Radiotherapy of soft tissue sarcomas

Background. As soft tissue sarcomas can arise in all regions of the body and at any age, the therapy represents a considerable interdisciplinary challenge. In the majority of patients radiotherapy is an important component of the treatment strategy. Aim. The following review summarizes the currently available evidence regarding the role of radiotherapy in the treatment of soft tissue sarcomas. Material and methods. A search in the PubMed database using the key words sarcoma and radiotherapy in the article types, clinical trial, randomized controlled trial, meta-analysis and "review was carried out to identify articles up to May 2014. The search for clinical trials was limited to the last 10 years and for reviews to the last 2 years. In addition, references included in the 305 identified manuscripts were also used. A systematic evaluation of the evidence based on the identified manuscripts was not performed. Results. In contrast to previous suppositions soft tissue sarcomas belong to the moderately radiation sensitive tumor entities. Accordingly, in a number of randomized trials adjuvant radiotherapy after surgical resection radiotherapy was shown to significantly decrease the local recurrence rate by at least a factor of 3. In cases of percutaneous radiotherapy, total doses of 60-66 Gy in conventional fractionation (5x2 Gy per week) were required for this effect. The benefits of radiotherapy are greater in the more malignant sarcomas (G2-3) and deep seated tumors. The side effects of radiotherapy depend greatly on the location of the sarcoma. In spite of the formation of fibrosis in high-dose areas (>50 Gy) functional results are generally only moderately impaired by radiotherapy. Preoperative radiotherapy has been shown to be as least as effective as postoperative radiotherapy, although typically only 50 Gy in conventional fractionation was applied. Especially in large soft tissue sarcomas or in locations close to radiation-sensitive organs, such as the retroperitoneum, preoperative radiotherapy should be preferentially considered. In the absence of validated data modern histological subtyping of soft tissue sarcomas has so far little influence on the indications for radiotherapy. Discussion. Radiotherapy plays an important role in the management of soft tissue sarcomas. The optimal usage requires a close interdisciplinary coordination of all disciplines involved.