Shah Chirag, Verma Vivek, Takiar Radhika, Vajapey Ramya, Amarnath Sudha, Murphy Erin, Mesko Nathan W, Lietman Steven, Joyce Michael, Anderson Peter, Shepard Dale, Budd Thomas
Departments of *Radiation Oncology ¶Hematology and Oncology, Taussig Cancer Institute ‡Department of Orthopedics §Musculoskeletal Tumor Center ∥Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH †Department of Radiation Oncology, University of Nebraska, Omaha, NE.
Am J Clin Oncol. 2016 Dec;39(6):630-635. doi: 10.1097/COC.0000000000000319.
Radiation therapy represents a vital component in the multidisciplinary management of soft tissue sarcomas. Combined with limb-preserving surgery, radiation therapy represents a standard of care treatment option for patients with high-grade sarcomas. Radiation therapy for soft tissue sarcoma continues to evolve with changes in timing, techniques, and targets. Over the past 2 decades, increasing data have supported the role of preoperative radiotherapy with the potential for lower total doses of radiation and improved long-term function coming at the cost of increased wound complications for certain locations. Retroperitoneal sarcomas represent a location where preoperative treatment is becoming the standard of care based on anatomic constraints and challenges with delivering postoperative radiotherapy. Multiple radiation therapy techniques exist to deliver treatment; currently both 3-dimensional conformal radiotherapy and intensity-modulated radiation therapy (IMRT) are appropriate options, although increasing data support the role of IMRT in reducing dose to critical structures (bone, bowel, kidneys, vessels) while maintaining target coverage. Traditional target volumes have included larger fields; however, recent prospective data have demonstrated that image guidance in conjunction with smaller treatment volumes may reduce toxicity while not increasing marginal failures, although follow-up is short. Because of the toxicity associated with treatment, novel radiotherapy strategies are being used such as stereotactic radiotherapy as well as the use of tumor genetics to identify patients most likely to benefit most from radiotherapy.
放射治疗是软组织肉瘤多学科管理的重要组成部分。与保肢手术相结合，放射治疗是高级别肉瘤患者的标准治疗选择。软组织肉瘤的放射治疗在时间、技术和靶区方面不断发展。在过去20年中，越来越多的数据支持术前放疗的作用，其潜在优势是总放射剂量可能降低，长期功能改善，但代价是某些部位伤口并发症增加。基于解剖学限制以及术后放疗面临的挑战，腹膜后肉瘤是术前治疗正成为标准治疗方式的一个部位。有多种放射治疗技术可用于实施治疗；目前三维适形放疗和调强放射治疗（IMRT）都是合适的选择，尽管越来越多的数据支持IMRT在减少关键结构（骨骼、肠道、肾脏、血管）剂量的同时保持靶区覆盖的作用。传统的靶区体积包括较大的野；然而，最近的前瞻性数据表明，图像引导结合较小的治疗体积可能会降低毒性，同时不会增加边缘复发，尽管随访时间较短。由于与治疗相关的毒性，正在采用新的放疗策略，如立体定向放疗以及利用肿瘤遗传学来识别最有可能从放疗中获益最多的患者。
