Preoperative stereotactic ablative body radiotherapy with postoperative conventional irradiation of soft tissue sarcomas: Protocol overview with a preliminary safety report

Новиков, С. Н.; Gafton, Georgiy; Ebert, Mariya; Fedosova, E.; Melnik, J.; Zinovev, Grigoriy; Gafton, Ivan; Sinyachkin, M. S.; Kanaev, Sergey

doi:10.1016/j.radonc.2021.05.025

Cited by 6 publications

(3 citation statements)

References 14 publications

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“…The VMAT plans were done with multiple arcs so that at least 95% of the PTV received 100% of the dose. In cases where the tumor was close to the skin, the skin flash tool was used ( 15 , 16 ). Normal tissue constraints included: (1) Part of the longitudinal skin and subcutaneous tissue contralateral to the target area was protected as much as possible; (2) An uninvolved skin strip >2 cm in size coplanar to the PTV to <10 Gy mean dose; (3) ALARA principles were utilized for any joint in proximity to PTV; (4) If the dose to the PTV conflicts with the dose to the organs at risk, normal tissue restriction should be given priority.…”

Section: Methodsmentioning

confidence: 99%

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Preoperative sequential chemotherapy and hypofractionated radiotherapy combined with comprehensive surgical resection for high-risk soft tissue sarcomas: a retrospective study

Qu,

Tian,

Wang

et al. 2024

Front. Oncol.

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IntroductionThe management of soft tissue sarcomas presents considerable therapeutic challenges. This study was designed to assess the efficacy of neoadjuvant sequential chemotherapy and hypofractionated radiotherapy in conjunction with extensive surgical resection for the treatment of high-risk soft tissue sarcomas.Materials and methodsWe performed a retrospective review of 31 high-risk soft tissue sarcoma patients treated at our institution from June 2021 to June 2023. The cohort consisted of 21 males and 10 females with a mean age of 55.7 years and included both initial and recurrent disease presentations. Our treatment regimen comprised two to three cycles of neoadjuvant chemotherapy coupled with hypofractionated radiotherapy, delivered at 5 Gy per fraction to a total dose of 25–35 Gy across 5–7 days, prior to surgical resection aimed at achieving wide margins. Data collection was systematic, covering surgical outcomes, chemoradiotherapy-related complications, and prognostic factors.ResultsAll patients completed the prescribed course of neoadjuvant chemoradiotherapy. 29% patients experienced grade 3+ chemotherapy toxicity, necessitating a reduction or interruption in their chemotherapy regimen. Limb preservation was accomplished in 30 patients finally. Response evaluation using RECIST 1.1 criteria post-neoadjuvant therapy revealed 9.7% with PD, 58.1% with SD, 29% with a PR, and 3.2% with a CR, culminating in an ORR of 32.2%. Postoperative complications included superficial wound infections in four patients and deep incisional infections in another four. 6 patients had developed metastasis, and 3 patients were still alive. Two experienced local recurrence. One-year DFS was 79.3%, with a one-year OS rate of 89.6%.ConclusionNeoadjuvant sequential chemotherapy and hypofractionated radiotherapy followed by extensive surgical resection represents an effective treatment paradigm for high-risk soft tissue sarcomas. This multimodal approach not only facilitates tumor reduction but also significantly reduces the risks of local recurrence and distant metastasis.

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Section: Methodsmentioning

confidence: 99%

“…Preoperative MRI, surgical and pathology reports were used to create postopGTV. PostopCTV included postopGTV with 3 cm margins in cranio-caudal direction and 1.5 cm margins in the radial dimensions (without going beyond the boundaries of the involved compartment) ( 15 ).…”

Section: Methodsmentioning

confidence: 99%

Preoperative sequential chemotherapy and hypofractionated radiotherapy combined with comprehensive surgical resection for high-risk soft tissue sarcomas: a retrospective study

Qu,

Tian,

Wang

et al. 2024

Front. Oncol.

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“…SBRT has already been widely applied to advanced breast cancer as salvage treatment targeting to osseous and brain metastasis or other oligometastatic sites (Nicosia et al, 2022;Viani et al, 2021). Preoperative SBRT may be advantageous for downstaging the tumor to enable breast conservation and improving pCR rate (Piras et al, 2023), with multiple trials investigating neoadjuvant SBRT in various malignancies (Holyoake et al, 2021;Kishi et al, 2020;Liu et al, 2022;Novikov et al, 2021) are currently ongoing. In addition, preclinical evidence suggested that SBRT has immunomodulatory properties by inducing cancer cells necrosis and releasing neoantigens to boost neoantigen-specific immune response and upregulate the expression of PD-L1 on tumor cells (Deng et al, 2014;Han et al, 2022;Park et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of neoadjuvant stereotactic body radiotherapy plus adebrelimab and chemotherapy for triple-negative breast cancer: A pilot study

Chen,

Gu,

Zhang

et al. 2023

Preprint

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Background:Emerging data have supported the immunostimulatory role of radiotherapy, which could exert a synergistic effect with immune checkpoint inhibitors (ICIs). With proven effective but suboptimal efficacy of ICI and chemotherapy in triple-negative breast cancer (TNBC), we designed a pilot study to explore the efficacy and safety of neoadjuvant stereotactic body radiotherapy (SBRT) plus adebrelimab and chemotherapy in TNBC patients.Methods:Treatment-naïve TNBC patients received two cycles of intravenous adebrelimab (20mg/kg, every 3 weeks), and SBRT (24Gy/3f, every other day) started at the second cycle, then followed by six cycles of adebrelimab plus nab-paclitaxel (125 mg/m² on days 1 and 8) and carboplatin (area under the curve 6 mg/mL per min on day 1) every 3 weeks. The surgery was performed within 3-5 weeks after the end of neoadjuvant therapy. Primary endpoint was pathological complete response (pCR, ypT0/is ypN0). Secondary endpoints included objective response rate (ORR), residual cancer burden (RCB) 0-I and safety.Results:13 patients were enrolled and received at least one dose of therapy. 10 (76.9%) patients completed SBRT and were included in efficacy analysis. 90% (9/10) of patients achieved pCR, both RCB 0-I and ORR reached 100% with 3 patients achieved complete remission. Adverse events (AEs) of all?grade and grade 3-4 occurred in 92.3% and 53.8%, respectively. 1 (7.7%) patient had treatment-related serious AEs. No radiation-related dermatitis or death occurred.Conclusions:Adding SBRT to adebrelimab and neoadjuvant chemotherapy led to a substantial proportion of pCR with acceptable toxicities, supporting further exploration of this combination in TNBC patients.Funding:This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Clinical trial number:NCT05132790.

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Preoperative ultra-hypofractionation radiotherapy in extremity/trunk wall soft tissue sarcoma — A meta-analysis of prospective studies

Kao¹

2023

Cancer/Radiothérapie

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Preoperative stereotactic ablative body radiotherapy with postoperative conventional irradiation of soft tissue sarcomas: Protocol overview with a preliminary safety report

Cited by 6 publications

References 14 publications

Preoperative sequential chemotherapy and hypofractionated radiotherapy combined with comprehensive surgical resection for high-risk soft tissue sarcomas: a retrospective study

Preoperative sequential chemotherapy and hypofractionated radiotherapy combined with comprehensive surgical resection for high-risk soft tissue sarcomas: a retrospective study

Efficacy and Safety of neoadjuvant stereotactic body radiotherapy plus adebrelimab and chemotherapy for triple-negative breast cancer: A pilot study

Preoperative ultra-hypofractionation radiotherapy in extremity/trunk wall soft tissue sarcoma — A meta-analysis of prospective studies

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