2163 - Preoperative Conventionally vs. Moderately Fractionated Radiotherapy for Non-Metastatic Soft Tissue Sarcoma: The Physician- and Patient-Reported Outcome
Presenter(s)
N. N. Lu1, L. B. Xu2, Z. G. Zhao2, X. X. Zhang2, Z. Y. Yang3, Q. Chang4, L. Q. Wang5, M. Li6, L. H. Gong7, F. Liu1, D. Liu8, S. L. Wang9, Q. Zhang10, S. J. Yu2, and L. Li11; 1Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China., Beijing, China, 2Department of Orthopedics, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China, Beijing, China, 3Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China, 4Department of Ultrasonography, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China, Beijing, China, 5Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China., Beijing, China, 6Department of Diagnostic Imaging, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China, Beijing, China, 7Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China., Beijing, China, 8Department of Pathology. JingXin Hospital, Beijing, China, 9Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 10Department of Orthopedics. JiShuiTan Hospital., Beijing, China, 11Department of Pathology. JiShuiTan Hospital, Beijing, China
Purpose/Objective(s): We hypothesized that the addition of tyrosine-kinase inhibitor (TKI) or PARP inhibitor to preoperative conventionally (CF) or moderately fractionated (MF) RT will improve the R0 limb-conserving rate for non-metastatic extremity or trunk soft tissue sarcoma (STS) without increase of major wound complications (MWCs).
Materials/Methods: Preoperative VMAT of 50Gy/25f with concurrent and sequential Anlotinib (12mg QD) or Apatinib (500mg QD), or 43.5Gy/15f with Fluzoparib (100mg Bid) were given for CF or MF groups. NCI-CTC 5.0, MSTS, TESS, SF-36 and EORTC-QLQ-C30 questionnaires are used to assess acute events, limb function and QOL. The primary endpoint was defined as MWCs as per the SR2 criteria.
Results: From Jul 2020 to Jul 2024, 120 patients were enrolled. The median onset age is 54 (18-84) years old. The median tumor size is 9.2 (1.5-30) cm. All except 6 tumors (95%) were evaluated as unresectable or borderline resectable. Patients' characteristics were well balanced, except for more lower-extremity (82.7% vs. 61.8%) location and more G2-3 tumors (80.8% vs. 75.0%) in MF-RT group. The observed =Grade 3 acute toxicity is hypertension (13.2%), ALT elevation (5.9%), dermatitis (4.4%) in CF group, and ECOG decrease (5.8%), dermatitis (1.9%), hemorrhage (1.9%) in MF group. All toxicities are attributed to the drugs, except for dermatitis.
Among 113 patients receiving operation (2 with amputation), 75 and 38 patients had R0 and R1 resection. The MWCs rate was 29.7% for whole group, 27.0% for CF and 33.3% for MF groups, with similar rates for lower limb tumors (33.3% in CF and 35% in MF groups). With median follow-up time of 38.3 (3 to 58.5) months in CF group and 16.7 (4.4 to 21.8) months in MF group, the 2-year OS, LC, DMFS, LSS was 95.3%, 93.5%, 90.6%, 98.5% and 97.4%, 95.6%, 84.0%, 93.7%, respectively. However, the rate of Grade 2-3 fibrosis (17.8% vs. 13.3%) was slightly higher in the MF group. Furthermore, 1 patient underwent amputation due to MWC in MF group. The MSTS score showed a worse change in the MF group (p=0.05). QOL scores of patients in CF group returned to baseline levels at 6 months postoperatively, while the MF group only reached baseline levels at 9 to 12 months postoperatively. When only lower limb primary patients were compared (42 CF and 43 MF), the largest differences were still observed in the SF-36 physical function, with mean differences of 21.6, 21.7, and 15.3 points at 6, 9, and 12 months postoperatively, respectively (p=0.034); EORTC RF2, with mean differences of 13.9, 23.7, and 17.5 points, respectively (p=0.017); and EF2 changes (p=0.0008), with mean differences of 12.4, 19.6, and 19.3 points, respectively (p=0.0008).Conclusion: For patients with non-metastatic STS, whether CF or MF- RT was used, or whether TKIs or PARP inhibitors were added, there were no significant differences in resection rates or MWCs rate. However, it should be noted that patients in the MF group had slower recovery of QOL, with function items being worse than those in the CF-RT group.