What is the role of radiation therapy in the treatment of soft-tissue sarcomas of the extremities?

Updated: Dec 03, 2018
  • Author: Vinod B Shidham, MD, FRCPath; Chief Editor: Omohodion (Odion) Binitie, MD  more...
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Small, superficial, or low-grade tumors treated with only a wide local excision have a very low risk of local recurrence. [27] For better local control, many patients undergoing surgical excision receive radiation therapy. In patients who refuse or cannot tolerate surgery, radiation alone can be an effective treatment for certain extremity sarcomas.

After wide surgical excision, radiation therapy enhances local control for primary extremity sarcomas. The concept of limb-sparing surgery with postoperative irradiation has been validated by randomized trials of amputation versus wide local excision. [41] Usually, a total dose of about 60 Gy is adequate. A large, single-institution series reported long-term disease control with postoperative radiation therapy for soft-tissue sarcoma of the extremities with acceptable toxicity. Older age and recurrence were poor prognostic factors. [42]

Postoperative radiation can also be delivered to the tumor bed by means of brachytherapy, in which radioactive sources are implanted in the patient. The advantage of this approach is that it requires a much shorter time for initiation and completion of therapy than external radiation does. External beam radiation is used for 6 weeks, beginning 1 month or more after surgery; brachytherapy usually is started within a week of surgery and completed in 4 or 5 days.

Because of its technical complexity, brachytherapy requires an experienced radiation oncologist during the operating procedure. Brachytherapy and external beam radiation appear to be equally effective when properly administered.

The employment of preoperative radiation therapy may allow less radical forms of surgery to be used, specifically on large tumors that otherwise may compromise limb-sparing procedures. Radiation-induced tumor shrinkage decreases the magnitude of resection needed and reduces the risk of seeding by viable tumor cells. Local fibrosis may make the resection more challenging.

Findings from one study showed that intensity-modulated radiotherapy (IMRT) achieved better local control of high-grade soft-tissue sarcoma at 5 years than brachytherapy did, though higher rates of adverse features occurred in the group receiving IMRT. [43]

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