Preoperative vs. postoperative radiotherapy in the treatment of soft tissue sarcomas: a matter of presentation

A Systematic Overview of Radiation Therapy Effects in Soft Tissue Sarcomas

“…Generally, liposarcomas have higher local control rate than MFH, and synovial sarcomas are somewhere in between (6,11,13,17). The patient populations analysed are small, however, and liposarcoma, for example, is a highly heterogeneous disease, and it has to be emphasized that the outcome is greatly determined by its histologic subtype (14).…”

“…In addition, an increased tumour-related death rate is observed after incomplete resections (10,20). Another aspect of treatment outcome is that local relapse at referral to a sarcoma centre is associated with a poorer local control rate (3,6,14). Radiation therapy plays a major role in the management of STS, mainly in combination with conservative and function-sparing surgery.…”

“…With preoperative radiotherapy there is a potential towards eliminating contamination of the surroundings by tumour cells during surgery, and resectability may be improved with tumour shrinkage. On the negative side, preoperative radiotherapy is associated with a higher wound complication rate (6,38,39). Moreover, the preoperative setting demolishes exact histopathological diagnosis and molecular assessments of the surgical specimen.…”

“…If re-excision is judged to be necessary, postoperative EBRT is recommended. Furthermore, it is has been observed that patients have a higher local control rate with the re-excision approach than patients without re-excision treated with EBRT alone to 50 Gy after gross total excision at an outside centre (6).…”

“…However, there is a paucity of dose-response data (3,9,11,28). In general, the preoperative EBRT dose used in most centres is 50 Gy in 2 Gy fractions (2,6,38). Depending on the pathological findings, a postoperative boost of 10 to 15 Gy is given.…”