This critical review aims to summarize the relevant published data regarding hypofractionation regimens for preoperative radiation therapy (RT) prior to surgery for soft tissue sarcoma (STS) of the extremity or superficial trunk. We identified peer-reviewed publications using a PubMed search on the MeSH headings of “soft tissue sarcoma” AND “hypofractionated radiation therapy.” To obtain complication data on similar anatomical radiotherapeutic scenarios we also searched “hypofractionated radiation therapy” AND “melanoma” as well as “hypofractionated radiation therapy” AND “breast cancer.” We then used reference lists from relevant articles to obtain additional pertinent publications. We also incorporated relevant abstracts presented at international sarcoma meetings and relevant clinical trials as listed on the ClinicalTrials.gov website. Detailed data are presented and contextualized for ultra-hypofractionated and moderately hypofractionated regimens with respect to local control, wound complications, and amputation rates. Comparative data are also presented for late toxicities including: fibrosis, joint limitation, edema, skin integrity, and bone fracture or necrosis. These data are compared to a standard regimen of 50 Gy in 25 daily fractions delivered over 5 weeks. This analysis supports the continued use of a standard regimen for preoperative RT for STS of 25 × 2 Gy over 5 weeks without concurrent chemotherapy. Use of concurrent chemotherapy with preoperative RT for STS should be reserved for well-designed clinical trials. A randomized trial of ultra-hypofractionated and moderately hypofractionated pre op RT for STS is warranted, but it is critical for the primary endpoint (or co-primary endpoint) to be late toxicity to: bone, soft tissue, joint, and skin.

中文翻译：

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我们准备好迎接快车道生活了吗？局限性软组织肉瘤术前大分割放疗的批判性回顾

这篇批判性综述旨在总结已发表的有关四肢或浅表躯干软组织肉瘤 (STS) 手术前术前放射治疗 (RT) 的大分割方案的相关数据。我们使用 PubMed 搜索 MeSH 标题“软组织肉瘤”和“大分割放射治疗”来确定同行评审的出版物。为了获得类似解剖放射治疗方案的并发症数据，我们还搜索了“大分割放射治疗”和“黑色素瘤”以及“大分割放射治疗”和“乳腺癌”。然后，我们使用相关文章中的参考文献列表来获取其他相关出版物。我们还纳入了国际肉瘤会议上提出的相关摘要以及 ClinicalTrials.gov 网站上列出的相关临床试验。提供了超大分割和中度大分割方案在局部控制、伤口并发症和截肢率方面的详细数据并进行了背景分析。还提供了晚期毒性的比较数据，包括：纤维化、关节限制、水肿、皮肤完整性以及骨折或坏死。这些数据与 5 周内每天 25 次分次 50 Gy 的标准治疗方案进行了比较。该分析支持在 5 周内继续使用 25 × 2 Gy 的 STS 术前放疗标准方案，而不进行同步化疗。同步化疗与术前放疗治疗 STS 应保留给精心设计的临床试验。对 STS 进行超大分割和中度大分割术前放疗的随机试验是必要的，但主要终点（或共同主要终点）是对骨、软组织、关节和皮肤的晚期毒性至关重要。