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Soft Tissue Sarcoma and Radiation Therapy Advances, Impact on Toxicity

  • Sarcoma (SH Okuno, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Since adjuvant radiotherapy was introduced in the 1970s for soft tissue sarcoma (STS), sequential clinical trials characterized the toxicities induced by radiotherapy when given post-operatively and pre-operatively. Gradual technological advancements led to more precise radiotherapy delivery through intensity-modulated radiation therapy (IMRT) and more accurate targeting through image-guided radiotherapy (IGRT) to minimize normal tissues from high-dose irradiation. These improvements ultimately reduced the long-term toxicities from radiotherapy. Due to the rarity and complexity of the disease, patients with STS should be treated at institutes where multidisciplinary discussion and care can be provided. Patients with STS should ideally be offered the choice of participating in clinical trials. International phase III trials are ongoing through COG-NRG Oncology (Pazopanib Neoadjuvant Trial in Non-Rhabdomyosarcoma Soft Tissue Sarcomas (PAZNTIS)) to define the role of radiotherapy in combination with pazopanib in the clinical care of extremity STS and through EORTC (STRASS) to define the role of pre-operative radiotherapy in the treatment of retroperitoneal STS. Outside of clinical trials, extremity STS should be treated at centers of expertise where high-quality IMRT–IGRT is administered to lessen acute and long-term toxicities. In patients with extremity STS, pre-operative IMRT–IGRT is preferred as better target delineation and image guidance can be achieved. While acute wound complication remains a concern, patients treated using pre-operative IMRT–IGRT are largely spared of severe chronic irreversible radiation-related side effects such as bone fracture, fibrosis, edema, and joint stiffness that alter limb functions. For STS originating from the retroperitoneum, if radiotherapy is recommended following multidisciplinary case discussion, pre-operative radiotherapy is preferred over post-operative radiotherapy. Post-operatively, normal radiosensitive organs fill the surgical cavity, which is the targeted volume of radiotherapy; hence, post-operative radiotherapy for retroperitoneal STS is associated with severe to fatal toxicities. Pre-operative radiotherapy has a more favorable toxicity profile as the retroperitoneal STS displaces, and thus spares, normal structures and organs from the high-dose irradiation volume.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Wang D, Abrams RA. Radiotherapy for soft tissue sarcoma: 50 years of change and improvement. Am Soc Clin Oncol Educ Book. 2014:244–51. doi:10.14694/EdBook_AM.2014.34.244. This article gives an overvue of the technical adcances in radiation therapy and their impact on the toxicity profile in the treatments of extremity soft-tissue sarcoma. It also brings forth the addition of targeted therapy and it’s combination with radiation therapy.

  2. Lawrence Jr W, Donegan WL, Natarajan N, Mettlin C, Beart R, Winchester D. Adult soft tissue sarcomas. A pattern of care survey of the American College of Surgeons. Ann Surg. 1987;205(4):349–59.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Smith GM, Johnson GD, Grimer RJ, Wilson S. Trends in presentation of bone and soft tissue sarcomas over 25 years: little evidence of earlier diagnosis. Ann R Coll Surg Engl. 2011;93(7):542–7. doi:10.1308/147870811X13137608455055. This article highlights that despite the need to diagnose sarcomas earlier, very little improvement in early diagnosis occurred in the past 25 years. Gives a good picture of the patient at diagnosis in relation to symptomes and tumor size.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Mazeron JJ, Suit HD. Lymph nodes as sites of metastases from sarcomas of soft tissue. Cancer. 1987;60(8):1800–8.

    Article  CAS  PubMed  Google Scholar 

  5. Fong Y, Coit DG, Woodruff JM, Brennan MF. Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg. 1993;217(1):72–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Christie-Large M, James SL, Tiessen L, Davies AM, Grimer RJ. Imaging strategy for detecting lung metastases at presentation in patients with soft tissue sarcomas. Eur J Cancer. 2008;44(13):1841–5. doi:10.1016/j.ejca.2008.06.004.

