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Background Standard therapy for localised, resectable high risk soft tissue sarcomas consists of wide excision and radiotherapy over several weeks. This treatment schedule is hardly feasible in geriatric and frail patients. In order not to withhold radiotherapy from these patients, hypofractionated radiotherapy with 25 Gy in 5 fractions was evaluated in a geriatric patient population. Patients and methods A retrospective analysis was performed of 18 geriatric patients with resectable high risk soft tissue sarcomas of extremities and thoracic wall. Wound healing and short term oncologic outcome were analysed. In addition, dose constraints for radiotherapy of the extremities were transferred from normofractionated to hypofractionated radiotherapy regimens. Results Feasibility was good with 17/18 patients completing treatment as planned. Wound healing complication rate was in the range of published data. Two patients developed local and distant recurrence, two patients isolated distant recurrences. No isolated local recurrences were observed. Keeping the constraints was possible in all cases without compromising the coverage of the target volume. Conclusions Hypofractionated radiotherapy and surgery was well tolerated even in this specific patient population. With feasibility concerning early wound healing problems and adapted constraints, which allow for the treatment of most resectable extremity tumours, the concept warrants further evaluation in patients unfit for standard radiotherapy.

Additional file 1. Table 1. Dose constraints for Organs at Risk (OARs). Table 2. Volume of interest (VOI) definition. Table 3. Statistical information for the comparison of dosimetrical data.

Figure S1. Overview of assessable reports (‘yes’ or ‘no’) in regard to brain invasion and available, overlapping reports of the different modalities. Figure S2. Assessable reports (‘yes’ or ‘no’) in regard to bone involvement and the overlap of the different modalities. Figure S3. Cross-classification tables for a) the surgeon’s description of brain invasion and corresponding histopathologic findings and b) operative reports considering bone invasion and associated imaging-based findings. Only assessable and distinct results (‘yes’ and ‘no’) were considered. (PDF 122 kb)