Radiotherapy for Soft Tissue Sarcoma: 50 Years of Change and Improvement

Abstract

Radiotherapy for soft tissue sarcoma (STS) has advanced significantly over the past 50 years. This review focuses briefly on the period from 1964 to 1999 and more substantially on the changes of the past 15 years, such as IMRT and image-guided radiotherapy (IG-RT), especially when brought together (IG-IMRT) in the same planning and delivery process to treat localized STS. In particular, the introduction of IG-RT, target volume definitions for IG-RT, and review of recent clinical trials using IG-RT to treat localized STS in extremity will be reviewed. Finally, potential investigational agents combined with IG-RT to improve outcomes in patients with localized STS are discussed.KEY POINTSRadiotherapy for soft tissue sarcoma (STS) has advanced significantly over the past 50 years.Advanced radiotherapy technologies such as IG-RT or IG-IMRT are associated with significant reduction of radiation-related toxicities.Both preoperative and postoperative radiotherapy are equivalent in local control but are associated with different toxicity profiles.Preoperative radiotherapy is associated with less chronic effects but with increased wound complications mainly in lower-extremity STS.Progress to combine targeted agents with STS radiotherapy or chemoradiotherapy is moving slowly, but is urgently needed to improve local control in STS of certain sites such as retroperitonean and/or reduction of distant metastasis in large, high-grade STS.