    Article  CAS  PubMed  Google Scholar 

  7. Pisters PW, Harrison LB, Woodruff JM, Gaynor JJ, Brennan MF. A prospective randomized trial of adjuvant brachytherapy in the management of low-grade soft tissue sarcomas of the extremity and superficial trunk. J Clin Oncol. 1994;12(6):1150–5.

    CAS  PubMed  Google Scholar 

  8. Yang JC, Chang AE, Baker AR, Sindelar WF, Danforth DN, Topalian SL, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16(1):197–203.

    CAS  PubMed  Google Scholar 

  9. White LM, Wunder JS, Bell RS, O’Sullivan B, Catton C, Ferguson P, et al. Histologic assessment of peritumoral edema in soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 2005;61(5):1439–45. doi:10.1016/j.ijrobp.2004.08.036.

    Article  PubMed  Google Scholar 

  10. Pisters PW, O’Sullivan B, Maki RG. Evidence-based recommendations for local therapy for soft tissue sarcomas. J Clin Oncol. 2007;25(8):1003–8. doi:10.1200/JCO.2006.09.8525.

    Article  PubMed  Google Scholar 

  11. Prescribing, recording and reporting photon beam therapy (supplement to ICRU report 50), report 62. J ICRU. 1999.

  12. Prescribing, recording, and reporting photon-beam intensity-modulated radiation therapy (IMRT): Contents. J ICRU. 2010;10(1):NP. doi:10.1093/jicru/ndq002.

  13. Dawson LA, Sharpe MB. Image-guided radiotherapy: rationale, benefits, and limitations. Lancet Oncol. 2006;7(10):848–58. doi:10.1016/S1470-2045(06)70904-4.

    Article  PubMed  Google Scholar 

  14. Wong P, Dickie C, Lee D, Chung P, O’Sullivan B, Letourneau D, et al. Spatial and volumetric changes of retroperitoneal sarcomas during pre-operative radiotherapy. Radiother Oncol. 2014. doi:10.1016/j.radonc.2014.08.004.

    Google Scholar 

  15. Roberge D, Skamene T, Nahal A, Turcotte RE, Powell T, Freeman C. Radiological and pathological response following pre-operative radiotherapy for soft-tissue sarcoma. Radiother Oncol. 2010;97(3):404–7. doi:10.1016/j.radonc.2010.10.007.

    Article  PubMed  Google Scholar 

  16. O’Sullivan B, Davis AM, Turcotte R, Bell R, Catton C, Chabot P, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002;359(9325):2235–41. doi:10.1016/S0140-6736(02)09292-9.

    Article  PubMed  Google Scholar 

  17. Bahig H, Roberge D, Bosch W, Levin W, Petersen I, Haddock M, et al. Agreement among RTOG sarcoma radiation oncologists in contouring suspicious peritumoral edema for preoperative radiation therapy of soft tissue sarcoma of the extremity. Int J Radiat Oncol Biol Phys. 2013;86(2):298–303. doi:10.1016/j.ijrobp.2013.01.032.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Wang D, Bosch W, Roberge D, Finkelstein SE, Petersen I, Haddock M, et al. RTOG sarcoma radiation oncologists reach consensus on gross tumor volume and clinical target volume on computed tomographic images for preoperative radiotherapy of primary soft tissue sarcoma of extremity in Radiation Therapy Oncology Group studies. Int J Radiat Oncol Biol Phys. 2011;81(4):e525–8. doi:10.1016/j.ijrobp.2011.04.038. With the advent of novel radiation techniques, this article gives a clear definition of target volume delineation.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Wang D, Zhang Q, Eisenberg BL, Kane JM, Li XA, Lucas D et al. Significant reduction of late toxicities in extremity sarcoma patients treated with image-guided radiotherapy to a reduced target volume: results of RTOG 0630. J Clin Oncol. 2014. The use of IGRT in the post-operative treatement of STS is well explained and the authors have demonstrated a reduction in chronic toxicities and thus far, no increase in local resurrences.

