Preoperative vs postoperative radiation therapy for extremity soft tissue sarcoma: controversy and present management.
OBJECTIVE
The 5-year results of the Canadian multicenter prospectively randomized phase III trial that compared preoperative with postoperative radiotherapy for patients with extremity soft tissue sarcomas were recently presented at the 2004 meeting of the American Society of Clinical Oncology. These latter findings serve as an impetus for this current review to assess the optimal sequencing of adjuvant radiotherapy for such patients undergoing limb-preserving surgery.


RESULTS
The recent studies, including the 2004 American Society of Clinical Oncology presentation, described in this paper show no significant rise in the incidence of long-term side effects, such as delayed wound healing and subcutaneous tissue damage, in patients with extremity soft tissue sarcomas who receive once-daily preoperative irradiation followed by limb-preserving surgery. Postoperative radiotherapy may be best reserved for patients who are most likely to undergo a wide local excision with adequate (>10 mm) tumor-free margins (such as low-grade lesions in the lower extremities). There is an increasing use of neoadjuvant chemoradiation in this group of patients, especially for high-grade and large lesions.


CONCLUSIONS
Further investigations regarding the preoperative management of extremity soft tissue sarcomas are continuing in an attempt to optimize the survival and functional status of these patients, while minimizing the permanent side effects resulting from such treatment.
Wolfson
Aaron H
AH
Department of Radiation Oncology and Obstetrics and Gynecology, The Miller School of Medicine at the University of Miami, FL 33136, USA. awolfson@med.miami.edu
D005121:Extremities; D006801:Humans; D011182:Postoperative Care; D011300:Preoperative Care; D018714:Radiotherapy, Adjuvant; D012509:Sarcoma / Q000532:radiotherapy* / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D016896:Treatment Outcome