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Preoperative hypofractionated radiotherapy for soft tissue sarcomas: a systematic review
Siyer Roohani1, Felix Ehret2,3, Marta Kobus2
1Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. siyer.roohani@charite.de.
Preoperative hypofractionated radiotherapy (HFRT) shows promising results for soft tissue sarcomas (STS), offering comparable oncological outcomes and favorable toxicity profiles to standard treatment. This approach may improve patient adherence and cost-effectiveness.
Area of Science:
- Oncology
- Radiation Oncology
- Surgical Oncology
Background:
- Soft tissue sarcomas (STS) are rare, aggressive malignancies often treated with long preoperative radiotherapy (RT) courses followed by surgery.
- Concerns exist regarding potential increased toxicity and worse outcomes with shorter, hypofractionated RT courses (HFRT).
- Evidence suggests HFRT may enhance treatment adherence, cost-effectiveness, and patient access.
Purpose of the Study:
- To systematically review and summarize current evidence on preoperative HFRT for STS.
- To compare toxicity and oncological outcomes of HFRT versus traditional normofractionated RT in STS treatment.
Main Methods:
- A systematic review of clinical trials was conducted using multiple databases (PubMed, Cochrane, ClinicalTrials.gov, Embase, Ovid Medline) following PRISMA guidelines.
- Included studies focused on preoperative HFRT for STS, excluding retroperitoneal sarcomas, postoperative RT, and hyperthermia.
- Data from 13 eligible articles (8 phase II trials, 5 retrospective analyses) published up to November 30th, 2021, were analyzed.
Main Results:
- The review analyzed 13 studies, primarily involving 5x5 Gy preoperative HFRT for high-grade STS.
- HFRT demonstrated comparable or lower toxicity rates than historical normofractionated RT data.
- Local control rates were similar to normofractionated RT, with a significantly shorter treatment duration.
Conclusions:
- Preoperative HFRT appears to be a viable treatment option for STS, supported by retrospective and phase II trial data.
- Favorable oncological outcomes and toxicity profiles were observed with HFRT.
- Further evidence from ongoing prospective phase II trials is anticipated to clarify acute and late toxicity, with no phase III randomized trials published yet.
