Sarcoma
Preop RT dose de-escalation in a radiosensitive histology, benchmarked against historic 50 Gy series rather than a randomised arm.
DOREMY NCT02106312
ForLocalized translocation-confirmed myxoid liposarcoma, trunk or extremity, resectable
TL;DR5yr LRFS 97.4% after 36Gy/18fx preop RT in myxoid liposarcoma, wound complications 21%, median f/u 66.4mo.
The number that moves the dose decision is 97.4% 5yr LRFS at 36 Gy, matched to a 21% wound complication rate, with only 3% late G3. Dose is 2 Gy daily to 36 Gy preop, standard fractionation, so it transfers directly. This is a de-escalation read confined to translocation-confirmed MLS.
In localized translocation-confirmed myxoid liposarcoma of trunk or extremity going to resection, this supports 36 Gy preop as a discussed option in place of 50 Gy; it does not extend to other soft tissue sarcoma histologies, which were not enrolled.
36 Gy in 2 Gy daily fractions preop yielded 97.4% 5yr LRFS (95% CI 93.9-100%) at median 66.4 mo, with late G3 in only 3%. Standard fractionation, no special technique required, so the de-escalation from 50 Gy transfers directly in translocation-confirmed MLS.
The surgical read is the wound complication rate: 21% overall, 16% needing intervention, after preop RT at the reduced dose. Whether that beats 50 Gy is untested here (no comparator arm), but it is the number to weigh against reconstruction planning in trunk and extremity resections.
10 details 1 trial watching
Prospective, single-group, phase 2 nonrandomized trial across 9 tertiary sarcoma centers in Europe and the US. Enrollment ran November 2010 to May 2020; data analyzed January to December 2025. Median follow-up 66.4 months (IQR 48.8-87.5).
Adults with biopsy-proven and translocation-confirmed localized myxoid liposarcoma of the trunk or extremity. N=90, mean age 47 (SD 13.1), 50 (56%) male.
Preoperative RT to a reduced dose of 36 Gy in once-daily 2-Gy fractions, followed by resection. Delivered per protocol in all patients. Three pts (3%) did not proceed to surgery because of intercurrent metastatic disease.
Long-term local recurrence-free survival, progression-free survival, disease-specific survival, overall survival, and late toxic effects. No single stated primary endpoint for this long-term analysis.
Wound complications in 18 pts (21%), with 14 (16%) requiring intervention. Late toxic effects were grade 2 in 13 pts (15%) and grade 3 in 3 pts (3%).
The authors argue the long-term data support adopting 36 Gy as an option through shared decision-making, explicitly on the grounds that a phase 3 trial is impractical in a rare cancer. That is an argument about feasibility, not about evidence level, and the reader should price it as such.
Fourteen-year accrual window spans changing surgical and imaging practice, so the wound complication rate reflects a long era rather than current technique. Late toxicity is reported only as pooled grade counts, without organ or site attribution, which limits comparison against 50 Gy series.
| Endpoint | 5yr rate | 95% CI |
|---|---|---|
| Local recurrence-free survival | 97.4% | 93.9-100% |
| Progression-free survival | 81.0% | 72.6-89.4% |
| Disease-specific survival | 89.5% | 82.6-96.4% |
| Overall survival | 88.5% | 81.2-95.8% |
Single-arm phase 2, no randomised 50 Gy comparator; authors concede phase 3 impractical in a rare histology. Long f/u strengthens but does not replace randomisation.
- Wound complication rate vs 50 Gy in a randomised comparison n=300 · primary completion 2031-01 · prospective MLS registry, 36Gy vs 50Gy preop arms
- Whether dose reduction extends to other translocation-driven sarcoma subtypes
- Local control beyond 10 years