"10.1016/j.adro.2025.101953","title":"The Impact of Radiation Dose to Bowel on the Risk of Developing Gastrointestinal Toxicities When Treating Abdominopelvic Soft-Tissue Sarcomas With Preoperative Radiation Therapy","abstract":"Introduction : Abdominopelvic soft tissue sarcomas (AP-STS) are selectively treated with radiation therapy (RT) followed by surgery. We investigated dosimetric factors predictive for acute and long-term gastrointestinal (GI) toxicities in patients treated with preoperative RT for AP-STS. Methods : We performed a retrospective cohort study of patients treated for non-metastatic AP-STS with preoperative RT and surgery from 2005-2020. Individual loops of small and large bowel as well as a \"Bowel Bag\" space were auto-contoured using a clinically validated deep learning-based approach (nnU-Net) and then manually reviewed. Chi-Square or Fisher's Exact test were utilized to assess how bowel dosimetry related to the development of GI toxicities. In particular, the effect on GI toxicity of exceeding bowel constraints as defined in the consensus guidelines was evaluated. Recurrence outcomes were analyzed using the Kaplan Meier method. Results : We evaluated 76 patients with median follow-up of 46 months (IQR 42-50). Approximately half of tumors were located in the RP space (n=39, 51%). 60 patients (79%) presented with de novo disease, and 21% (n=16) were recurrent presentations that had not received prior RT. 14 patients (18%) had a local recurrence (LR) alone, 23 (30%) a distant recurrence alone, and 3 (4%) combined local and distant recurrence. As a result of RT, 23 patients (30%) had acute grade 1-2 diarrhea, and 14 (18%) had grade 1 nausea. There were no acute grade 3 toxicities. Six patients (8%) had any long-term RT-related toxicity, including 1 small bowel obstruction. Patients were more likely to have an acute GI toxicity if bowel bag V45>195cm 3 (p=0.05). Conclusion : Traditional RT volumetric bowel dose constraints are frequently exceeded given the large size of AP-STS at presentation and the corresponding large RT volumes. Exceeding the conventional bowel dosimetric constraints should not dissuade the use of RT, but instead signal the need for aggressive prophylactic management of potential toxicities.","journal":"Advances in Radiation Oncology","year":2025,"id":581477,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9559,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1493091,"name":"Netherton TJ","orcid":null,"position":1,"is_corresponding":false},{"id":1493092,"name":"Wang Xa","orcid":null,"position":2,"is_corresponding":false},{"id":1493093,"name":"Lim Ty","orcid":null,"position":3,"is_corresponding":false},{"id":279504,"name":"Haitao Wang","orcid":"0000-0001-6910-974X","position":4,"is_corresponding":false},{"id":404348,"name":"Dershan Luo","orcid":"0000-0002-5768-1471","position":5,"is_corresponding":false},{"id":406339,"name":"Congjun Wang","orcid":"0000-0003-4741-4289","position":6,"is_corresponding":false},{"id":1493094,"name":"Thrower SL","orcid":null,"position":7,"is_corresponding":false},{"id":757615,"name":"Callistus Nguyen","orcid":"0000-0003-4832-869X","position":8,"is_corresponding":false},{"id":1005037,"name":"Heather Lyu","orcid":"0000-0001-7759-0799","position":9,"is_corresponding":false},{"id":1493095,"name":"Christopher Scally","orcid":null,"position":10,"is_corresponding":false},{"id":1493096,"name":"Roland CL","orcid":null,"position":11,"is_corresponding":false},{"id":854557,"name":"Devarati Mitra","orcid":"0000-0002-2225-164X","position":12,"is_corresponding":false},{"id":1493097,"name":"Bishop AJ","orcid":null,"position":13,"is_corresponding":false},{"id":274163,"name":"Ahsan Farooqi","orcid":"0000-0001-9605-7113","position":14,"is_corresponding":false},{"id":1493098,"name":"Guadagnolo BA","orcid":null,"position":15,"is_corresponding":false},{"id":404731,"name":"Alison Yoder","orcid":"0000-0002-2606-3814","position":0,"is_corresponding":true}],"reference_count":29,"raw_metadata":null,"created_at":"2026-07-19T02:58:47.357782Z","pmid":"41492444","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}