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Radiotherapy in soft tissue sarcoma

  • Falk RöderEmail author
short review

Summary

Radiation therapy (RT) is an integral part of the treatment of adult soft tissue sarcomas (STS). In extremity STS, RT generally increases local control (LC) compared to wide excision alone while the magnitude of benefit depends on the individual risk profile. Neoadjuvant treatment results in less late toxicity paralleled by improved functional outcome but comes along with increased wound complications compared to postoperative radiation. In retroperitoneal sarcoma, neoadjuvant radiation seems to improve LC at least in liposarcomas while its impact in other histologies remains unclear. Postoperative radiation should not be used except in highly selected cases due to clear disadvantages regarding target coverage and side effects. The introduction of modern radiation techniques like intensity-modulated RT and image-guided RT has further improved the therapeutic ratio and is strongly recommended. Alternative boosting techniques like intraoperative RT or brachytherapy might be used to increase efficacy in high-risk patients although their value has not been proven in modern randomized trials.

Keywords

Radiotherapy Sarcoma Intensity-modulated radiotherapy Image-guided radiotherapy Review 

Notes

Conflict of interest

F. Röder declares that he has no competing interests.

References

  1. 1.
    Roeder F, Krempien R. Intraoperative radiation therapy (IORT) in soft-tissue sarcoma. Radiat Oncol. 2017;12:20.CrossRefGoogle Scholar
  2. 2.
    Rosenberg SA, Tepper J, Glatstein E, et al. R: The treatment of soft-tissue sarcomas of the extremities. Ann Surg. 1982;196:305–14.CrossRefGoogle Scholar
  3. 3.
    Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvat radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16:197–203.CrossRefGoogle Scholar
  4. 4.
    Albertsmeier M, Rauch A, Roeder F, et al. External beam radiation therapy for resectable soft tissue sarcoma: a systematic review and meta-analysis. Ann Surg Oncol. 2018;25:754–67.CrossRefGoogle Scholar
  5. 5.
    Jebsen NL, Trovik CS, Bauer HC, et al. Radiotherapy to improve local control regardless of surgical margin and malignancy grade in extremity and trunk wall soft tissue sarcoma: a Scandinavian sarcoma group study. Int J Radiat Oncol Biol Phys. 2008;71:1196–203.CrossRefGoogle Scholar
  6. 6.
    National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology (NCCN guidelines) soft tissue sarcoma version 2. 2019. www. Nccn.org.Google Scholar
  7. 7.
    Casali PG, Abecassis N, Aro HT, et al. ESMO Guidelines Committee and EURACAN. Soft-tissue and visceral sarcoma: ESMO-EURACAN Clinical practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(suppl):iv51–iv67.CrossRefGoogle Scholar
  8. 8.
    O’Sullivan B, Davis AM, Turcotte R, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomized trial. Lancet. 2002;359:2235–41.CrossRefGoogle Scholar
  9. 9.
    Davis AM, O’Sullivan B, Turcotte R, et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol. 2005;75:48–53.CrossRefGoogle Scholar
  10. 10.
    Folkert MR, Singer S, Brennan MF, 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;32:3236–41.CrossRefGoogle Scholar
  11. 11.
    O’Sullivan B, Griffin AM, Dickie CI, 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;119:1878–84.CrossRefGoogle Scholar
  12. 12.
    Dickie CI, Parent AL, Chung PW, et al. Measuring interfractional and intrafractional motion with cone beam computed tomography and an optical localization system for lower extremity soft tissue sarcoma patients treated with preoperative intensity-modulated radiation therapy. Int J Radiat Oncol Biol Phys. 2010;78:1437–44.CrossRefGoogle Scholar
  13. 13.
    DeLaney TF. Fine tuning the radiation treatment for extremity soft tissue sarcomas. Ann Surg Oncol. 2018;25:3785–6.CrossRefGoogle Scholar
  14. 14.
    Roeder F, Lehner B, Saleh-Ebrahimi L, et al. Intraoperative electron radiation therapy combined with external beam radiation therapy and limb sparing surgery in extremity soft tissue sarcoma: a retrospective single center analysis of 183 cases. Radiother Oncol. 2016;119:22–9.CrossRefGoogle Scholar
  15. 15.
