Local Control With Moderately Hypofractionated Definitive Radiotherapy Delivered With a Simultaneous Integrated Boost Technique to Non-extremity Soft Tissue and Bone Sarcomas.
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AIMS: While surgery is the primary treatment for soft tissue sarcomas (STS) and primary bone sarcomas, a notable proportion of patients with non-extremity tumours do not undergo resection. Outcome data for definitive radiotherapy in this context are limited, as is evidence on the use of hypofractionation at non-extremity sites near sensitive organs at risk. We report our institutional experience delivering moderately hypofractionated definitive radiotherapy (MHDRT) to patients with inoperable non-extremity STS and bone sarcomas including those who were unfit for, or declined, surgery. MATERIALS AND METHODS: Fifty-nine adult sarcoma patients received MHDRT to non-extremity disease between July 2021 and September 2024 in 60 treatment courses (54 photon, 6 proton). Radiotherapy was delivered over 28 fractions at two dose levels, with 50.4 Gy to the low-dose target volume and a simultaneous integrated boost (SIB) to the high-dose target volume of 63 Gy for STS and 70 Gy for bone sarcomas. Two patients received treatment over 30 fractions to a comparable dose with a SIB of ≥2.2 Gy per fraction. RESULTS: With a median follow-up of 17.7 months, local control at 1 year was 90.8% for STS (n = 37), 100% for chordoma (n = 14) and 55.6% for high-grade primary bone sarcomas (n = 9). Acute and late grade 3 toxicities were observed in 5 (8.3%) and 6 (10%) patients respectively. CONCLUSION: These data indicate that MHDRT can be delivered to inoperable non-extremity sarcomas with acceptable toxicity and encouraging early local control rates, representing an important radical treatment option in this patient group.