Department of Radiation Oncology, Centro Integral Oncológico Clara Campal (C.I.O.C.C.), HM Hospitales, Calle Oña 10, 28050, Madrid, Spain.
Facultad de Ciencias de la Salud, Universidad Camilo José Cela, Madrid, Spain.
Clin Transl Oncol. 2024 Jan;26(1):204-213. doi: 10.1007/s12094-023-03237-y. Epub 2023 Jun 5.
Preoperative radiation therapy following by limb-sparing or conservative surgery is a standard approach for limb and trunk STS. Data supporting hypofractionated radiotherapy schedules are scarce albeit biological sensitivity of STS to radiation would justify it. We sought to evaluate the impact of moderate hypofractionation on pathologic response and its influence on oncologic outcomes.
From October 2018 to January 2023, 18 patients with limb or trunk STS underwent preoperative radiotherapy at a median dose of 52.5 Gy (range 49.5-60 Gy) in 15 fractions of 3.5 Gy (3.3-4 Gy) with or without neoadjuvant chemotherapy. A favorable pathologic response (fPR) was considered as ≥ 90% tumor necrosis on specimen examination.
All patients completed planned preoperative radiotherapy. Eleven patients (61.1%) achieved a fPR, and 7 patients (36.8%) a complete pathologic response with total disappearance of tumor cells. Nine patients (47%) developed grade 1-2 acute skin toxicity, and 7 patients (38.8%) had wound complications on follow-up. With a median follow-up of 14 months (range 1-40), no cases of local relapse were observed, and actuarial 3-year overall survival (OS) and distant metastases-free survival (DMFS) are 87% and 76.4%, respectively. In the univariate analysis, the presence of a favorable pathologic response (fPR) was associated with improved 3-year OS (100% vs. 56.03%, p = 0.058) and 3-year DMFS (86.91% vs. 31.46%, p = 0.002). Moreover, both complete or partial RECIST response and radiological stabilization of the tumor lesion showed a significant association with higher rates of 3-year distant metastasis-free survival (DMFS) (83% vs. 83% vs. 56%, p < 0.001) and 3-year overall survival (OS) (100% vs. 80% vs. 0, p = 0.002).
Preoperative moderate hypofractionated radiation treatment for STS is feasible and well tolerated and associates encouraging rates of pathologic response that could have a favorable impact on final outcomes.
保肢或保守手术联合术前放疗是肢体和躯干软组织肉瘤（STS）的标准治疗方法。尽管 STS 对放疗具有生物学敏感性，但支持分割剂量放疗方案的数据仍然缺乏。我们旨在评估适度分割放疗对病理反应的影响及其对肿瘤学结果的影响。
自 2018 年 10 月至 2023 年 1 月，18 例肢体或躯干 STS 患者接受术前放疗，中位剂量为 52.5Gy（范围 49.5-60Gy），15 次分割，每次 3.5Gy（3.3-4Gy），联合或不联合新辅助化疗。将标本检查肿瘤坏死率≥90%定义为良好的病理反应（fPR）。
所有患者均完成了计划的术前放疗。11 例（61.1%）患者达到 fPR，7 例（36.8%）患者完全病理缓解，肿瘤细胞完全消失。9 例（47%）患者发生 1-2 级急性皮肤毒性，7 例（38.8%）患者在随访中出现伤口并发症。中位随访 14 个月（范围 1-40），无局部复发病例，3 年总生存率（OS）和无远处转移生存率（DMFS）分别为 87%和 76.4%。单因素分析显示，良好的病理反应（fPR）与改善的 3 年 OS（100% vs. 56.03%，p=0.058）和 3 年 DMFS（86.91% vs. 31.46%，p=0.002）相关。此外，完全或部分 RECIST 反应和肿瘤病变的影像学稳定与更高的 3 年无远处转移生存率（DMFS）（83% vs. 83% vs. 56%，p<0.001）和 3 年总生存率（OS）（100% vs. 80% vs. 0，p=0.002）显著相关。
STS 的术前适度分割放疗是可行的，且耐受良好，并可获得较高的病理反应率，这可能对最终结果产生有利影响。
