Evaluation of postoperative stereotactic ablative radiotherapy

Background: This study aimed to compare the efficacy and safety of conventional fractionated radiotherapy (CFRT) and stereotactic ablative radiotherapy (SABR) in the postoperative management of head and neck sarcomas. Materials and methods: A retrospective analysis was conducted on 40 patients with resected head and neck sarcomas who had received postoperative radiotherapy with either CFRT (n = 30) or SABR (n = 10). The median radiation dose was 35 Gy (range: 24-40 Gy in 3-5 fractions) for SABR and 62 Gy (range: 60-70 Gy in 30-35 fractions) for CFRT. Results: Median follow-up was 60 months. Five-year overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were comparable between the CFRT and SABR groups. In multivariate analysis, R2 resection was independently associated with worse OS (p = 0.02) and DMFS (p = 0.02). Both R2 resection (p = 0.009) and tumor size ≥ 5 cm (p = 0.01) were identified as independent predictors of poorer LRFS. The overall incidence of grade ≥ 3 late toxicity was 10%, with no significant difference between SABR and CFRT (p = 0.25). Notably, three of the four severe toxicity events occurred in patients with tumors involving the orbit. Conclusions: CFRT remains the established postoperative standard for head and neck sarcomas. Our findings suggest that SABR may also be considered for carefully selected patients, although its use requires caution in anatomically sensitive locations such as the orbit. Further prospective studies are needed to confirm its safety and to better define patient selection criteria.