Soft Tissue Sarcoma of the Trunk and Extremities
Conditions
Brief summary
Phase II, national, multicentric, prospective, randomized (1:1) non-inferiority trial with two parallel groups, incorporating a concurrent observational cohort of eligible non-randomized patients, designed to address critical knowledge gaps by prospectively evaluating the safety, efficacy, and feasibility of preoperative ultra-hypofractionated radiotherapy (HFRT) in patients with soft tissue sarcomas (STS) of the extremities and trunk.
Detailed description
This study is designed to address critical knowledge gaps by prospectively evaluating the safety, efficacy, and feasibility of preoperative ultra-hypofractionated radiotherapy (HFRT) in patients with soft tissue sarcomas (STS) of the extremities and trunk. Eligible patients will be randomized to receive an ultra-hypofractionated RT regimen consisting of 30 Gy delivered in 5 fractions of 6 Gy, followed by surgical resection at one of two predefined intervals: either 1-2 weeks or 4-6 weeks after completion of radiotherapy. In parallel, a non-randomized observational cohort will be recorded, consisting of patients treated according to current standard practice - surgery alone or surgery preceded by nonventional RT (50 Gy in 25 fractions) - to provide a contemporaneous benchmark for comparison. The aim of this study is to gather high-quality clinical evidence on the impact of ultra-hypofractionated RT on oncologic outcomes, treatment-related toxicity, perioperative morbidity, and patient-reported quality of life. Evaluation of logistical and economic implications of treatment de-escalation, such as healthcare resource utilization and treatment burden are also an important point to be addressed. By systematically assessing these endpoints, this study aims to inform future clinical guidelines and support the potential integration of ultra-hypofractionated RT into routine clinical practice for selected patients with localized STS.
Interventions
PROCEDUREhypofractionated radiotherapy (30Gy/5 fractions) and surgical resection at 1-2 weeks after treatment
hypofractionated radiotherapy (30Gy/5 fractions) and surgical resection at 1-2 weeks after treatment
PROCEDUREhypofractionated radiotherapy (30Gy/5 fractions) and surgical resection at 4-6 weeks after treatment
hypofractionated radiotherapy (30Gy/5 fractions) and surgical resection at 4-6 weeks after treatment
Sponsors
Italian Sarcoma Group
Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Group A (randomized): hypofractionated radiotherapy (30Gy/5 fractions) and surgical resection at 1-2 weeks after treatment. Group B (randomized): hypofractionated radiotherapy (30Gy/5 fractions) and surgical resection at 4-6 weeks after treatment. Observational cohort: standard treatment with surgery ± standard radiotherapy (50Gy/25 fractions)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Voluntary written informed consent, with the ability to fully understand and effectively communicate, before performance of any study-related procedure not part of normal medical practice, with the understanding that consent may be withdrawn by the subject at any time without prejudice to future medical care. * Age \> 18 years * Proven diagnosis of primary, resectable extremity/trunk wall STS with low-medium risk (Sarculator© predicted 10y-OS \> 60%) * Measurable disease criteria (RECIST 1.1 and CHOI) * ECOG: 0, 1 or 2 (if influenced by orthopedic condition and not by general status) * No major contraindication to the planned radiotherapy or surgical treatment * Active participation with adherence to requested treatment schedule and follow-up * Female subject will undergo a negative pregnancy test * Adequate bone marrow function (hemoglobin \> 9g/dL, Leukocytes \> 3000/mm³, platelets \> 100,000/mm³). Patients with plasma creatinine ≤ 1.6 mg/dL, transaminase (AST-SGOT, ALT-SGPT) ≤ 2.5 times the UNL; total bilirubin ≤ 1.5 time the UNL; alkaline phosphatase ≤ 2.5 times the UNL are acceptable. CRP, LDH, total protein and albumin must also be recorded. * HBV and HCV serologies must be performed prior to patient inclusion. If hepatitis B surface antigen (HBsAg) is positive, further evaluation is required to exclude active viral replication (i.e., testing for hepatitis B e antigen \[HBeAg\] and HBV DNA). If either of these markers is positive, study inclusion is not recommended. In such cases, prophylactic treatment with lamivudine may be considered at the investigator's discretion. If a potential participant tests positive for anti-HCV antibodies, active infection must be ruled out through a qualitative HCV PCR test. If PCR testing cannot be performed, or if it confirms active infection, the patient will not be eligible for the study. Patients must be HIV-seronegative, with a CD4+ T-cell count greater than 400/mm³. Individuals with clinically significant immunodeficiency-either congenital or acquired-are not eligible for enrollment
