Proton RT for Retroperitoneal Sarcomas

• Phase I: Determine MTD [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
  To determine the maximum tolerated dose (MTD) of preoperative IG-IMPT with simultaneously integrated boost to the high risk margin of retroperitoneal sarcoma. This is mainly based on evaluation of acute toxicity profile of each participant.
  
  
• Phase II: Determine Local Control Rate [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  To determine the local control rate after the protocol treatment (IG-IMPT MTD with simultaneously integrated boost to the high risk margin) followed by surgical resection.
  
  

• Overall Survival [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  To estimate overall survival
  
  
• Pathologic Response [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  To estimate pathologic response (percentage of necrosis and margin status, especially status of the high-risk margin)
  
  
• Tumor Response [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  To estimate the tumor response through the comparison of CT imaging before and after the protocol treatment.
  
  
• Progression-Free Survival Times [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  To assess progression-free survival times relative to surrogate biological endpoints in tissue and blood in each participant
  
  

While being screened to determine eligibility for this study you may choose to participate in an additional blood sample for circulating DNA and a genomic DNA sample.

Since we are looking for the highest dose of Proton Beam Radiation Therapy that can be administered safely without severe or unmanageable side effects in participants that have retroperitoneal sarcomas, not everyone who participates in this research study will receive teh same dose of study therapy. The dose you get will depend on the number of participants who have been enrolled in the study before you and how well they have tolerated their doses. Your study doctor will tell you which dose you will get.

Radiation planning is standard of care for all patients undergoing radiation therapy. Before you begin radiation therapy you will have a radiation planning CT scan of the tumor site. This scan will be in addition to the scans done in order to confirm your eligibility for this study. Doctors will use teh images from this scan to plan your radiation treatment.

You will receive radiation therapy every day Monday through Friday for about six weeks. You will receive study therapy as an outpatient. During radiation therapy, you will be seen by the study doctor once a week. Each visit will take about 15 minutes, and the following assessments will be completed: medical history, vital signs, body weight and assessments for any side effects you may be experiencing.

After the final dose of proton therapy you will be assessed for side effects of radiation following your last dose and before surgery. The following assessments will be completed before your surgery at this visit: Chest CT, CT/MRI of the abdomen/pelvis and routine blood tests to check for overall health.

You will be seen for a follow-up visit within one month of discharge following surgery and again four months after the surgery. At the first follow-up visit, the following assessment will be completed: medical history, vital signs and body weight, questions about side effects and routine blood tests to check for overall health. At the four month follow up visit the following assessment will be completed: medical history, vital signs and body weight, chest CT and abdominal/pelvic CT.

After your four month follow-up visit, you will be seen twice yearly following radiation for the first five years and then once a year for the rest of your life.