Soft Tissue Sarcoma
Conditions
Brief summary
This prospective, single-institution Phase I/II clinical trial investigates the safety, feasibility, and preliminary efficacy of preoperative carbon-ion radiotherapy (CIRT) for patients with resectable soft tissue sarcoma. Given the radioresistant nature of sarcomas and the limitations of photon-based preoperative radiotherapy-particularly high wound complication rates-CIRT is expected to enhance local tumor control while minimizing treatment-related toxicity and surgical morbidity. The trial consists of an initial dose-escalation phase (phase 1) to identify an optimal and tolerable dose level, followed by an expansion phase (phase 2) assessing the feasibility of completing both CIRT and surgery without major wound complications. CIRT is delivered in eight fractions over two weeks, with surgery planned 6-8 weeks after radiotherapy. Primary endpoints include the incidence of grade 3-5 post-operative wound complications within 120 days and overall treatment completion. Secondary endpoints include pathological response, surgical outcomes, local control, progression-free survival, overall survival, and patient-reported quality of life. All participants will be followed for at least 12 months postoperatively to evaluate safety and long-term outcomes.
Interventions
RADIATIONCarbon-Ion Radiotherapy (CIRT)
Participants receive preoperative CIRT as the investigational intervention, delivered in 8 fractions, once daily, four times per week. In Phase I, three dose levels (DL1: 32.0 GyE, DL2: 34.0 GyE, DL3: 36.0 GyE) are evaluated using a 3+3 dose-escalation design to determine the recommended Phase II dose (RP2D). Three patients are initially enrolled per dose level, expanded to six if dose-limiting toxicities occur. In Phase II, all participants receive CIRT at the RP2D following a Simon's two-stage design (Stage I: 20 patients; Stage II: 22 additional if criteria met). Treatment uses fixed-beam or rotating gantry techniques. Post-treatment imaging (CT or MRI) is performed 4-6 weeks after CIRT, followed by surgical resection 6-8 weeks post-radiotherapy. All participants are followed for at least 12 months after surgery to assess postoperative wound complications, treatment completion, and overall outcomes.
Sponsors
Yonsei University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults aged 19 years or older. * Histologically confirmed soft tissue sarcoma deemed suitable for curative resection. * Determined by the Yonsei Cancer Center sarcoma multidisciplinary team that preoperative carbon-ion radiotherapy followed by surgery is appropriate, considering tumor histologic subtype, size, and location. * Eastern Cooperative Oncology Group (ECOG) performance status 0-1 or Karnofsky Performance Status (KPS) ≥ 70. * Adequate organ function (including hematologic, hepatic, and renal function) suitable for radiotherapy and surgery. * Voluntarily provided written informed consent.
Exclusion criteria
* Presence of distant metastases. * Inability to plan carbon-ion radiotherapy due to metallic implants or other factors at the tumor site. * History of prior radiotherapy to the same anatomical region. * Presence of other serious medical conditions or active infections that, in the investigator's judgment, could interfere with study participation. * Presence of active implanted electronic devices (e.g., pacemaker or defibrillator) without established safety for carbon-ion radiotherapy. * Pregnant or breastfeeding women.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Phase I: Incidence of Dose-Limiting Toxicities (DLTs) | From initiation of CIRT to 30 days after surgery | To evaluate the safety and tolerability of preoperative CIRT and identify the optimal tolerated dose level. DLTs are defined as grade ≥3 toxicities, including severe wound complications, prolonged hospitalization, or significant treatment delay, assessed according to CTCAE version 5.0. |
| Phase II: Proportion of Patients Completing Both CIRT and Surgery Without Grade 3-5 Postoperative Wound Complications or Serious Adverse Events | From initiation of CIRT to 120 days after surgery | To determine the clinical feasibility and safety of completing preoperative CIRT followed by surgical resection without major wound-healing complications or treatment-related serious adverse events (SAEs). The endpoint represents the proportion of patients achieving treatment completion without grade 3-5 wound complications or other SAEs within 120 days postoperatively. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pathological Tumor Response Rate | At surgical specimen evaluation (6-8 weeks after CIRT) | To determine the rate of pathological tumor regression or necrosis in resected specimens following preoperative CIRT, based on standardized histologic grading criteria. |
| R0 Resection Rate | At surgery (6-8 weeks after CIRT) | To evaluate the proportion of patients achieving microscopically margin-negative (R0) resection after preoperative CIRT, reflecting its impact on surgical resectability. |
| Local Control and Progression-Free Survival | From date of surgery to 12 months postoperatively | To estimate 1-year local control and progression-free survival using Kaplan-Meier analysis as measures of preliminary efficacy. |
| Incidence of Acute Treatment-Related Toxicities | From initiation of CIRT to 30 days after surgery | To record and grade all acute adverse events associated with preoperative carbon-ion radiotherapy using CTCAE v5.0 criteria to characterize the overall safety profile at each dose level. |
| Quality of Life (EORTC QLQ-C30) | Baseline, post-CIRT, and 3, 6, and 12 months after surgery | To assess longitudinal changes in patient-reported quality of life using the EORTC QLQ-C30 questionnaire throughout treatment and follow-up. |
| Body Composition Change (InBody Analysis) : Skeletal-Muscle Mass Change | Baseline, post-CIRT, and 3, 6, and 12 months after surgery | Unit of Measure: kg |
| Body Composition Change (InBody Analysis) :Body-Fat Composition Change | Baseline, post-CIRT, and 3, 6, and 12 months after surgery | Body-Fat Composition Change |
| Overall Survival | From initiation of CIRT to 12 months postoperatively | To evaluate 12-month overall survival as an exploratory efficacy endpoint of preoperative CIRT. |
| Surgery Feasibility and Completion Rate | From completion of CIRT to 30 days after surgery | To assess the proportion of participants who successfully undergo and complete surgical resection following preoperative CIRT without protocol deviation or treatment interruption. |
Countries
South Korea
Outcome results
None listed