title: Preoperative Radiosurgery for Soft Tissue Sarcoma.
abstract: OBJECTIVE
  Preoperative radiation followed by surgical resection is a standard treatment for soft tissue sarcomas (STSs). The conventional method of radiation is 5 weeks to approximately 50 Gy. We report on our initial experience and phase II single-arm study assessing 5 fractions of stereotactic body radiotherapy (SBRT), followed by surgical resection for STS.
  
  
  METHODS
  Thirteen patients and 14 tumors were treated with preoperative SBRT; tumors were mostly poorly differentiated (5) or myxoid (5) and were located on the leg (10), arm (2) or groin (2). The median tumor size in greatest dimension was 7.6 cm (maximum 16 cm). Twelve patients received 35 Gy in 5 fractions; for 2 deeper tumors the dose was 40 Gy in 5 fractions. Ten patients were administered 0.5 cm bolus to improve the dose. Gross tumor volume was expanded 0.5 cm radially and 3 cm along the tissue plane. Treatment was to an isodose line (median 81%) and was delivered every other day. Maximum dose to the skin was 46 Gy (median 41 Gy).
  
  
  RESULTS
  The median follow-up period was 279 days. Surgical resection occurred a median of 37 days after completion of SBRT. Four patients had acute toxicity consisting of 2 grade 2 and 2 grade 3 skin reactions; all cases of skin toxicity resolved by the time of surgery. Percent tumor necrosis ranged from 10% to 95% (median 60%). All patients had negative margins. Planned vacuum-assisted wound closure was used in 4 patients; there were no other major wound complications. There was 1 local recurrence and 7 distant recurrences.
  
  
  CONCLUSIONS
  This is the initial experience of radiosurgery for preoperative treatment of STSs. We have found this to be well tolerated, convenient for the patients, and a much shorter treatment course, allowing patients to undergo surgery and subsequent chemotherapy quicker. Surgical complications and control rates are satisfactory. The initial results are encouraging for further investigation.
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Kubicek
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Tamara
authors.initials: T
authors.lastname: LaCouture
authors.affiliation: Orthopedic Surgery.
authors.forename: Maureen
authors.initials: M
authors.lastname: Kaden
authors.affiliation: Orthopedic Surgery.
authors.forename: Tae Won
authors.initials: TW
authors.lastname: Kim
authors.affiliation: Medical Oncology, Cooper University Hospital, One Cooper Plaza, Camden, NJ.
authors.forename: Nati
authors.initials: N
authors.lastname: Lerman
authors.affiliation: Medical Oncology, Cooper University Hospital, One Cooper Plaza, Camden, NJ.
authors.forename: Polina
authors.initials: P
authors.lastname: Khrizman
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Ashish
authors.initials: A
authors.lastname: Patel
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Qianyi
authors.initials: Q
authors.lastname: Xu
authors.affiliation: Orthopedic Surgery.
authors.forename: Richard
authors.initials: R
authors.lastname: Lackman
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011832:Radiation Injuries / Q000453:epidemiology / Q000503:physiopathology; D016634:Radiosurgery / Q000379:methods* / Q000401:mortality; D011879:Radiotherapy Dosage; D018570:Risk Assessment; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome