Radiation for soft tissue sarcoma – pro
Sarcomas are a rare disease, with 9,220 new soft tissue sarcomas diagnoses and 3,560 deaths in the United States in 2007. Many are in the limbs and sometmims neaodjuvant radiation can allow limb sparing. Several studies showed that large sarcomas benefit form preoperative chemotherapy and radiation and allow greater limb sparing. The NCCN guidelines currently recommends radiation therapy for extremity sarcomas for high grade lesions and for low grade lesions which are larger than 5 cm or have close or positive margins. Radiotherapy may be delivered post-operatively instead of pre-operatively for a variety of reasons, including the incidental diagnosis of sarcoma at surgery, upgrading after evaluation at surgery, inability to obtain a negative margin with acceptable functional outcomes, and more extensive lesion than expected based on pre-operative imaging and pathologic data. It appears that post-operative and pre-operative radiation treatment has both benefits and detriments and should be discussed on an individual basis with each patient in a multi-disciplinary setting.
Aradhana Kaushal et al,The Role of Radiation Therapy in the Management of Sarcomas, Surg Clin North Am. Jun 2008; 88(3): 629viii.
NCCN, Soft tissue sarcoma, Extrasarc-1 2014