Hypofractionated accelerated radiation dose-painting (HARD) improves outcomes in unresected soft-tissue sarcoma.

Autor: Bryant JM; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa 33612, FL, USA. Electronic address: John.Bryant@moffitt.org., Mills MN; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa 33612, FL, USA., Liveringhouse C; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa 33612, FL, USA., Palm R; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa 33612, FL, USA., Druta M; Department of Sarcoma, H. Lee Moffitt Cancer Center and Research Institute, Tampa 33612, FL, USA., Brohl A; Department of Sarcoma, H. Lee Moffitt Cancer Center and Research Institute, Tampa 33612, FL, USA., Reed DR; Department of Sarcoma, H. Lee Moffitt Cancer Center and Research Institute, Tampa 33612, FL, USA., Johnstone PA; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa 33612, FL, USA., Miller JT; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa 33612, FL, USA., Latifi K; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa 33612, FL, USA., Feygelman V; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa 33612, FL, USA., Yang GQ; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa 33612, FL, USA., Naghavi AO; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa 33612, FL, USA. Electronic address: Arash.Naghavi@moffitt.org.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2025 Jan; Vol. 202, pp. 110644. Date of Electronic Publication: 2024 Nov 19.
DOI: 10.1016/j.radonc.2024.110644
Abstrakt: Soft tissue sarcomas (STS) are radioresistant with a low α/β, which may have a biologic benefit with hypofractionation. For unresectable STS, the dose escalation required to achieve durable control is often limited by long-term toxicity risk. We sought to compare an isotoxic approach utilizing hypofractionated accelerated radiation dose-painting (HARD) versus standard fractionated radiation therapy (SFT) in patients with unresected STS. We conducted a retrospective analysis of patients with unresected STS who received either HARD (n = 49) or SFT (n = 43) with photon-based therapy between 1990 and 2022. The 2 HARD regimens each use 3 dose levels based on risk of disease burden. The gross disease, intermediate risk, and low-risk clinical target volumes were treated with either 20-22 fractions of 3/2.5/2-2.2 Gy or 28 fractions of 2.5/2.2/1.8 Gy. SFT included patients treated with definitive intent, receiving ≥ 50 Gy in 1.8-2 Gy per fraction. Clinical endpoints included 3-year local control (LC), overall survival (OS), and progression-free survival (PFS), along with treatment-related toxicity. With a median age of 67 and tumor size of 7 cm, most patients were stage IV (37 %), grade 3 (67 %), had no concurrent systemic therapy (70 %), and were lower extremity tumors (24 %). HARD cohort consisted of higher age, stage, recurrent disease, and median BED 4 (p < 0.05), when compared to SFT. With a median follow-up of 35.9 months, HARD demonstrated significant improvement in 3-year LC (96.4 % vs. 48.4 %, p < 0.001), compared to SFT overall, with a median PFS benefit (16 vs. 10 months, p = 0.037) for non-distantly metastatic patients at baseline. On multivariate analysis, HARD was significantly associated with improved LC (HR 0.058, 95 % CI 0.005-0.682, p = 0.024). The HARD regimen found no significant increase in toxicity, with limited acute grade 3 (24 %, all dermatitis) and late grade 3 toxicity (6 %) observed, with no grade 4 or 5 events. HARD regimen significantly improves LC for unresectable STS without a significant increase in toxicity, when compared to a standard fractionated approach, supporting further prospective investigation of this treatment approach.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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