Radiotherapy for skin tumors and soft-tissue sarcomas: Current state of the art and recent advances

Radiotherapy plays a pivotal role in the management of skin cancers and soft-tissue sarcomas in both curative and adjuvant settings. Over recent years, several clinical trials and international guidelines have refined its indications and identified new strategies that are likely to influence clinical practice. This review provides an updated overview of the role of radiotherapy in basal cell carcinoma, cutaneous squamous cell carcinoma, cutaneous melanoma, Merkel cell carcinoma, cutaneous lymphoma, and soft-tissue sarcoma. Recent evidence highlights the potential benefit of consolidation radiotherapy following hedgehog inhibitors in locally advanced basal cell carcinoma, improved outcomes with the combination of cemiplimab and radiotherapy in cutaneous squamous cell carcinoma, integration of stereotactic radiotherapy with immune checkpoint inhibitors for melanoma brain metastases, the importance of minimizing the interval between surgery and postoperative radiotherapy in Merkel cell carcinoma, the limitations of ultra-low-dose radiotherapy for indolent cutaneous lymphomas, and the emergence of hypofractionated preoperative radiotherapy schedules for soft-tissue sarcoma. By distinguishing established indications from emerging evidence, this review summarizes the developments most likely to influence contemporary radiation oncology practice and highlights areas where further prospective studies are warranted.