"Current Use and Clinical Applications of Intraoperative Radiotherapy in Soft Tissue Sarcomas: Insights from a National Survey in Spain".

Soft tissue sarcomas (STS) require a multidisciplinary approach that balances oncologic control with functional preservation. Adjuvant external beam radiotherapy (EBRT) improves local control but is often limited by its toxicity. Intraoperative radiotherapy (IORT) allows for precise delivery of a single high dose during surgery, minimizing radiation exposure to adjacent tissues. This study reviews the role of IORT to treat sarcoma in the extremities and retroperitoneum, while also evaluating current clinical applications, prognosis and usage trends in Spain, based on a national survey that collected responses from all centers currently using IORT. IORT is employed in STS treatment in 11 Spanish hospitals (mostly electron-based systems), but the volume of patients treated is very low (63.6% use IORT in ≤10 cases per year). Despite favorable local control rates and reduced morbidity, access to IORT remains inconsistent at sarcoma referral centers. Broader integration and standardized protocols are needed, alongside future prospective studies on neoadjuvant EBRT and IORT.