Limb-sparing management in extremity soft-tissue sarcomas in the adult: the radiation oncologist's viewpoint

Current management of extremity soft-tissue sarcomas achieves local control in a high proportion of patients. This paper describes the local methods to conserve limb function that have largely replaced traditional approaches of ablative surgery. Frequently, these methods employ conservative surgery with preoperative or postoperative radiotherapy. An understanding of the biology and behaviour of these rare tumours is necessary to optimize the goals of limb conservation without compromising local control. Appropriate surgical and radiotherapy techniques are facilitated by planned pretreatment staging methods and communication between the surgical and radiation oncology teams. Although a high rate of local control can be expected, distant metastases continue to be a problem. Future strategies should be directed towards scheduling of optimal local treatments with the investigation of adjuvant systemic methods to reduce the rate of distant metastases.