  20. Felderhof JM, Creutzberg CL, Putter H, Nout RA, Bovee JV, Dijkstra PD, et al. Long-term clinical outcome of patients with soft tissue sarcomas treated with limb-sparing surgery and postoperative radiotherapy. Acta Oncol. 2013;52(4):745–52. doi:10.3109/0284186X.2012.709947.

    Article  PubMed  Google Scholar 

  21. Pisters PW, Harrison LB, Leung DH, Woodruff JM, Casper ES, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol. 1996;14(3):859–68.

    CAS  PubMed  Google Scholar 

  22. Davis AM, O’Sullivan B, Turcotte R, Bell R, Catton C, Chabot P, et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol. 2005;75(1):48–53.

    Article  PubMed  Google Scholar 

  23. Baldini EH, Lapidus MR, Wang Q, Manola J, Orgill DP, Pomahac B, et al. Predictors for major wound complications following preoperative radiotherapy and surgery for soft-tissue sarcoma of the extremities and trunk: importance of tumor proximity to skin surface. Ann Surg Oncol. 2013;20(5):1494–9. doi:10.1245/s10434-012-2797-1. Article describing four imprtant predictors of major wound complications in patients treated with pre-operative RT. Factors to take into consideration when treatment decisions are being made.

    Article  PubMed  Google Scholar 

  24. O’Sullivan B, Griffin AM, Dickie CI, Sharpe MB, Chung PW, Catton CN, et al. Phase 2 study of preoperative image-guided intensity-modulated radiation therapy to reduce wound and combined modality morbidities in lower extremity soft tissue sarcoma. Cancer. 2013;119(10):1878–84. doi:10.1002/cncr.27951. Article showing collaboration between radiation oncologist and surgeons in Princess Margarate Hospital in Toronta, Canada, to spare skin flap for wound closure. Although acute wound complication rates were similar then previously reported the rate of primary wound closure was higher showing a possible avenue to decrease acute wound complications in patients treated with pre-operative RT.

    Article  PubMed  Google Scholar 

  25. Folkert MR, Singer S, Brennan MF, Kuk D, Qin LX, Kobayashi WK, et al. Comparison of local recurrence with conventional and intensity-modulated radiation therapy for primary soft-tissue sarcomas of the extremity. J Clin Oncol. 2014;32(29):3236–41. doi:10.1200/JCO.2013.53.9452. Comparaison between local control and toxicty profiles in patients treated in a single institution with 3DCRT vs IMRT. The results show an improvement in local control with a decrease in toxicities.

    Article  PubMed  Google Scholar 

  26. Dickie CI, Parent AL, Griffin AM, Fung S, Chung PW, Catton CN, et al. Bone fractures following external beam radiotherapy and limb-preservation surgery for lower extremity soft tissue sarcoma: relationship to irradiated bone length, volume, tumor location and dose. Int J Radiat Oncol Biol Phys. 2009;75(4):1119–24. doi:10.1016/j.ijrobp.2008.12.006.

    Article  PubMed  Google Scholar 

  27. Lewis JJ, Leung D, Woodruff JM, Brennan MF. Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg. 1998;228(3):355–65.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Swallow CJ, Catton CN. Improving outcomes for retroperitoneal sarcomas: a work in progress. Surg Oncol Clin N Am. 2012;21(2):317–31. doi:10.1016/j.soc.2012.01.002. Clear and concise review on retroperitoneal sarcomas and published data.

    Article  PubMed  Google Scholar 

  29. Stoeckle E, Coindre JM, Bonvalot S, Kantor G, Terrier P, Bonichon F, et al. Prognostic factors in retroperitoneal sarcoma: a multivariate analysis of a series of 165 patients of the French Cancer Center Federation Sarcoma Group. Cancer. 2001;92(2):359–68.

    Article  CAS  PubMed  Google Scholar 

  30. Heslin MJ, Lewis JJ, Nadler E, Newman E, Woodruff JM, Casper ES, et al. Prognostic factors associated with long-term survival for retroperitoneal sarcoma: implications for management. J Clin Oncol. 1997;15(8):2832–9.

