Hypofractionated Pre-operative Radiotherapy for Soft Tissue Sarcoma: A Systematic Review
A partir d'une revue systématique de la littérature publiée jusqu'en octobre 2023 (25 articles), cette étude fait le point sur la radiothérapie hypofractionnée pour le traitement pré-opératoire d'un sarcome des tissus mous
Purpose: Hypofractionated radiotherapy (HFRT) is being used more frequently for many common cancer sites. Conventionally fractionated radiotherapy treatment regimens have remained the standard of care when radiotherapy is indicated for soft tissue sarcoma (STS). The aim of this study is to systematically review published data on the use of pre-operative hypofractionated radiotherapy as part of a curative treatment paradigm in patients with soft tissue sarcoma. Herein we summarise current evidence for the use of hypofractionated radiotherapy in the pre-operative treatment of STS. Methods and Materials: We conducted a database search for prospectively or retrospectively collected data on patients with a diagnosis of soft tissue sarcoma treated with HFRT. Studies evaluating soft tissues sarcoma of all histological subtypes affecting extremities or trunk were included in the search. Articles were screened by two independent reviewers for inclusion in this review. Patient, treatment, toxicity and outcome data was recorded and collated from selected studies. Results: 25 articles are included in this review. Nine prospective trials have been published since 2020. Dose fractionations range from 25-40Gy in 5 fractions or 28-42.75Gy in 8-15 fractions. Local control and overall survival outcomes are consistent with historical data for conventionally fractionated radiotherapy. Acute toxicity and wound complication rates are in keeping with acceptable results. Late toxicity data is limited and requires longer follow up. Rates of pathological complete response are promising across all studies. Conclusions: There is a growing body of evidence supporting hypofractionation as safe and effective in the pre-operative treatment of STS. This review highlights potential areas that could be further investigated to optimise pre-operative treatment for soft tissue sarcoma.