Navigating the Role of Radiotherapy for Extremity Soft Tissue Sarcomas

Background/Objectives: The basis for treatment of sarcoma is surgical resection. However, since the introduction of limb salvage surgery, guidelines recommend radiation as a complement to surgery for high-grade sarcomas. The aim of the present narrative review was to provide a comprehensive update about the role of surgery and radiotherapy (RT) for extremity soft tissue sarcoma (ESTS), to increase both surgeons’ and oncologists’ understanding of radiation as an adjuvant to sarcoma surgery and to illuminate areas of uncertainty that requires further research. Methods: A search on PubMed using relevant MeSH terms was performed, focusing on original research, meta-analyses and review articles. Related articles were identified through snowballing. Results: The support for the use of radiotherapy in conjunction with limb salvage is strong. Complication profiles differ between pre- and postoperative RT and attempts to further limit these are both technological and surgical. Preoperative radiotherapy provides the best results regarding long-term complications so far. Hypo-fractionation is showing promise, but awaiting long-term results for complications remains an area of research rather than clinical practice. Particle beam therapy and internal radiation show effects on control, but due to technical and availability issues, their role is mainly in previously irradiated or inoperable tumors. Conclusions: Upcoming research into adjusted deliveries, doses and planning is anticipated. To further personalize treatment, studies into sarcoma subtypes are indicated.