The effectiveness of the use of local hyperthermia as a method of physical radiosensitization as part of the combined treatment of localized forms of primary and recurrent sarcomas of soft tissues

Objective. To estimate the effectiveness and tolerance of soft tissue sarcoma (STS) combined treatment, including preoperative thermoradiotherapy (TRT), surgical treatment and intraoperative radiation therapy (IORT).

Methods. We assessed the tolerance and both immediate and long-term results of treatment for 105 patients with locally advanced STS, 50 of whom underwent combined treatment with local hyperthermia (LHT) (prospective set). 55 patients from the control group received treatment without the use of LHT (retrospective group).

Results. It was proven that the preoperative course of TRT significantly increases the frequency of objective clinical response in the study group — 30% versus 9.1% in the control (p<0.05). The prevalence of two-year relapse-free and overall survival was observed in patients of the study group with recurrent STS — 77.8% compared with the control group — 46.7% (p=0.05) and 100% versus 86.7%, respectively (p=0.05). The incidence of early radiation reactions and late radiation changes is comparable in both groups.

Conclusion. The use of TPT contributes to a significant increase in the frequency of an objective clinical response, and allows to improve two-year relapse-free and overall survival in a subgroup of patients with relapses of SMT. When prescribing the TRT course, it is necessary to take into account the main clinical and morphological factors that have a significant impact on its immediate effectiveness. LHT as a radiosensitizer in the combined treatment of SMT does not adversely affect the frequency and degree of radiation reactions/changes in normal tissues.

1. Каприн АД, Старинский ВВ, Петрова ГВ. Злокачественные новообразования в России в 2017 году (заболеваемость и смертность). М., 2018:250.

2. Старцева ЖА, Слонимская ЕМ, Тюкалов ЮИ и соавт. Роль локальной гипертермии в комбинированном лечении сарком мягких тканей. Сибирский онкологический журнал. 2015;(3):76-81.

3. Mariotto AB, Noone AM, Howlader N et al. Cancer survival: an overview of measures, uses, and interpretation. J Natl Cancer Inst. Monogr. 2014;2014(49):145-186.

4. Abeshouse A, AdebamowoC, AdebamowoSN et al. Comprehensive and integrated genomic characterization of adult soft tissue sarcomas. Cell. 2017;171(8):950-965.e2.

5. Levy A, Le Péchoux C, Terrier P et al. Epithelioid sarcoma: Need for a multimodal approach to maximize the chances of curative conservative treatment. Ann Surg Oncol. 2014;21:269-276.

6. Andra C, Klein A, Dürr HR et al. External-beam radiation therapy combined with limb-sparing surgery in elderly patients (>70 years) with primary soft tissue sarcomas of the extremities. Strahlenther Onkol. 2017;193:604-611.

7. Palassini E, Ferrari S, Verderio P et al. Feasibility of preoperative chemotherapy with or without radiation therapy in localized soft tissue sarcomas of limbs and superficial trunk in the Italian Sarcoma Group/Grupo Espanol de Investigacion en Sarcomas randomized clinical trial: three versus five cycles of full-dose epirubicin plus ifosfamid. J Clin Oncol. 2015;33:3628-3634.

8. Mullen JT, Kobayashi W, Wang JJ et al. Long-term follow-up of patients treated with neoadjuvant chemotherapy and radiotherapy for large extremity soft tissue sarcomas. Cancer. 2012;118:3758-3765.

9. Stoeckle E, Coindre JM, Rind M et al. Evaluating surgery quality in soft tissue sarcoma. Recent Results Cancer Res. 2009;179:229-242.