Locations:
Search IconSearch
November 2, 2023/Cancer/Radiation Oncology

Studying Ultra-Hypofractionated Radiotherapy for Soft Tissue Sarcoma

Meta-analysis suggests efficacy and safety

23-CNR-4210973-CQD-Hero-650×450 Dr Mayo

Preoperative, ultra-hypofractionated radiotherapy (RT) for soft tissue sarcoma (STS) offers patients excellent two-year local control and complication rates similar to the current standard of care, according to a new meta-analysis from Cleveland Clinic researchers. They presented their findings at the American Society for Radiation Oncology (ASTRO) 65th annual meeting.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

“Right now, the standard of care for intermediate to high-grade soft tissue sarcoma involves surgery with conventional radiotherapy before or afterwards, with patients typically receiving preoperative 50 Gy in 25 treatment sessions,” says Zachary Mayo, MD, a senior radiation oncology resident and first author of the study. “As treatments for other cancers have moved toward shorter courses, we’ve seen a growing interest in doing so for soft tissue sarcomas as well.”

Several studies in the literature evaluate the safety and efficacy of delivering RT over shorter treatment courses for patients with STS, including 5-fraction ultra-hypofractionated RT (25-40 Gy/5 treatments); however, these are small, single institution experiences with fewer than 50 patients in each study. Cleveland Clinic researchers sought to gain a broader perspective on the efficacy and safety of this delivery technique through a meta-analysis of currently published literature with subgroup analysis of total dose delivered.

Experiences with 5-fraction preoperative RT

Researchers queried medical research databases for potential studies to include, and seven studies met the inclusion criteria of STS of the extremity or trunk treated with 5-fraction preoperative RT, with a fraction size of ≥ 5 Gy per fraction. Studies must have reported two-year local control rates and major wound complications as well.

For the entire cohort, two-year local control was 96.9% (95% highest posterior density [HPD]: 0.93-0.98). The rate of major wound complications was 30.6% (95% HPD: 0.21-0.41), a rate similar to historical studies of conventionally fractionated radiotherapy. Of the 208 patients included in the meta-analysis, 144 received ≥ 30 Gy. There was a trend towards improved local control in patients receiving higher doses of RT.

Acute and late toxicity rates were also similar to historical studies, with acute toxicity of grade 2 dermatitis at 12.7% and late toxicity of grade 2 fibrosis at 11.1%, grade 2 stiffness at 6.0% and grade 2 lymphedema at 4.0%.

“Because soft tissue sarcoma is rare, this meta-analysis allows us to look at a larger patient cohort for indications of whether this investigational approach is working,” says Dr. Mayo. “The next step is a multi-institutional trial with universal RT protocols and a much larger sample size.”

Shifting the paradigm

Studies like this one are supporting a shift in the paradigm of treating soft tissue sarcomas from long courses of preoperative RT to short courses of hypo- and ultra-hypofractionated RT that have been used successfully in breast and prostate cancers.

Cleveland Clinic has been treating select patients with extremity STS with ultra-hypofractionated RT for about six years. Patients deemed to be candidates for this treatment regimen following multidisciplinary sarcoma tumor board discussion receive five fractions over the course of five days.

Advertisement

“The ultra-hypofractionated approach allows patients to complete treatment in a much shorter interval than the standard five weeks that is typical under the current standard of care,” says Shauna Campbell, DO, of the Department of Radiation Oncology at Cleveland Clinic, and senior author of the study. “This approach potentially reduces the financial and psychosocial stressors patients face with longer courses of RT, and the results of our meta-analysis indicate this approach is safe and effective. We are looking forward to validating these results with a multi-institutional study.”

Advertisement

Related Articles

22-CNR-3127708-CQD-Hero2-650×450-credits
November 22, 2023/Cancer/Radiation Oncology
A Germline Biomarker Offers Insight Into Treatment Selection for Men With Prostate Cancer

Correlation found between the biomarker HSD3B1 and resistance to combined hormone therapy and radiotherapy

23-CNR-4164208 ASTRO 2023 graphic CQD
September 21, 2023/Cancer/Radiation Oncology
Top 10 Presentations You Don’t Want to Miss at ASTRO 2023

Highlighting top abstracts for the annual radiation oncology conference

23-CNR-3964459-CQD-Hero-650×450 SBRT
New Study Highlights Potential Benefits of Ultrasound-Guided Prostate SBRT

Transperineal ultrasound a viable, non-invasive option for monitoring intra-fractional prostate motion

ASTRO 2022 abstracts
November 4, 2022/Cancer/Radiation Oncology
Top Research from ASTRO 2022

Key abstracts highlight advances in treating locally advanced and refractory disease

radiation therapy
October 14, 2022/Cancer/Radiation Oncology
Radiation Oncology-Biology Integration Network (ROBIN) Explores Precision Medicine

Multidisciplinary team to examine radiation therapy combined with immunotherapy

21-CNR-2572058-CQD-Hero-650×450-1
March 17, 2022/Cancer/Radiation Oncology
Aggressive Daily Radiation in Breast Cancer Survivor with Angiosarcoma: A Case Study

Preoperative treatment ensures successful surgical resection

Squamous Cell carcinoma under microscopy
December 2, 2021/Cancer/Radiation Oncology
Study Identifies Prognostic Subgroups in Cutaneous Squamous Cell Carcinoma

Modification of traditional staging factors associated with survival in high-risk disease

21-CNR-2098260 CQD 650×450
November 19, 2021/Cancer/Radiation Oncology
Multimodal Therapy for Radiation-Induced Chest Wall Sarcoma: A Case Study

Hyperthermia, neoadjuvant chemoradiation and reconstruction hold promise of long-term survival

Ad