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<p>Soft tissue sarcomas are rare and heterogeneous. Perioperative radiation therapy for localized grade&#xa0;2–3 soft tissue sarcomas is standard treatment and should be performed at experienced centers. Preoperative irradiation is preferred for tumors in the extremities and trunk wall due to its favourable side effect profile. For myxoid liposarcomas, dose de-escalation may be considered. Hypofractionated preoperative radiation shows promising results but is not yet a&#xa0;standard treatment. The SU2C-SARC032 trial has proven the benefit of pembrolizumab combined with radiation therapy in pleomorphic sarcomas and dedifferentiated liposarcomas, and its use should be assessed on an individual basis. For extremity and trunk wall sarcomas, current contrast-enhanced MRI with T1 and T2 weighting is required and should be registered with the radiation planning CT. For retroperitoneal soft tissue sarcomas, a&#xa0;contrast-enhanced radiation planning CT is used. Use of intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT) with daily image-guided RT (IGRT) using orthogonal kV image-guidance or preferably cone-beam CT (CB-CT) is recommended due to the improved side effect profile. Preoperative radiation therapy is not a&#xa0;standard treatment for the unselected group of retroperitoneal soft tissue sarcomas, but it may be considered for well-differentiated and grade&#xa0;1–2 dedifferentiated liposarcomas according to the STRASS and STREXIT data.</p>

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Perioperative Strahlentherapie bei Weichgewebesarkomen

  • 期刊论文

  • 发表日期：

    2025年5月5日

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  • Siyer Roohani

摘要

Soft tissue sarcomas are rare and heterogeneous. Perioperative radiation therapy for localized grade 2–3 soft tissue sarcomas is standard treatment and should be performed at experienced centers. Preoperative irradiation is preferred for tumors in the extremities and trunk wall due to its favourable side effect profile. For myxoid liposarcomas, dose de-escalation may be considered. Hypofractionated preoperative radiation shows promising results but is not yet a standard treatment. The SU2C-SARC032 trial has proven the benefit of pembrolizumab combined with radiation therapy in pleomorphic sarcomas and dedifferentiated liposarcomas, and its use should be assessed on an individual basis. For extremity and trunk wall sarcomas, current contrast-enhanced MRI with T1 and T2 weighting is required and should be registered with the radiation planning CT. For retroperitoneal soft tissue sarcomas, a contrast-enhanced radiation planning CT is used. Use of intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT) with daily image-guided RT (IGRT) using orthogonal kV image-guidance or preferably cone-beam CT (CB-CT) is recommended due to the improved side effect profile. Preoperative radiation therapy is not a standard treatment for the unselected group of retroperitoneal soft tissue sarcomas, but it may be considered for well-differentiated and grade 1–2 dedifferentiated liposarcomas according to the STRASS and STREXIT data.