Development and the need for implementation of a health-related quality of life measurement strategy for patients with soft tissue sarcoma undergoing preoperative radiotherapy

Background and purpose: Soft tissue sarcomas (STS) are a rare and heterogeneous group of tumours. Treatment strategies are based on histological subtype, patient performance status, tumour location, and size. Common treatment modalities include surgery, (neo)adjuvant chemotherapy, and (neo)adjuvant radiotherapy. While disease control and survival remain primary research focuses, health-related quality of life (HRQoL) is equally important. Accurately assessing HRQoL outcomes is particularly difficult due to the heterogeneity of STS, variations in treatment, tumour location and surgical interventions, and the preva-lence of these rare cancers. Patients and methods: To address this gap, a sarcoma-specific tool was developed complementing the most used cancer-generic EORTC QLQ-C30 questionnaire, with additional items tailored to the specific challenges of radiotherapy and surgery in sarcoma patients. The final questionnaire consists of the EQ-5D-5L, EORTC QLQ-C30, and additional EORTC Item Library items addressing stiffness, pain in muscles and bones, scar pain, as well as items of the PRO-CTCAE. The selection was made with significant input from patients with STS who underwent radiotherapy previously and with input from clinicians who were present at the multidisciplinary consultation. Results and Interpretation: The newly developed HRQoL tool is currently undergoing validation within the SCOPES trial (NTC04425967), evaluating HRQoL outcomes in patients undergoing standard versus hypofractionated radiotherapy. This tool will lead to better understanding the full impact of treatment on sarcoma patients and hopefully, ultimately improve their HRQoL. Moreover, it provides a standardized framework that can be utilized across studies, facilitating the comparison of HRQoL data and enabling more consistent and comprehensive insights into patient outcomes.