Early Outcomes of Preoperative 5-fraction Radiation Therapy for Soft Tissue Sarcoma Followed by Immediate Surgical Resection

ABSTRACT Purpose/Objectives There are limited data regarding the use of hypofractionated radiation therapy (RT) for soft tissue sarcoma. We report early oncologic outcomes and wound complications of patients undergoing preoperative hypofractionated (5 fraction) RT followed by immediate surgical resection. Materials/Methods An IRB-approved database of patients treated with preoperative RT for soft tissue sarcoma was queried. Patients treated with a hypofractionated dosing regimen followed by immediate (within 7 days) planned wide surgical resection were identified. Results Between 2016 to 2019, sixteen patients met eligibility criteria. The median clinical follow-up was 10.7 months (range 1.7-33.2). The median patient age was 64 years old (range 33-88). Ten of the sarcomas were located in the lower extremity, 4 in the upper extremity, and two were located in the trunk. Five patients had metastatic disease at diagnosis. The majority of the patients received a total radiation dose of 30 Gy in 5 fractions (range 27.5-40 Gy) on consecutive days. All patients were planned with IMRT/VMAT. The median time to surgical resection following the completion of RT was 1 day (range 0-7 days). The median time from initial biopsy results to completion of primary oncologic therapy was 20 days (range 16-35). Ten patients achieved R0 resection, whereas the remaining 6 patients achieved R1 resection. Of the 13 patients assessed for local control, no patients developed local failure. Five patients developed wound healing complications (31%), of which only three patients (19%) required return to the operating room. Conclusions Treatment of soft tissue sarcoma with preoperative hypofractionated RT followed by immediate resection resulted in a median of 20 days from biopsy results to completion of oncologic therapy. Early outcomes demonstrate favorable wound healing. Further prospective data with long-term follow-up is required to determine the oncologic outcomes and toxicity of hypofractionated preoperative RT.