    CAS  PubMed  Google Scholar 

  31. Gronchi A, Miceli R, Colombo C, Stacchiotti S, Collini P, Mariani L, et al. Frontline extended surgery is associated with improved survival in retroperitoneal low- to intermediate-grade soft tissue sarcomas. Ann Oncol. 2012;23(4):1067–73. doi:10.1093/annonc/mdr323.

    Article  CAS  PubMed  Google Scholar 

  32. Sampath S, Hitchcock YJ, Shrieve DC, Randall RL, Schultheiss TE, Wong JY. Radiotherapy and extent of surgical resection in retroperitoneal soft-tissue sarcoma: multi-institutional analysis of 261 patients. J Surg Oncol. 2010;101(5):345–50. doi:10.1002/jso.21474.

    PubMed  Google Scholar 

  33. Singer S, Corson JM, Demetri GD, Healey EA, Marcus K, Eberlein TJ. Prognostic factors predictive of survival for truncal and retroperitoneal soft-tissue sarcoma. Ann Surg. 1995;221(2):185–95.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Catton CN, O’Sullivan B, Kotwall C, Cummings B, Hao Y, Fornasier V. Outcome and prognosis in retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 1994;29(5):1005–10.

    Article  CAS  PubMed  Google Scholar 

  35. Le Pechoux C, Musat E, Baey C, Al Mokhles H, Terrier P, Domont J, et al. Should adjuvant radiotherapy be administered in addition to front-line aggressive surgery (FAS) in patients with primary retroperitoneal sarcoma? Ann Oncol. 2013;24(3):832–7. doi:10.1093/annonc/mds516.

    Article  PubMed  Google Scholar 

  36. Hassan I, Park SZ, Donohue JH, Nagorney DM, Kay PA, Nasciemento AG, et al. Operative management of primary retroperitoneal sarcomas: a reappraisal of an institutional experience. Ann Surg. 2004;239(2):244–50. doi:10.1097/01.sla.0000108670.31446.54.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Nussbaum DP, Speicher PJ, Gulack BC, Ganapathi AM, Englum BR, Kirsch DG, et al. Long-term oncologic outcomes after neoadjuvant radiation therapy for retroperitoneal sarcomas. Ann Surg. 2014. doi:10.1097/SLA.0000000000000840.

    PubMed  Google Scholar 

  38. Smith MJ, Ridgway PF, Catton CN, Cannell AJ, O’Sullivan B, Mikula LA, et al. Combined management of retroperitoneal sarcoma with dose intensification radiotherapy and resection: long-term results of a prospective trial. Radiother Oncol. 2014;110(1):165–71. doi:10.1016/j.radonc.2013.10.041. Phase II trial showing unaccaptable toxicities with no benefit in local control with the addition of brachytherapy in the management of retroperitoneal sarcomas.

    Article  PubMed  Google Scholar 

  39. Pawlik TM, Pisters PW, Mikula L, Feig BW, Hunt KK, Cormier JN, et al. Long-term results of two prospective trials of preoperative external beam radiotherapy for localized intermediate- or high-grade retroperitoneal soft tissue sarcoma. Ann Surg Oncol. 2006;13(4):508–17. doi:10.1245/ASO.2006.05.035.

    Article  PubMed  Google Scholar 

  40. Jones JJ, Catton CN, O’Sullivan B, Couture J, Heisler RL, Kandel RA, et al. Initial results of a trial of preoperative external-beam radiation therapy and postoperative brachytherapy for retroperitoneal sarcoma. Ann Surg Oncol. 2002;9(4):346–54.

    Article  PubMed  Google Scholar 

  41. Wilkinson MJ, Martin JL, Khan AA, Hayes AJ, Thomas JM, Strauss DC. Percutaneous core needle biopsy in retroperitoneal sarcomas does not influence local recurrence or overall survival. Ann Surg Oncol. 2014. doi:10.1245/s10434-014-4059-x.

