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Meta-Analysis of 5-Fraction Preoperative Radiotherapy for Soft Tissue Sarcoma. | LitMetric

AI Article Synopsis

  • * The analysis included 7 studies with a total of 209 patients, revealing a high 2-year local control (LC) rate of 96.9% and a major wound complication (MWC) rate of 30.6%, with no significant differences in complications based on radiation dosage.
  • * The findings suggest that preoperative 5-fraction RT provides excellent local control while maintaining similar levels of complications and toxicities compared to traditional radiation methods, indicating a need for larger trials with standardized treatment protocols.

Article Abstract

Objectives: Studies investigating preoperative 5-fraction radiation therapy (RT) for soft tissue sarcoma (STS) are limited. We performed a meta-analysis to determine the efficacy and safety of this treatment paradigm.

Methods: This study-level meta-analysis was conducted using Bayesian methods. Statistical estimation for risk of outcome rates was conducted by posterior mean and 95% highest posterior density (HPD) intervals. Studies with 2-year local control (LC) and description of major wound complications (MWC) per the CAN-NCIC-SR2 study were included and served as the primary endpoints. Secondary endpoints included rates of acute and late toxicity. A total of 10 studies were identified and 7 met the inclusion criteria. Subgroup analyses were performed for ≥30 Gy vs <30 Gy.

Results: A total of 209 patients from 7 studies were included. Five studies used ≥30 Gy (n=144), and 2 studies <30 Gy (n=64). Median follow-up was 29 months (range: 21 to 57 mo). Primary tumor location was lower extremity in 68% and upper extremity in 22%. Most tumors were intermediate or high grade (95%, 160/169), and 50% (79/158) were >10 cm. The two-year LC for the entire cohort was 96.9%, and the rate of MWC was 30.6%. There was a trend toward improved LC with ≥ 30 Gy (95% HPD: 0.95 to 0.99 vs 0.84 to 0.99). There was no difference in MWC (95% HPD: 0.18 to 0.42 vs 0.17 to 0.55) or late toxicity between the groups.

Conclusions: Preoperative 5-fraction RT for STS demonstrates excellent 2-year LC with MWC and toxicity similar to standard fractionation preoperative RT. Multi-institutional trials with a universal RT protocol are warranted.

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Source
http://dx.doi.org/10.1097/COC.0000000000001110DOI Listing

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