Top Line: What is the rate of post-op wound complication following hypofractionated radiation for soft tissue sarcoma?
The Study: Neoadjuvant radiation is often employed prior to resection of extremity and superficial soft tissue sarcoma to reduce recurrence risk. Compared to adjuvant RT, neoadjuvant RT is often shorter and has less long-term toxicity, but it has a higher risk of wound complications. MC1973 was a phase 2 trial of 120 patients with resectable extremity (48.7% proximal lower extremity) or superficial trunk STS who were planned to receive neoadjuvant RT. The RT regimen was 42.75 Gy in 15 fractions over 3 weeks. The CTV was a standard 2-4 cm longitudinal margin and 1-1.5 cm radial margin from the gross tumor. The adjacent bone was limited to a mean dose ≤ 32 Gy and V35 <64% while a contralateral segment of soft tissue was limited to V18 <50% to avoid circumferential treatment. The rate of major post op wound complications was 23.1%, and the majority of these were in the proximal lower extremities (67%). DFS at 1 year was 86%. Another recent phase 2 trial, HYPORT-STS, also evaluated 42.75 Gy in 15 fractions but with longer follow up. In that trial, the rate of wound complications was 31%, and the rate of local recurrence free survival at 4 years was 93%.
TBL: In this prospective, phase 2 trial, the rate of wound complications after hypofractionated neoadjuvant RT for soft tissue sarcoma was comparable to that of conventional fractionation. | Ahmed, Int J Radiat Oncol Biol Phys 2025
The Study: Neoadjuvant radiation is often employed prior to resection of extremity and superficial soft tissue sarcoma to reduce recurrence risk. Compared to adjuvant RT, neoadjuvant RT is often shorter and has less long-term toxicity, but it has a higher risk of wound complications. MC1973 was a phase 2 trial of 120 patients with resectable extremity (48.7% proximal lower extremity) or superficial trunk STS who were planned to receive neoadjuvant RT. The RT regimen was 42.75 Gy in 15 fractions over 3 weeks. The CTV was a standard 2-4 cm longitudinal margin and 1-1.5 cm radial margin from the gross tumor. The adjacent bone was limited to a mean dose ≤ 32 Gy and V35 <64% while a contralateral segment of soft tissue was limited to V18 <50% to avoid circumferential treatment. The rate of major post op wound complications was 23.1%, and the majority of these were in the proximal lower extremities (67%). DFS at 1 year was 86%. Another recent phase 2 trial, HYPORT-STS, also evaluated 42.75 Gy in 15 fractions but with longer follow up. In that trial, the rate of wound complications was 31%, and the rate of local recurrence free survival at 4 years was 93%.
TBL: In this prospective, phase 2 trial, the rate of wound complications after hypofractionated neoadjuvant RT for soft tissue sarcoma was comparable to that of conventional fractionation. | Ahmed, Int J Radiat Oncol Biol Phys 2025