Preoperative hypofractionated radiotherapy for soft tissue sarcoma

In The Lancet Oncology, B Ashleigh Guadagnolo and colleagues 1 Guadagnolo BA Bassett RL Mitra D et al. Hypofractionated, 3-week, preoperative radiotherapy for patients with soft tissue sarcomas (HYPORT-STS): a single-centre, open-label, single-arm, phase 2 trial. Lancet Oncol. 2022; 23: 1547-1557 Summary Full Text Full Text PDF Scopus (10) Google Scholar report the early results of a single-arm, single-centre, prospective trial (HYPORT-STS) evaluating a moderately hypofractionated regimen of preoperative radiotherapy (42·75 Gy in 15 fractions of 2·85 Gy/day for 3 weeks [five fractions per week]) in patients with soft tissue sarcomas of the extremities or trunk. The authors chose the landmark CAN-NCIC-SR2 trial 2 O'Sullivan B Davis AM Turcotte R et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002; 359: 2235-2241 Summary Full Text Full Text PDF PubMed Scopus (1177) Google Scholar , 3 Davis AM O'Sullivan B Turcotte R et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol. 2005; 75: 48-53 Summary Full Text Full Text PDF PubMed Scopus (524) Google Scholar for comparison in the absence of randomisation and strictly defined their primary endpoint of major wound complications within 120 days of surgery consistently with the comparative trial. I congratulate the authors for their tremendous work. They managed to conduct one of the largest prospective trials evaluating a specific radiotherapy regimen in patients with soft tissue sarcomas of the extremities or trunk in nearly two decades. Most relevant issues possibly affecting the outcome were considered thoroughly and thoughtfully during the clear study design; however, some issues might be worth addressing in more detail. Hypofractionated, 3-week, preoperative radiotherapy for patients with soft tissue sarcomas (HYPORT-STS): a single-centre, open-label, single-arm, phase 2 trialModerately hypofractionated preoperative radiotherapy delivered to patients with soft tissue sarcomas was safe and could therefore be a more convenient alternative to conventionally fractionated radiotherapy. Patients can be counselled about these results and potentially offered this regimen, particularly if it facilitates care at a sarcoma specialty centre. Results on long-term oncological, late toxicity, and functional outcomes are awaited. Full-Text PDF