Neoadjuvant hypofractionated radiotherapy and chemotherapy for extremity soft tissue sarcomas: Safety, feasibility, and early oncologic outcomes of a phase 2 trial

Silva, Maria Letícia Gobo; Mello, Celso Abdon Lopes de; Aguiar, Samuel; Costa, Felipe D’Almeida; Filho, Paulo Roberto Stevanato; Bezerra, Tiago Santoro; Nakagawa, Suely Akiko; Nascimento, Antonio G.; Cunha, Isabela Werneck da; Batista, Ranyell Matheus Spencer Sobreira; Daher, Ulisses Ribaldo Nicolau; Formiga, Maria Nirvana da Cruz; Germano, Janaina Naiara; Kupper, Bruna Elisa Catin; Pellizzon, A.C.; Lopes, Ademar

doi:10.1016/j.radonc.2021.03.033

Cited by 19 publications

(9 citation statements)

References 32 publications

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“…This approach is particularly advantageous in cases where tumors are situated in proximity to critical blood vessels and nerve sites, allowing for the feasibility of achieving an R0 resection [4]. Our institution's implementation of combined chemo-radiation therapy, in a preoperative sequential manner, demonstrated good tolerability, with a tumor downsizing rate (Objective Response Rate, ORR) of 32% (10/31), consistent with previously reported ndings [13]. Furthermore, our study revealed intriguing observations: while tumor volume increased in some patients, the solid component within the tumor exhibited a signi cant decrease, blood supply markedly reduced, and the nal pathological results con rmed a tumor necrosis rate exceeding 90%.…”

Section: Discussionsupporting

confidence: 86%

“…Gobo Silva et al found that neoadjuvant hyperfractionated radiotherapy combined with chemotherapy may increase the rates of limb preservation and is well-tolerated by patients. However, these ndings are based on studies with small sample sizes and require further validation in larger patient cohorts [13]. To verify the e cacy and safety of this protocol in more subtypes, our center has instituted an innovative preoperative therapeutic protocol for the treatment of high-risk soft tissue sarcomas.…”

Section: Introducionmentioning

confidence: 99%

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Preoperative Sequential Chemotherapy and hypofractionated Radiotherapy Combined with Comprehensive Surgical Resection for High-Risk Soft Tissue Sarcomas: A Retrospective Study

Qu,

Tian,

Wang

et al. 2024

Preprint

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Introduction: The management of soft tissue sarcomas presents considerable therapeutic challenges. This study was designed to assess the efficacy of neoadjuvant sequential chemotherapy and hypofractionated radiotherapy in conjunction with extensive surgical resection for the treatment of high-risk soft tissue sarcomas. Materials and methods We performed a retrospective review of 31 high-risk soft tissue sarcoma patients treated at our institution from June 2021 to June 2023. The cohort consisted of 21 males and 10 females with a mean age of 55.7 years and included both initial and recurrent disease presentations. Our treatment regimen comprised two to three cycles of neoadjuvant chemotherapy coupled with hypofractionated radiotherapy, delivered at 5 Gy per fraction to a total dose of 25–35 Gy across 5–7 days, prior to surgical resection aimed at achieving wide margins. Data collection was systematic, covering surgical outcomes, chemoradiotherapy-related complications, and prognostic factors. Results All patients completed the prescribed course of neoadjuvant chemoradiotherapy. 29% patients experienced grade 3 + chemotherapy toxicity, necessitating a reduction or interruption in their chemotherapy regimen. Limb preservation was accomplished in 30 patients finally. Response evaluation using RECIST 1.1 criteria post-neoadjuvant therapy revealed 9.7% with PD, 58.1% with SD, 29% with a PR, and 3.2% with a CR, culminating in an ORR of 32.2%. Postoperative complications included superficial wound infections in four patients and deep incisional infections in another four. Two patients developed pulmonary metastases, two presented with multiple metastatic sites, and one experienced local recurrence. DFS rate was 83.9%, with a one-year OS rate of 88.2%. Conclusion Neoadjuvant sequential chemotherapy and hypofractionated radiotherapy followed by extensive surgical resection represents an effective treatment paradigm for high-risk soft tissue sarcomas. This multimodal approach not only facilitates tumor reduction but also significantly reduces the risks of local recurrence and distant metastasis.

