{
  "abstract": "Introduction: Spatially fractionated radiotherapy (SFRT) enables focal dose escalation in bulky/high-grade STS. Proton SFRT, leveraging its Bragg peak, reduces low-dose exposure but may increase proximal skin dose, potentially influencing perioperative wound complications. Comparative data remain limited.\n\nMethods: We retrospectively reviewed 37 high-grade or bulky STS patients (2009–2023) treated with preoperative SFRT (photon or proton GRID/Lattice) followed by conventional fractionated radiotherapy (CFRT) and surgery. Toxicities (including major wound complications per NCIC criteria) and oncologic outcomes were analyzed using Fisher’s exact tests and Kaplan–Meier.\n\nResults: Median follow-up was 40 months. Sixteen patients (43.2%) received proton SFRT; all received CFRT (median: 50.4 Gy). Major wound complications 6/16 (37.5%) proton SFRT vs 8/21 (38.1%) photon SFRT patients, with no significant difference (P = 1.000). Acute grade 2-3 (6/16 vs 11/21) and late (3/16 vs 9/21) toxicities did not differ significantly between modalities; no grade 4 or 5 toxicities occurred. Major pathological response (MPR, ≥80% necrosis) was achieved in 12/35 evaluable patients (34.3%) and was not associated with SFRT type (P = 0.489). In exploratory analysis, MPR was associated with longer disease-free survival (median 80 vs. 27 months, P = 0.014). Proton SFRT plans had significantly higher dose heterogeneity (D90/D10 = 0.038 vs 0.093, P = 0.04).\n\nDiscussion: In this largest-to-date retrospective cohort of neoadjuvant proton- versus photon-based SFRT + CFRT for STS, no statistically significant differences in perioperative or skin toxicity were observed, and MPR (≥80% necrosis) occurred in 34.3% of evaluable patients; given the small, non-randomized sample these results should be considered hypothesis-generating.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Radiation Oncology, University of Maryland Medical Center",
    "LifeBridge Health",
    "University of Maryland School of Medicine",
    "Partners in Healthcare Technology, LLC"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Adeniyi A. Olabumuyi"
    },
    {
      "affs": [
        0
      ],
      "name": "Matthew H. Brown"
    },
    {
      "affs": [
        1
      ],
      "name": "Soha Bazyar"
    },
    {
      "affs": [
        2
      ],
      "name": "Sina Mossahebi"
    },
    {
      "affs": [
        3
      ],
      "name": "James W. Snider"
    },
    {
      "affs": [
        2
      ],
      "name": "Dan Kunaprayoon"
    },
    {
      "affs": [
        2
      ],
      "name": "Vincent Y. Ng"
    },
    {
      "affs": [
        2
      ],
      "name": "William F. Regine"
    },
    {
      "affs": [
        2
      ],
      "name": "Jason K. Molitoris"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ekad2v4c80jd5.bib",
  "cited_by": 0,
  "doi": "10.3389/fonc.2026.1741156",
  "fulltext_url": null,
  "id": "ekad2v4c80jd5",
  "issns": [
    "2234-943X"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1741156/full",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Sarcoma Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7224111981",
  "pdf_url": "https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2026.1741156/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-28",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/ekad2v4c80jd5.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:14Z",
      "native_id": "10.3389/fonc.2026.1741156",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1741156/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2234-943X",
      "subfield": "oncology"
    }
  ],
  "title": "Clinical outcomes and toxicity after proton- versus photon-based spatially fractionated radiotherapy for soft-tissue sarcoma: a retrospective cohort",
  "title_text": "Clinical outcomes and toxicity after proton- versus photon-based spatially fractionated radiotherapy for soft-tissue sarcoma: a retrospective cohort",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:14Z",
  "url": "https://research.draconitic.com/paper/ekad2v4c80jd5",
  "venue": "Frontiers in Oncology",
  "versions": []
}