Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX..
Department of Radiation Oncology, Dana Farber/Brigham Women's Hospital, Boston, MA.
Semin Radiat Oncol. 2024 Apr;34(2):180-194. doi: 10.1016/j.semradonc.2023.12.003.
This critical review aims to summarize the relevant published data regarding hypofractionation regimens for preoperative radiation therapy (RT) prior to surgery for soft tissue sarcoma (STS) of the extremity or superficial trunk. We identified peer-reviewed publications using a PubMed search on the MeSH headings of "soft tissue sarcoma" AND "hypofractionated radiation therapy." To obtain complication data on similar anatomical radiotherapeutic scenarios we also searched "hypofractionated radiation therapy" AND "melanoma" as well as "hypofractionated radiation therapy" AND "breast cancer." We then used reference lists from relevant articles to obtain additional pertinent publications. We also incorporated relevant abstracts presented at international sarcoma meetings and relevant clinical trials as listed on the ClinicalTrials.gov website. Detailed data are presented and contextualized for ultra-hypofractionated and moderately hypofractionated regimens with respect to local control, wound complications, and amputation rates. Comparative data are also presented for late toxicities including: fibrosis, joint limitation, edema, skin integrity, and bone fracture or necrosis. These data are compared to a standard regimen of 50 Gy in 25 daily fractions delivered over 5 weeks. This analysis supports the continued use of a standard regimen for preoperative RT for STS of 25 × 2 Gy over 5 weeks without concurrent chemotherapy. Use of concurrent chemotherapy with preoperative RT for STS should be reserved for well-designed clinical trials. A randomized trial of ultra-hypofractionated and moderately hypofractionated pre op RT for STS is warranted, but it is critical for the primary endpoint (or co-primary endpoint) to be late toxicity to: bone, soft tissue, joint, and skin.
这篇评论性综述旨在总结关于术前放射治疗（RT）的相关文献，这些文献是关于四肢或浅表躯干软组织肉瘤（STS）术前的短程放疗方案。我们使用 PubMed 上的 MeSH 标题“软组织肉瘤”和“短程放疗”进行了同行评议文献的检索。为了获得类似解剖学放射治疗情况下的并发症数据，我们还检索了“短程放疗”和“黑色素瘤”以及“短程放疗”和“乳腺癌”。然后，我们使用相关文章的参考文献列表获得了其他相关出版物。我们还将国际肉瘤会议上的相关摘要和 ClinicalTrials.gov 网站上列出的相关临床试验纳入其中。我们详细介绍并比较了超短程和中短程放疗方案在局部控制、伤口并发症和截肢率方面的结果。我们还比较了晚期毒性的相关数据，包括纤维化、关节受限、水肿、皮肤完整性以及骨折或坏死。这些数据与标准的 50 Gy/25 次/5 周方案进行了比较。这项分析支持继续使用标准的术前 RT 方案治疗 STS，即 25 次 2 Gy/5 周，无需同期化疗。术前 RT 联合同期化疗应保留用于精心设计的临床试验。需要进行超短程和中短程术前 RT 治疗 STS 的随机试验，但至关重要的是，主要终点（或共同主要终点）应是晚期毒性，包括骨骼、软组织、关节和皮肤的毒性。
