ArticleBMC cancer2026
Carbon ion radiotherapy for unresectable primary or recurrent soft tissue sarcomas: long-term outcomes based on the local effect model.
Article in BMC cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe application of carbon ion radiotherapy (CIRT) for unresectable primary or recurrent soft tissue sarcoma (STS) remains controversial and existing data are limited. We herein present our institutional experience with CIRT for unresectable primary or recurrent STS.
methodsWe retrospectively evaluated the outcomes of CIRT in unresectable primary or recurrent STS patients at our center. We assessed the 4-and 5-year local control (LC), overall survival (OS), distant metastasis free survival (DMFS), progression free survival (PFS), as well as acute and late toxicities. Additionally, we analyzed the prognostic factors associated with the treatment outcomes.
resultsBetween June 2015 and August 2022, 48 consecutive patients with unresectable primary (n = 8, 16.7%) or recurrent (n = 40, 83.3%) STS were treated with CIRT. The most common tumor sites were the retroperitoneum and pelvis (75.0%). The predominant histological subtypes included liposarcoma (20.8%), leiomyosarcoma (10.4%), synovial sarcoma (8.3%) and undifferentiated pleomorphic sarcoma (8.3%). Nine patients (18.8%) had a history of prior in-field radiotherapy. The median follow-up duration was 48.6 months. The 4-year LC, OS, DMFS, and PFS rates were 65.8%, 59.7%, 50.3%, and 36.7%, respectively. The 5-year LC, OS, DMFS, and PFS rates were 60.3%, 54.7%, 44.0%, and 28.0%, respectively. The median survival time was 67.3 months. Late toxicities included grade 3 dermatitis (n = 2, 4.2%), grade 3 decreased joint range of motion (n = 1, 2.1%), and grade 3 peripheral neuropathy (n = 1, 2.1%). Patients who received a higher prescribed dose (biologically effective dose, BED ≥ 129 Gy) exhibited significantly better LC (p = 0.010) and PFS (p = 0.004) compared to those who received a lower prescribed dose. A pre-CIRT neutrophil-to-lymphocyte ratio (NLR) ≥ 3 was significantly associated with inferior DMFS (p = 0.020).
conclusionsFor select patients with unresectable primary or recurrent STS, CIRT represents a potentially effective and well-tolerated treatment option, though it requires careful evaluation of neural risks-particularly for lesions adjacent to critical nerve structures.
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