Preoperative radiation therapy for sarcoma of soft tissue

Experience at the Massachusetts General Hospital in the management of 36 patients with sarcoma of soft tissue who were accepted for treatment by radiation followed by surgery is described. The tumors in these patients were extensive: greater than 5 cm in 33. Actual radiation doses covered a broad range for a variety of technical and medical reasons. The general dose aim has been 5000--6000 rad (200 rad 5 times a week) followed in approximately three weeks by conservative resection; a boost dose to the tumor bed has been given intraoperatively (interstitial or electron beam technique) or postoperatively (small field external beam, fractionated dose technique). Histologic change in the operative specimen increased with histologic grade of tumor, viz. more severe change in the less well-differentiated tumor. There was a trend toward more marked change with increasing dose for levels of 4000 rad and more. Local control has been achieved in 31 of 33 patients (follow-up of three months to eight years) treated by radiation followed by surgery. For three patients, the planned resection proved not to be technically feasible and treatment was completed by further radiation; of these, two had a local failure. Wound healing was delayed in six of the 33 treated by radiation followed by resection.