Top Line: Can preoperative radiation dose be reduced for myxoid liposarcoma?
The Study: Myxoid liposarcoma is a bit of an outlier among sarcomas in being very radiosensitive. With standard preoperative doses, they frequently have marked reduction in tumor volume at surgery. And while the standard 50 Gy in 25 fractions has excellent outcomes, there is a risk of postop complications. The DOREMY trial tested whether dose de-escalation is effective for myxoid liposarcoma. This single-arm phase 2 trial enrolled 90 patients with translocation-confirmed, nonmetastatic MLS of the extremity or trunk, treating all to 36 Gy in 18 daily fractions with IMRT. At a median follow-up of 66 months, 5-year local recurrence free survival was an impressive 97.4%. Of the two local recurrences, one had positive margins and a poor pathologic response, and the other was a 32-cm tumor with close margins. Five-year PFS, DSS, and OS were 81%, 89.5%, and 88.5%, respectively. Wound complications requiring intervention occurred in 16%, any grade 2+ late AEs in 18%, and grade 3 events in only 3%. It’s worth noting that the radiobiologically comparable 25 Gy/5 fx regimen has also shown good early control, so the de-escalation signal isn't isolated to this schedule.
TBL: In this single arm, phase 2 trial, reduced dose (36 Gy in 18 fractions) preoperative RT for myxoid liposarcoma resulted in 97.4% LRFS at 5 years. | Lansu, JAMA Oncol 2026
The Study: Myxoid liposarcoma is a bit of an outlier among sarcomas in being very radiosensitive. With standard preoperative doses, they frequently have marked reduction in tumor volume at surgery. And while the standard 50 Gy in 25 fractions has excellent outcomes, there is a risk of postop complications. The DOREMY trial tested whether dose de-escalation is effective for myxoid liposarcoma. This single-arm phase 2 trial enrolled 90 patients with translocation-confirmed, nonmetastatic MLS of the extremity or trunk, treating all to 36 Gy in 18 daily fractions with IMRT. At a median follow-up of 66 months, 5-year local recurrence free survival was an impressive 97.4%. Of the two local recurrences, one had positive margins and a poor pathologic response, and the other was a 32-cm tumor with close margins. Five-year PFS, DSS, and OS were 81%, 89.5%, and 88.5%, respectively. Wound complications requiring intervention occurred in 16%, any grade 2+ late AEs in 18%, and grade 3 events in only 3%. It’s worth noting that the radiobiologically comparable 25 Gy/5 fx regimen has also shown good early control, so the de-escalation signal isn't isolated to this schedule.
TBL: In this single arm, phase 2 trial, reduced dose (36 Gy in 18 fractions) preoperative RT for myxoid liposarcoma resulted in 97.4% LRFS at 5 years. | Lansu, JAMA Oncol 2026