    Google Scholar 

  42. Tuan J, Vitolo V, Vischioni B, Iannalfi A, Fiore MR, Fossati P, et al. Radiation therapy for retroperitoneal sarcoma. Radiol Med. 2014;119(10):790–802. doi:10.1007/s11547-013-0350-3.

    Article  PubMed  Google Scholar 

  43. Ballo MT, Zagars GK, Pollock RE, Benjamin RS, Feig BW, Cormier JN, et al. Retroperitoneal soft tissue sarcoma: an analysis of radiation and surgical treatment. Int J Radiat Oncol Biol Phys. 2007;67(1):158–63. doi:10.1016/j.ijrobp.2006.08.025.

    Article  PubMed  Google Scholar 

  44. Zlotecki RA, Katz TS, Morris CG, Lind DS, Hochwald SN. Adjuvant radiation therapy for resectable retroperitoneal soft tissue sarcoma: the University of Florida experience. Am J Clin Oncol. 2005;28(3):310–6.

    Article  PubMed  Google Scholar 

  45. Pezner RD, Liu A, Chen YJ, Smith DD, Paz IB. Full-dose adjuvant postoperative radiation therapy for retroperitoneal sarcomas. Am J Clin Oncol. 2011;34(5):511–6. doi:10.1097/COC.0b013e3181f4796d.

    PubMed  Google Scholar 

  46. Gilbeau L, Kantor G, Stoeckle E, Lagarde P, Thomas L, Kind M, et al. Surgical resection and radiotherapy for primary retroperitoneal soft tissue sarcoma. Radiother Oncol. 2002;65(3):137–43.

    Article  PubMed  Google Scholar 

  47. Alektiar KM, Hu K, Anderson L, Brennan MF, Harrison LB. High-dose-rate intraoperative radiation therapy (HDR-IORT) for retroperitoneal sarcomas. Int J Radiat Oncol Biol Phys. 2000;47(1):157–63.

    Article  CAS  PubMed  Google Scholar 

  48. Sindelar WF, Kinsella TJ, Chen PW, DeLaney TF, Tepper JE, Rosenberg SA, et al. Intraoperative radiotherapy in retroperitoneal sarcomas. Final results of a prospective, randomized, clinical trial. Arch Surg. 1993;128(4):402–10.

    Article  CAS  PubMed  Google Scholar 

  49. Perera GB, Wilson SE, Barie PS, Butler JA. Duodenocaval fistula: a late complication of retroperitoneal irradiation and vena cava replacement. Ann Vasc Surg. 2004;18(1):52–8. doi:10.1007/s10016-003-0097-8.

    Article  PubMed  Google Scholar 

  50. Gieschen HL, Spiro IJ, Suit HD, Ott MJ, Rattner DW, Ancukiewicz M, et al. Long-term results of intraoperative electron beam radiotherapy for primary and recurrent retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 2001;50(1):127–31.

    Article  CAS  PubMed  Google Scholar 

  51. Bartlett EK, Roses RE, Meise C, Fraker DL, Kelz RR, Karakousis GC. Preoperative radiation for retroperitoneal sarcoma is not associated with increased early postoperative morbidity. J Surg Oncol. 2014;109(6):606–11. doi:10.1002/jso.23534.

    Article  PubMed  Google Scholar 

  52. Alford S, Choong P, Chander S, Henderson M, Powell G, Ngan S. Outcomes of preoperative radiotherapy and resection of retroperitoneal sarcoma. ANZ J Surg. 2013;83(5):336–41. doi:10.1111/j.1445-2197.2012.06211.x.

    Article  PubMed  Google Scholar 

  53. Bossi A, De Wever I, Van Limbergen E, Vanstraelen B. Intensity modulated radiation-therapy for preoperative posterior abdominal wall irradiation of retroperitoneal liposarcomas. Int J Radiat Oncol Biol Phys. 2007;67(1):164–70. doi:10.1016/j.ijrobp.2006.08.023.

