Techniques to modulate radiotherapy toxicity and outcome in soft tissue sarcoma

Radiotherapy (RT) targeting of soft tissue sarcoma presents considerable opportunity and challenges in realizing the dual goals of tissue and function preservation and maintaining high local control. Traditional RT target volumes used for soft tissue sarcoma have largely been constrained by available technology and are not ideal in some situations. The advent of very precise treatment planning and delivery systems, including three-dimensional conformal radiotherapy and intensity-modulated radiotherapy, means it is possible to select target volumes that more closely approach the optimum. Consequently, these new approaches provide great opportunity for treatment enhancement in the future. It can be expected that newer techniques for RT planning and delivery will challenge the existing dogma concerning target delineation for optimal radiotherapy outcome. It can be foreseen that the precise knowledge of appropriate targets will continue to evolve for different clinical scenarios and likely be greatly influenced by enhanced imaging capability. Advancement of three-dimensional conformal radiotherapy and intensity-modulated radiotherapy over the next decade must rely on the consistent reporting and sharing of results concerning outcome of normal tissue from volumetric treatment planning.