Exclusion criteria
* Age \< 18y * Soft tissue sarcomas (STS) originating at different sites (i.e., retroperitoneal, abdominal, pelvic, head and neck), gynecological sarcomas, as well as gastrointestinal stromal tumors (GISTs), desmoid-type fibromatosis and pediatric-type sarcomas (i.e., extraosseous Ewing sarcoma, embryonal/alveolar rhabdomyosarcoma, desmoplastic small round cell tumor) are excluded. * Recurrent or metastatic condition or previous whoop-surgery for sarcoma (incisional biopsies are allowed if performed 6 months before referral). * Unresectable tumors (with limb sparing surgery) * Diagnosed oncological condition in the 5 years before enrollment (exceptions: Gleason \<6 prostatic adenocarcinoma; In-situ cervical cancer and melanoma; basal cell skin carcinoma radically treated) * Prior radiation treatment to the site designated for planned surgery or radiotherapy, regardless of indication * Any medical condition that can impair and reduce life expectancy to less than 2 years including but not limited to significant systemic diseases grade 3 or higher on the CI-CTCAE v5.0 scale, that limit patient availability, or according to investigator judgment may contribute significantly to treatment toxicity * Uncontrolled bacterial, fungal, or viral infections-either systemic or localized at the site of planned surgery or radiotherapy * Severe psychiatric disorder, psychological, familial, social or geographic circumstances that limit the patient's ability to comply with the protocol or informed consent. * Patients who had participated in another clinical trial and/or had received any other investigational product in the last 30 days prior to inclusion * Patients who had received any other treatment for the disease under study including chemotherapy, radiotherapy, surgery or any other treatment with curative intent. incisional biopsies are allowed if performed 6 months before referral. * Inability to comply with the requested follow-up * Women who are pregnant or breast-feeding * Any condition that is unstable or could jeopardize the safety of the patient and their compliance in the study * BMI \> 40 and BMI \< 18
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Determine the incidence of postoperative complications | Day of surgery (DOS); 7-14-21-30-60-90 days post DOS; 4-8-12-16-20-24 months post DOS | The primary objective of this study is to determine the incidence of postoperative complications (according to Clavien-Dindo) within 90 days from surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative complications | 7-14-21-30-60-90 days DOS, 4-8-12-16-20-24 months post DOS | Postoperative complications (classified according to Clavien-Dindo and CCI) |
| Cumulative Incidence of Local Recurrence (CCI-LR) | Months 4-8-12-16-20-24 post surgery | Cumulative Incidence of Local Recurrence (CCI-LR) |
| Cumulative Incidence of Distant Metastasis (CCI-DM) | Months 4-8-12-16-20-24 post surgery | Cumulative Incidence of Distant Metastasis (CCI-DM) |
| Pathological response | At any time during the study | Pathological response |
| Radiological response (RECIST 1.1 and CHOI) | Months 4-8-12-16-20-24 post surgery | Radiological response (RECIST 1.1 and CHOI) |
| Disease-Free Survival (DFS) | Months 4-8-12-16-20-24 post surgery | Disease-Free Survival (DFS) |
| Quality of Life (QoL) | At last available QoL assessment date for patients without confirmed deterioration | Quality of Life (QoL) |
| Treatment-related toxicity | 7-14-21-30-60-90 days DOS, 4-8-12-16-20-24 months post DOS | Treatment-related toxicity (based on Common Terminology Criteria for Adverse Events \[NCI-CTCAE\] version 5.0) |
| Overall Survival (OS) | At the last date that patient was known to be alive | Overall Survival (OS) |
Contacts
CONTACTGianluca Ignazzi
CONTACTViviana Appolloni
PRINCIPAL_INVESTIGATORMarco Baia, MD
Findazione IRCCS Istituto Nazionale Tumori Milano
Outcome results
None listed