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

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).

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.