Radiation therapy for soft tissue sarcoma.

Soft tissue sarcomas can be adequately treated with wide local excision and postoperative irradiation, rather than the amputation of the affected extremity. Local control and good function can be achieved in the great majority of patients treated with radiation therapy, with particularly good results (95% local control) obtained for lesions of the distal extremity i.e., below the elbow or knee. The most common site of failure is distant metastasis, and the outstanding prognostic indicator is histologic grade. Disease-free survival correlates strongly with grade, with 85%, 51%, and 17% 2-yr disease-free survival for grades 1, 2, and 3, respectively. Lymph node metastasis is an uncommon first site of failure, and prophylactic nodal irradiation or lymphadenectomy is not recommended. The value of chemotherapy or immunotherapy is not firmly established as far as enhancing local control. It is hoped that distant metastasis can be prevented by the use of such adjuvant therapy. Locally advanced, nonresectable sarcoma may be better treated with high linear energy transfer (LET) radiation, and promising results have been reported with fast neutron treatment.