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Sarcoma
Volume 3, Issue 3-4, Pages 157-165
http://dx.doi.org/10.1080/13577149977587

Hyper-Fractionated Radiotherapy for Soft Tissue Sarcoma: Results of the Second Study of Hyper-Fractionated Radiotherapy

1Sarcoma unit, Royal Marsden Hospital NHS Trust, Fulham Road, London, UK
2Department of Clinical Oncology, Addenbrooke's Hospital, Cambridge, UK
3Department of Clinical Oncology, Weston Park Hospital NHS Trust, Sheffield, UK
4Department of Radiotherapy, Velindre NHS Trust, Whitchurch, Cardiff CF4 7XL, UK

Copyright © 1999 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose and Method. Hyper-fractionated radiotherapy for treatment of soft tissue sarcomas is designed to deliver a higher total dose of radiation without an increase in late normal tissue damage. In a previous study at the Royal Marsden Hospital, a total dose of 75 Gy using twice daily 1.25 Gy fractions resulted in a higher incidence of late damage than conventional radiotherapy using 2 Gy daily fractions treating to a total of 60 Gy. The current trial therefore used a lower dose per fraction of 1.2 Gy and lower total dose of 72 Gy, with 60 fractions given over a period of 6 weeks.

Subjects. A total of 37 patients (22 males and 15 females) with a median age of 56 years (range 19–88 years) were treated.

Results. Of eight patients treated pre-operatively, six showed a partial response and in two the tumour was static. The maximum acute toxicities were grade 1 in eight, grade 2 in 14 and grade 3 in 15 patients. Late toxicities of the skin were graded 1 in 10 and grade 2 in nine patients. Five patients complained of pain in the irradiated bone and soft tissues, which was of moderate severity (grade 2). Stiffness was graded 2 in three patients and severe (grade 3) in one.Three patients had moderate and one patient had severe lymphoedema following treatment. The 5-year recurrence-free survival probability of patients treated radically was 76%. Following excision of local recurrences the study group had a disease-free survival probability of 86% at 5 years.

Discussion. The regime is well tolerated with comparable local control and late complication rates to standard daily fractionated therapy.The potential benefit of this regime needs to be defined in a prospective randomized trial.