Fan Cong, Nystrom Lukas, Mesko Nathan W, Burke Zachary D, Mayo Zachary S, Shah Chirag S, Koyfman Shlomo A, Scott Jacob, Campbell Shauna R
Cleveland Clinic Lerner College of Medicine.
Department of Orthopedic Surgery.
Am J Clin Oncol. 2025 Jul 1;48(7):345-350. doi: 10.1097/COC.0000000000001185. Epub 2025 Mar 18.
This study compares toxicity and oncologic outcomes in a matched cohort of soft tissue sarcoma (STS) patients receiving ultra-hypofractionated preoperative radiation therapy (RT) or standard fractionated RT.
This IRB-approved study included patients with STS of the extremity, pelvis, or trunk treated with preoperative RT followed by surgical resection. Patients received either standard RT or ultra-hypofractionated RT (≥30 Gy over 5 fractions) between 2016 and 2023 with intensity-modulated RT at a single institution. Ultra-hypofractionated RT patients proceeded to surgical resection 0 to 7 days after RT and standard fractionated RT group 4 to 6 weeks after completion. The cohorts were matched based on tumor location and type of surgical closure. An inverse propensity weighting (IPW) method was used to balance group covariates.
A total of 74 patients were included in this study. 37 patients treated with ultra-hypofractionated RT were matched with 37 patients treated with standard fractionation RT. Median follow-up time was 21.00 [IQR 11.00, 45.00] months for ultra-hypofractionated RT and 29.00 [IQR 13.00, 43.00] months for standard fractionated RT ( P =0.58). Rates of major wound complications (MWC) were 44.4% ultra-hypofractionated RT versus 29.7% standard RT ( P =0.289). On logistic regression, MWC (OR 1.9, 95% CI 0.97-3.76, P =0.06) and wound dehiscence (OR 3.91, 95% CI 1.81-8.73, P =0.0006) were more common in the ultra-hypofractionated RT group. Clinically significant late toxicity (grade ≥2 fibrosis, joint stiffness, or edema) did not differ significantly. There was no difference in local control ( P =1.00) or distant metastases ( P =0.465).
Ultra-hypofractionated RT for STS results in excellent disease control. To reduce the risk of MWC, we have adopted delayed surgical resection for ultra-hypofractionated RT patients of 4 to 6 weeks.
本研究比较了接受超分割术前放射治疗（RT）或标准分割RT的软组织肉瘤（STS）患者队列中的毒性和肿瘤学结局。
这项经机构审查委员会批准的研究纳入了接受术前RT然后手术切除的肢体、骨盆或躯干STS患者。2016年至2023年期间，患者在单一机构接受标准RT或超分割RT（5次分割内≥30 Gy），采用调强放疗。超分割RT患者在放疗后0至7天进行手术切除，标准分割RT组在完成后4至6周进行手术切除。根据肿瘤位置和手术闭合类型对队列进行匹配。采用逆倾向加权（IPW）方法平衡组协变量。
本研究共纳入74例患者。37例接受超分割RT治疗的患者与37例接受标准分割RT治疗的患者相匹配。超分割RT的中位随访时间为21.00 [四分位间距11.00, 45.00] 个月，标准分割RT为29.00 [四分位间距13.00, 43.00] 个月（P =0.58）。严重伤口并发症（MWC）发生率在超分割RT组为44.4%，标准RT组为29.7%（P =0.289）。逻辑回归显示，MWC（比值比1.9，95%置信区间0.97 - 3.76，P =0.06）和伤口裂开（比值比3.91，95%置信区间1.81 - 8.73，P =0.0006）在超分割RT组更常见。具有临床意义的晚期毒性（≥2级纤维化、关节僵硬或水肿）无显著差异。局部控制（P =1.00）或远处转移（P =0.465）也无差异。
STS的超分割RT可实现良好的疾病控制。为降低MWC风险，我们对超分割RT患者采用了4至6周的延迟手术切除。
