Purpose and Method. Hyper-fractionated radiotherapy for treatment
of soft tissue sarcomas is designed to deliver a higher total dose of radiation without an
increase in late normal tissue damage. In a previous study at the Royal Marsden Hospital,
a total dose of 75 Gy using twice daily 1.25 Gy fractions resulted in a higher incidence of late
damage than conventional radiotherapy using 2 Gy daily fractions treating to a total of 60 Gy.
The current trial therefore used a lower dose per fraction of 1.2 Gy and lower total dose of 72
Gy, with 60 fractions given over a period of 6 weeks.
Subjects. A total of 37 patients (22 males and 15 females) with a median
age of 56 years (range 19–88 years) were treated.
Results. Of eight patients treated pre-operatively, six showed a
partial response and in two the tumour was static. The maximum acute toxicities were grade
1 in eight, grade 2 in 14 and grade 3 in 15 patients. Late toxicities of the skin were
graded 1 in 10 and grade 2 in nine patients. Five patients complained of pain in the irradiated
bone and soft tissues, which was of moderate severity (grade 2). Stiffness was graded 2 in
three patients and severe (grade 3) in one.Three patients had moderate and one patient had
severe lymphoedema following treatment. The 5-year recurrence-free survival probability of
patients treated radically was 76%. Following excision of local recurrences the study group
had a disease-free survival probability of 86% at 5 years.
Discussion. The regime is well tolerated with comparable local control
and late complication rates to standard daily fractionated therapy.The potential benefit of this
regime needs to be defined in a prospective randomized trial.