Radiotherapy in soft tissue sarcoma
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.
KeywordsRadiotherapy Sarcoma Intensity-modulated radiotherapy Image-guided radiotherapy Review
Conflict of interest
F. Röder declares that he has no competing interests.
- 6.National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology (NCCN guidelines) soft tissue sarcoma version 2. 2019. www. Nccn.org.Google Scholar
- 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
- 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
- 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.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
- 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