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A Mouse Model of Incompletely Resected Soft Tissue Sarcoma for Testing (Neo)adjuvant Therapies

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Published on: July 28, 2020

Low-dose neoadjuvant external beam radiation therapy for soft tissue sarcoma.

Kiran Devisetty¹, Wendy Kobayashi, Herman D Suit

¹Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 02114, USA.

International Journal of Radiation Oncology, Biology, Physics

|September 25, 2010

Summary

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Low-dose neoadjuvant external beam radiation therapy (EBRT) for soft tissue sarcoma did not reduce wound complications, with brachytherapy posing the highest risk. Further research is needed to optimize techniques for better outcomes.

Area of Science:

Oncology
Radiation Oncology
Surgical Oncology

Background:

Neoadjuvant external beam radiation therapy (EBRT) to 50 Gy for soft tissue sarcoma offers similar local control (LC) and overall survival to postoperative radiation therapy (PORT) at 60 Gy.
However, higher doses in neoadjuvant EBRT are associated with increased wound complications.

Purpose of the Study:

To evaluate if a reduced dose of neoadjuvant EBRT could decrease acute toxicity while preserving LC in soft tissue sarcoma patients.
To assess the impact of different PORT techniques on wound complications and LC.

Main Methods:

Retrospective analysis of 1,765 nonmetastatic soft tissue sarcoma patients treated with radiation therapy.
Identification of 42 patients who received low-dose neoadjuvant EBRT (median 20 Gy) followed by surgery and PORT (EBRT, brachytherapy, or IORT).

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Main Results:

Severe acute wound complications occurred in 36% of patients, strongly correlating with the PORT technique, particularly brachytherapy (69%).
The 5-year LC was 73%, influenced by PORT technique and histology, with a trend towards improvement with doses >60 Gy.
Five-year overall survival was 65%, significantly correlated with the extent of resection and margin status.

Conclusions:

Low-dose neoadjuvant EBRT did not mitigate severe acute wound complications, with brachytherapy identified as a significant risk factor.
Modifications to brachytherapy techniques may be necessary to reduce toxicity while maintaining LC.
Further investigation is required before widespread adoption of this approach.