Considerations for Optimal Implementation of Radiation Therapy Into Multidisciplinary Care for Patients With Sarcoma

Abstract

Radiation therapy (RT) plays an important role in reducing the risk of local recurrence associated with localized soft-tissue sarcoma (STS) treated with resection alone. The use of image guidance and intensity modulated RT has allowed for excellent local control after wide resection, even with positive margins, with an improved toxicity profile compared with historical strategies used in the literature. However, optimal implementation of RT into multidisciplinary care remains a challenge. Tumors can arise anywhere in the body and exhibit a wide range of behavior, so individualized use of RT is difficult. Data regarding RT for STS are also limited, so making evidence-based decisions is difficult. The American Society for Radiation Oncology recently commissioned a multidisciplinary task force, led by radiation oncologist chair and cochair Drs Kilian Salerno and Ashleigh Guadagnolo. Through 5 key questions (KQs), the recommendations address the most important topics for consideration when discussing RT use with a multidisciplinary treatment team. For patients with localized extremity sarcoma, the authors generally recommend delivering RT for patients at a high risk of recurrence (ie, patients with large, high-grade tumors, especially those expected to have positive margins after surgery). KQ2 and KQ3 recommend that most patients undergo preoperative intensity modulated RT using small clinical target volumes that have been associated with excellent local control in prospective studies. The final KQ discusses the role of preoperative RT in the management of patients with retroperitoneal sarcoma, which is controversial. Overall, the guidelines offer evidence-based expert consensus recommendations that can be used today as a starting point for a multidisciplinary recommendations about RT for patients at your clinic. I look forward to future versions of this guideline, which will consider the results of ongoing work aimed at further improving the value of RT for patients with STS.