Radiotherapy and brachytherapy in the management of adult soft tissue sarcomas

We present the update of the recommendations of the Société française de radiothérapie oncologique (the French society for radiation oncology) on soft tissue sarcomas. Currently, the initial management of sarcomas is very important as it may impact on patients' quality of life, especially in the case of limb soft tissue sarcomas, and on overall survival in trunk sarcomas. Radiotherapy has to be discussed within a multidisciplinary board meeting with results of biopsy, eventually re-examined by a dedicated sarcoma pathologist. The role of radiotherapy varies according to localization of soft tissue sarcomas; the use of intensity-modulated radiotherapy has become standard of care. It is part of the standard treatment for grade 2 and 3 sarcomas of the extremities and superficial trunk at least 5cm. Preoperative radiotherapy is generally preferred to postoperative irradiation in expert soft tissue sarcomas centres. In the case of incomplete resection, re-excision should be discussed. In such cases, radiation may be delivered preoperatively (50Gy in 25 fractions of 2Gy) or postoperatively. For retroperitoneal sarcomas, preoperative intensity-modulated radiotherapy cannot be proposed systematically following the results of STRASS trial. Concomitant chemoradiotherapy cannot be considered a standard treatment. All other soft tissue sarcomas sites will be addressed as well as as desmoid tumours, and other techniques that may be used such as brachytherapy and proton therapy. Hypofractionated radiotherapy for soft tissue sarcomas has also been adressed.