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Section: Discussionsupporting

confidence: 86%

Section: Introducionmentioning

confidence: 99%

Preoperative Sequential Chemotherapy and hypofractionated Radiotherapy Combined with Comprehensive Surgical Resection for High-Risk Soft Tissue Sarcomas: A Retrospective Study

Qu,

Tian,

Wang

et al. 2024

Preprint

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“…This showed 83.6% of patients achieving clear surgical margins and a 5‐year overall survival rate of 63% 63 . Several other studies have also reported similar positive outcomes with a 25 Gy dose fractionated across five sessions 64–69 . The HYPORT‐STS study differed from these by hypofractionating a more typical RT dose of 42.75 into 2.85 Gy individual fractions, which also showed comparable reductions in wound complications 70 .…”

Section: Radiation Therapymentioning

confidence: 70%

“…63 Several other studies have also reported similar positive outcomes with a 25 Gy dose fractionated across five sessions. [64][65][66][67][68][69] The HYPORT-STS study differed from these by hypofractionating a more typical RT dose of 42.75 into 2.85 Gy individual fractions, which also showed comparable reductions in wound complications. 70 Conversely, in a multicenter phase 2 trial, reduced fraction dosing (36 Gy) showed 91% of participants exhibiting significant pathological responses and decreased morbidity.…”

Section: Radiation Therapymentioning

confidence: 99%

Emerging innovations and advancements in the treatment of extremity and truncal soft tissue sarcomas

Walker,

Simister,

Carr‐Ascher

et al. 2023

Journal of Surgical Oncology

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In this special edition update on soft tissue sarcomas (STS), we cover classifications, emerging technologies, prognostic tools, radiation schemas, and treatment disparities in extremity and truncal STS. We discuss the importance of enhancing local control and reducing complications, including the role of innovative imaging, surgical guidance, and hypofractionated radiation. We review advancements in systemic and immunotherapeutic treatments and introduce disparities seen in this vulnerable population that must be considered to improve overall patient care.

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“…In people, there are two common preoperative radiation strategies accepted as standard of care for resectable, borderline resectable and nonresectable solid tumours: short‐course (typically 5 × 5 Gy or 5 × 6 Gy) and long‐course radiation therapy (typically 25 × 2.0 Gy) 8,9,20,21 . While both approaches have been shown to have near equal efficacy and acceptable safety in various solid tumour presentations, including breast, rectal, prostate, and soft tissue sarcomas, there is considerable debate on the optimum approach with no clear consensus 29–32 . The literature in veterinary medicine is sparse on neoadjuvant therapies in general and radiation in particular 11–13,18,19,33,34 .…”

Section: Discussionmentioning

confidence: 99%

Safety and feasibility of short course pre‐operative radiation therapy followed by surgical excision for canine solid tumours

Smith

Wustefeld‐Janssens

Hollenbeck

et al. 2022

Vet Comparative Oncology

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Surgical resection of solid tumours, especially in early stages of disease, remains a cornerstone of cancer treatment in dogs and cats. There are numerous publications that show a strong association between local tumour control and outcome. To achieve local control in some cases radiation therapy and surgery are combined, with radiation therapy being delivered in the neoadjuvant or adjuvant setting. The objective of the study was to report acute toxicity and surgical site complication data in dogs that received a short-course pre-operative (SCPO) radiation therapy protocol, followed by surgical excision for various solid tumours. Medical records were reviewed, and data was analysed retrospectively. Dogs were included if a dermal or subcutaneous solid tumour was treated with SCPO radiation therapy and then was resected on the last day of radiation or 2-3 weeks later. A total of 34 dogs with 35 primary tumours were included. Acute radiation toxicity was diagnosed in 14 sites (40%). VRTOG scores were grade 1 in 50%, grade 2 in 43%, and grade 3 in 7%. Surgical site complications were identified in 17% of dogs with an overall surgical site infection rate of 11%.According to the Clavien-Dindo classification, two dogs required medical intervention (grade 2), 1 dog required surgical intervention under general anaesthesia (grade 3b), and 1 dog died as a result of complications (grade 5). Logistic regression analysis found that anatomic site was significantly associated with complications, where tumours located on the extremity was protective (P = .02; OR 0.06).

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Neoadjuvant hypofractionated radiotherapy and chemotherapy for extremity soft tissue sarcomas: Safety, feasibility, and early oncologic outcomes of a phase 2 trial

Cited by 19 publications

References 32 publications

Preoperative Sequential Chemotherapy and hypofractionated Radiotherapy Combined with Comprehensive Surgical Resection for High-Risk Soft Tissue Sarcomas: A Retrospective Study

Preoperative Sequential Chemotherapy and hypofractionated Radiotherapy Combined with Comprehensive Surgical Resection for High-Risk Soft Tissue Sarcomas: A Retrospective Study

Emerging innovations and advancements in the treatment of extremity and truncal soft tissue sarcomas

Safety and feasibility of short course pre‐operative radiation therapy followed by surgical excision for canine solid tumours

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