    Article  PubMed  Google Scholar 

  54. Yoon SS, Chen YL, Kirsch DG, Maduekwe UN, Rosenberg AE, Nielsen GP, et al. Proton-beam, intensity-modulated, and/or intraoperative electron radiation therapy combined with aggressive anterior surgical resection for retroperitoneal sarcomas. Ann Surg Oncol. 2010;17(6):1515–29. doi:10.1245/s10434-010-0935-1.

    Article  PubMed Central  PubMed  Google Scholar 

  55. Tzeng CW, Fiveash JB, Popple RA, et al. Preoperative radiation therapy with selective dose escalation to the margin at risk for retroperitoneal sarcoma. Cancer. 2006;107(2):371–9.

    Article  PubMed  Google Scholar 

  56. Pervaiz N, Colterjohn N, Farrokhyar F, Tozer R, Figueredo A, Ghert M. A systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft-tissue sarcoma. Cancer. 2008;113(3):573–81. doi:10.1002/cncr.23592.

    Article  PubMed  Google Scholar 

  57. Woll PJ, Reichardt P, Le Cesne A, Bonvalot S, Azzarelli A, Hoekstra HJ, et al. Adjuvant chemotherapy with doxorubicin, ifosfamide, and lenograstim for resected soft-tissue sarcoma (EORTC 62931): a multicentre randomised controlled trial. Lancet Oncol. 2012;13(10):1045–54. doi:10.1016/S1470-2045(12)70346-7.

    Article  CAS  PubMed  Google Scholar 

  58. DeLaney TF, Spiro IJ, Suit HD, Gebhardt MC, Hornicek FJ, Mankin HJ, et al. Neoadjuvant chemotherapy and radiotherapy for large extremity soft-tissue sarcomas. Int J Radiat Oncol Biol Phys. 2003;56(4):1117–27.

    Article  PubMed  Google Scholar 

  59. Kraybill WG, Harris J, Spiro IJ, Ettinger DS, DeLaney TF, Blum RH, et al. Long-term results of a phase 2 study of neoadjuvant chemotherapy and radiotherapy in the management of high-risk, high-grade, soft tissue sarcomas of the extremities and body wall: radiation therapy oncology group trial 9514. Cancer. 2010;116(19):4613–21. doi:10.1002/cncr.25350.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  60. Wong P, Houghton P, Kirsch DG, Finkelstein SE, Monjazeb AM, Xu-Welliver M et al. Combining targeted agents with modern radiotherapy in soft tissue sarcomas. J Natl Cancer Inst. 2014;106(11). doi:10.1093/jnci/dju329.

  61. Meyer JM, Perlewitz KS, Hayden JB, Doung YC, Hung AY, Vetto JT, et al. Phase I trial of preoperative chemoradiation plus sorafenib for high-risk extremity soft tissue sarcomas with dynamic contrast-enhanced MRI correlates. Clin Cancer Res. 2013;19(24):6902–11. doi:10.1158/1078-0432.CCR-13-1594.

    Article  CAS  PubMed  Google Scholar 

  62. Canter RJ, Borys D, Olusanya A, Li CS, Lee LY, Boutin RD, et al. Phase I trial of neoadjuvant conformal radiotherapy plus sorafenib for patients with locally advanced soft tissue sarcoma of the extremity. Ann Surg Oncol. 2014;21(5):1616–23. doi:10.1245/s10434-014-3543-7.

    Article  PubMed Central  PubMed  Google Scholar 

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Nancy El-Bared, Philip Wong, and Dian Wang declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, Centre Hospitalier de L’Université de Montréal, Montréal, Québec, Canada

    Nancy El-Bared M.D. & Philip Wong M.D., M.Sc.

  2. Department of Radiation Oncology, Rush University Medical Center, 500 S. Paulina St, Chicago, IL, 60612, USA

    Dian Wang M.D., Ph.D.

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  1. Nancy El-Bared M.D.
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Correspondence to Dian Wang M.D., Ph.D..

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El-Bared, N., Wong, P. & Wang, D. Soft Tissue Sarcoma and Radiation Therapy Advances, Impact on Toxicity. Curr. Treat. Options in Oncol. 16, 19 (2015). https://doi.org/10.1007/s11864-015-0335-7

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