Pandemic driven preoperative moderate hypofractionated radiotherapy for soft tissue sarcomas

Area of Science:

• Oncology
• Radiation Oncology
• Surgical Oncology

Background:

• The COVID-19 pandemic necessitated modifications to cancer treatment protocols to minimize patient hospital visits.
• Moderate hypofractionation, a reduced-number-of-fractions radiation therapy technique, was explored as an alternative to conventional fractionation for soft tissue sarcoma (STS).

Purpose of the Study:

• To evaluate the clinical outcomes of preoperative moderate hypofractionation in STS patients during the COVID-19 pandemic.
• To assess the impact of this altered radiation schedule on wound complications, radiation toxicity, local tumor control, and distant metastases.

Main Methods:

• A retrospective analysis of 66 STS patients treated between January 2020 and December 2023.
• Outcomes assessed included wound complications within 120 days post-surgery, local recurrence, distant metastases, and radiation toxicity.
• Statistical analyses included logistic regression for wound complication factors and competing risk models for recurrence and metastasis.

Main Results:

• The study included 66 patients (mean age 74 years) with STS, predominantly in the lower extremities (64%).
• A wound complication rate of 33% was observed, with 13 moderate and 6 severe complications.
• Two-year cumulative incidences were 7.6% for local recurrence and 29% for distant metastases. Grade 3 acute dermatitis occurred in 1.5% and late toxicity in 3.0% of patients.

Conclusions:

• Preoperative moderate hypofractionation for STS during the COVID-19 pandemic yielded promising results.
• This approach did not increase postoperative wound complications and showed favorable local failure rates.
• The study supports the feasibility and efficacy of moderate hypofractionation in STS management during public health crises.