Abstract
Simple SummaryThe primary treatment of soft tissue sarcomas (STS) is radical resection. The use of adjuvant radiotherapy showed a significantly decreased incidence of local recurrence. In our previous study, we presented that preoperative hypofractionated radiotherapy is safe and efficient for treating an unselected group of patients with STS. This study aimed to assess the treatment scheme’s use in patients with primary STS treated at one institution. The preoperative radiotherapy (RT) scheme consisted of 5 Gy per fraction for a total dose of 25 Gy. Surgery was performed within 2–4 days from the last day of RT. We included 311 patients in this prospective study. In this group, with a significant percentage of patients with extensive, high-grade STS, hypofractionated preoperative radiotherapy was associated with similar local control compared to published studies dedicated to this population. The early tolerance was good, with a small number of late complications. Background: The use of adjuvant radiotherapy (RT) shows a significantly decreased incidence of local recurrence (LR) in soft tissue sarcomas (STS). This study aimed to assess the treatment scheme’s effect in patients with primary STS treated at one institution. Methods: In this phase 2 trial, 311 patients aged ≥18 years with primary, locally advanced STS of the extremity or trunk wall were assigned to multimodal therapy conducted at one institution. The preoperative RT scheme consisted of 5 Gy per fraction for a total dose of 25 Gy. Surgery was performed within 2–4 days from the last day of RT. The primary endpoint was LR-free survival (LRFS). Adverse events of the treatment were assessed. Results: We included 311 patients with primary locally advanced STS. The median tumor size was 11 cm. In total, 258 patients (83%) had high-grade tumors. In 260 patients (83.6%), clear surgical margins (R0) were obtained. Ninety-six patients (30.8%) had at least one type of treatment adverse event. LR was observed in 13.8% patients. The 5-year overall survival was 63%. Conclusion: In this group, with a significant percentage of patients with extensive, high-grade STS, hypofractionated preoperative RT was associated with good local control and tolerance.
Highlights
Limb-sparing or conservative surgery is a standard of care for the local treatment of soft tissue sarcomas (STS)
30% of patients received preoperative chemotherapy—Table 2 shows the characteristics of patients with or without chemotherapy
The following formula proposed by Fowler [15] and modified for easy daily practice calculations was used: biologically equivalent doses (BEDs) = ndapplied/(dreference + a/b) where n is the number of fractions, applied is the fraction size of the applied regimen, dreference is the conventional fraction size of 2 Gy, a/b is the ratio of radiation fractionation sensitivity
Summary
Limb-sparing or conservative surgery is a standard of care for the local treatment of soft tissue sarcomas (STS). In low-grade lesions, it may be considered if achieving inappropriate margins is anticipated, especially in larger tumors (stage IB) [1] These recommendations are based, among others, on the results of two randomized prospective trials: one based on postoperative brachytherapy and another using external beam RT; these both showed significant benefits in terms of local control with the addition of adjuvant treatment to limb-sparing surgery [2,3]. The National Cancer Institute of Canada SR-2 randomized phase III clinical trial suggests that RT, in the treatment of STS, can be sequenced either before or after the surgery, and both treatment methods appear to give comparable results in terms of local control of the disease Both schemes differ in terms of side effects with more acute adverse events of the preoperative schedule and more long-term adverse events, e.g., fibrosis, in the postoperative scheme [4,5]. Conclusion: In this group, with a significant percentage of patients with extensive, high-grade STS, hypofractionated preoperative RT was associated with good local control and tolerance
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
