• Xiaona Han, Xiaotao Zhang, Yaru Lin, Jinying Li, Lan Yu, Li Liu, Wenzhi Tong, Xi Cheng, Xiao Li, and Yanhao Liu.
• Department of Radiation Oncology, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, Qingdao, Shandong, China.
• Medicine (Baltimore). 2024 Nov 8; 103 (45): e40278e40278.

BackgroundStereotactic body radiotherapy (SBRT) and immune checkpoint inhibitors (ICIs) could obtain a certain synergistic effect on bone and soft tissue sarcoma (BSTS). Given its low radiosensitivity, BSTS usually require an irradiation dose >65 Gy to achieve local control. Herein, we developed a non-classical SBRT technique called "onion-shaped simultaneous boost (OSB)," and reported a patient with prostatic leiomyosarcoma which received non-classical SBRT and other systemic treatments.MethodsIn the case, a 49-year-old male patient was diagnosed with prostatic leiomyosarcoma in November 2018. In the radiotherapy plans, the maximum doses of the targets were more than 65 Gy, while the doses of the organs at risk (OARs) were strictly limited.ResultsAfter receiving radiotherapy, ICI, and other multidisciplinary modalities, the patient achieved partial response (PR).ConclusionIn this clinical case, we have observed that the OSB technique, which employs an increased per-fraction radiotherapy dose without the need to match the single-fraction doses typical of conventional SBRT, effectively enhances the therapeutic impact on leiomyosarcoma without an increase in radiotherapy-related side effects. By integrating the OSB technique with a multidisciplinary array of antineoplastic strategies, we can more effectively manage sarcomas in clinical practice.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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