Matched Cohort Analysis of Ultra-hypofractionated Versus Standard Fractionation Preoperative Radiation Therapy for Soft Tissue Sarcoma.

IF 1.8 4区医学 Q4 ONCOLOGY American Journal of Clinical Oncology-Cancer Clinical Trials Pub Date : 2025-07-01 Epub Date: 2025-03-18 DOI:10.1097/COC.0000000000001185

Cong Fan, Lukas Nystrom, Nathan W Mesko, Zachary D Burke, Zachary S Mayo, Chirag S Shah, Shlomo A Koyfman, Jacob Scott, Shauna R Campbell

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Abstract

Objective: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

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软组织肉瘤术前放疗超低分割与标准分割的匹配队列分析。

目的：本研究比较了一组接受超低分割术前放射治疗（RT）或标准分割术前放射治疗的软组织肉瘤（STS）患者的毒性和肿瘤预后。方法：这项经irb批准的研究纳入了肢体、骨盆或躯干的STS患者，术前接受RT治疗，然后手术切除。2016年至2023年期间，患者在单一机构接受标准放疗或超低分割放疗（≥30 Gy / 5分），并进行强度调节放疗。超低分割组患者在放疗后0 ~ 7天进行手术切除，标准分割组在完成后4 ~ 6周进行手术切除。根据肿瘤位置和手术闭合类型进行配对。采用逆倾向加权（IPW）法平衡组协变量。结果：本研究共纳入74例患者。37例患者采用超缩小分割放疗与37例标准分割放疗相匹配，超缩小分割放疗中位随访时间为21.00 [IQR: 11.00, 45.00]个月，标准分割放疗中位随访时间为29.00 [IQR: 13.00, 43.00]个月（P=0.58）。严重伤口并发症（MWC）的发生率超低分割放疗组为44.4%，标准放疗组为29.7% （P=0.289）。经logistic回归分析，MWC （OR 1.9, 95% CI 0.97-3.76， P=0.06）和创面裂开（OR 3.91, 95% CI 1.81-8.73， P=0.0006）在超低分割RT组中更为常见。临床显著的晚期毒性（≥2级纤维化、关节僵硬或水肿）无显著差异。There在局部对照（P=1.00）和远处转移（P=0.465）中无差异。结论：超低分割RT治疗STS有良好的疾病控制效果。为了降低MWC的风险，我们对超低分割RT患者4 ~ 6周采取延迟手术切除。

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来源期刊

American Journal of Clinical Oncology-Cancer Clinical Trials 医学-肿瘤学

CiteScore

4.90

自引率

0.00%

发文量

130

审稿时长

4-8 weeks

期刊介绍： American Journal of Clinical Oncology is a multidisciplinary journal for cancer surgeons, radiation oncologists, medical oncologists, GYN oncologists, and pediatric oncologists. The emphasis of AJCO is on combined modality multidisciplinary loco-regional management of cancer. The journal also gives emphasis to translational research, outcome studies, and cost utility analyses, and includes opinion pieces and review articles. The editorial board includes a large number of distinguished surgeons, radiation oncologists, medical oncologists, GYN oncologists, pediatric oncologists, and others who are internationally recognized for expertise in their fields.