    Al Yami A, Griffin AM, Ferguson PC, et al. Positive surgical margins in soft tissue sarcoma treated with preoperative radiation: is a postoperative boost necessary? Int J Radait Oncol Biol Phys. 2010;77:1191–7.CrossRefGoogle Scholar
  16. 16.
    Alamanda VK, Song Y, Shinohara E, et al. Postoperative radiation boost does not improve local recurrence rates in extremity soft tissue sarcomas. J Med Imaging Radiat Oncol. 2014;58:633–40.CrossRefGoogle Scholar
  17. 17.
    Roeder F, de Paoli A, Saleh-Ebrahimi L, et al. Intraoperative Electron Radiation Therapy Combined with external beam radiation therapy after gross total resection in extremity soft tissue sarcoma: a European pooled analysis. Ann Surg Oncol. 2018;25:3833–42.CrossRefGoogle Scholar
  18. 18.
    Roeder F, Lehner B, Schmitt T, et al. Excellent local control with IOERT and postoperative EBRT in high grade extremity sarcoma: results from a subgroup analysis of a prospective trial. BMC Cancer. 2014;14:350.CrossRefGoogle Scholar
  19. 19.
    Roeder F, Schulz-Ertner D, Nikoghosyan AV, et al. A clinical phase I/II trial to investigate preoperative dose-escalated intensity-modulated radiation therapy (IMRT) and intraoperative radiation therapy (IORT) in patients with retroperitoneal soft tissue sarcoma. BMC Cancer. 2012;12:287.CrossRefGoogle Scholar
  20. 20.
    Petersen IA, Haddock MG, Donohue JH, et al. Use of intraoperative electron beam radiotherapy in the management of retroperitoneal soft tissue sarcomas. Int J Radiat Oncol Biol Phys. 2002;52:469–75.CrossRefGoogle Scholar
  21. 21.
    Pawlik TM, Pisters PW, Mikula L, 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;13:508–17.CrossRefGoogle Scholar
  22. 22.
    Gronchi A, De Paoli A, Dani C, et al. Preoperative chemo-radiation therapy for localised retroperitoneal sarcoma: a phase I‑II study from the Italian Sarcoma Group. Eur J Cancer. 2014;50:784–92.CrossRefGoogle Scholar
  23. 23.
    Smith MJ, Ridgway PF, Catton CN, et al. Combined management of retroperitoneal sarcoma with dose intensification radiotherapy and resection: long-term results of a prospective trial. Radiother Oncol. 2014;110:165–71.CrossRefGoogle Scholar
  24. 24.
    Roeder F, Ulrich A, Habl G, et al. Clinical phase I/II trial to investigate preoperative dose-escalated intensity-modulated radiation therapy (IMRT) and intraoperative radiation therapy (IORT) in patients with retroperitoneal soft tissue sarcoma: interim analysis. BMC Cancer. 2014;14:617.CrossRefGoogle Scholar
  25. 25.
    Hull MA, Molina G, Niemierko A, et al. Improved local control with an aggressive strategy of preoperative (with or without intraoperative) radiation therapy combined with combined with radical surgical resection for retroperitoneal sarcoma. J Surg Oncol. 2017;9999:1–6.Google Scholar
  26. 26.
    Gieschen HL, Spiro IJ, Suit HD, et al. Long-term results of intraoperative electron beam radiotherapy for primary and recurrent retroperitoneal sarcoma. Int J Radiat Oncol Biol Phys. 2001;50:127–31.CrossRefGoogle Scholar
  27. 27.
    Kelly KJ, Yoon SS, Kuk D, et al. Comparison of perioperative radiation therapy and surgery versus surgery alone in 204 patients with primary retroperitoneal sarcoma: a retrospective 2‑institution study. Ann Surg. 2015;262:156–62.CrossRefGoogle Scholar
  28. 28.
    Stucky CC, Wasif N, Ashman JB, et al. Excellent local control with preoperative radiation therapy, surgical resection, and intra-operative electron radiation therapy for retroperitoneal sarcoma. J Surg Oncol. 2014;109:798–803.CrossRefGoogle Scholar
  29. 29.
    Bonvalot S, Gronchi A, Le Pechoux C, et al. STRASS(EORTC 62092): A phase III randomized study of preoperative radiotherapy plus surgery versus surgery alone for patients with retroperitoneal sarcoma. J Clin Oncol. 2019;37(suppl):11001 (abstract).Google Scholar
  30. 30.
    Gronchi A, Strauss DC, Miceli R, et al. Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma (RPS): a report on 1007 patients from the multi-institutional collaborative RPS working group. Ann Surg. 2016;263:1002–9.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of Radiotherapy and Radiation OncologyParacelsus Medical University of Salzburg, LandeskrankenhausSalzburgAustria

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