The Feasibility Study of Hypofractionated Radiotherapy with Regional Hyperthermia in Soft Tissue Sarcomas

Abstract

Introduction: Management of marginally resectable or unresectable soft tissue sarcomas (STS) in patients who are not candidates for neoadjuvant chemotherapy due to chemoresistant pathology or contraindications remains a challenge. Therefore, in these indications, we aimed to investigate a feasibility of 10x 3.25 Gy radiotherapy combined with regional hyperthermia (HT) that could be followed by surgery or 4x4 Gy radiotherapy with HT. Materials and methods: We recruited patients with locally advanced marginally resectable or unresectable STS who (1) presented chemoresistant STS subtype, or (2) progressed after neoadjuvant chemotherapy, or (3) were unfit for chemotherapy. The primary endpoint was the feasibility of the proposed regimen. Results: Thirty patients were enrolled. All patients received the first part of the treatment, namely radiotherapy with HT. Among them, 14 received the second part of radiotherapy with HT whereas 13 patients underwent surgery. Three patients did not complete the treatment protocol. The feasibility criteria were fulfilled in 90% of patients. Two patients developed distant metastases. One patient died due to distant progression. One patient developed rapid local recurrence after surgery. Conclusions: Hypofractionated radiotherapy with HT is a feasible treatment for marginally resectable or unresectable STS in patients who are not candidates for chemotherapy. Results of this clinical trial support the further validation of RT and HT combinations in STS.

Novel Definitive Hypofractionated Accelerated Radiation Dose-painting (HARD) for Unresected Soft Tissue Sarcomas

“…Achieving durable LC in unresected STS with RT has been limited by its radioresistant nature, 4 , 5 , 6 , 7 , 8 with photon-based 5-year LC of 28 to 73%. 31 Many attempts have been made to improve the LC for unresectable STS treated with RT, including concurrent systemic therapy, 32 heavy ion therapy, 33 combined hyperthermia, 34 and hypofractionation. 35 However, our study demonstrated impressive outcomes using our novel HARD photon-based regimen, with no instances of local or regional progression observed in this historically radioresistant cohort.…”

Neoadjuvant Radiation Therapy with Interdigitated High-Dose LRT for Voluminous High-Grade Soft-Tissue Sarcoma

“…If proven effective, this technique could merge with the broader front of the management of STS including marginally resectable and unresectable, in which novel approaches of combining various fractionation RT schemes with other treatment modalities including hyperthermia and chemotherapy have been actively proposed and investigated. 90 , 91 …”

Epithelioid sarcoma

“…Currently hypofractionated preoperative RT may be advised [87,88]. Referral to a sarcoma center for hypofractionated radiotherapy with hyperthermia may be considered in patients with marginally resectable or unresectable ES and in patients who are not eligible for chemotherapy [89]. Adjuvant radiation therapy is recommended in cases with positive margins (R1/R2 resections).…”