Roeder Falk
Department of Radiotherapy and Radiation Oncology, Paracelsus Medical University, Landeskrankenhaus, Salzburg 5020, Austria.
Cancers (Basel). 2020 Nov 3;12(11):3242. doi: 10.3390/cancers12113242.
Radiation therapy (RT) is an integral part of the treatment of adult soft-tissue sarcomas (STS). Although mainly used as perioperative therapy to increase local control in resectable STS with high risk features, it also plays an increasing role in the treatment of non-resectable primary tumors, oligometastatic situations, or for palliation. Modern radiation techniques, like intensity-modulated, image-guided, or stereotactic body RT, as well as special applications like intraoperative RT, brachytherapy, or particle therapy, have widened the therapeutic window allowing either dose escalation with improved efficacy or reduction of side effects with improved functional outcome. This review summarizes the current evidence for RT in adult STS including typical indications, outcomes, side effects, dose and fractionation regimens, and target volume definitions based on tumor localization and risk factors. It covers the different overall treatment approaches including RT either as part of a multimodal treatment strategy or as a sole treatment, namely its use as an adjunct to surgery in resectable STS (perioperative RT), as a primary treatment in non-resectable tumors (definitive RT), as a local treatment modality in oligometastatic disease or as palliative therapy. Due to the known differences in clinical course, general treatment options and, consequently, outcome depending on lesion localization, the main part of perioperative RT is divided into three sections according to body site (extremity/trunk wall, retroperitoneal, and head and neck STS) including the discussion of special applications of radiation techniques specifically amenable to this region. The review of the current evidence is accompanied by a summary on ongoing clinical research pointing at future directions of RT in STS.
放射治疗（RT）是成人软组织肉瘤（STS）治疗的一个重要组成部分。尽管主要用作围手术期治疗，以提高具有高风险特征的可切除STS的局部控制率，但它在不可切除的原发性肿瘤、寡转移情况或姑息治疗中也发挥着越来越重要的作用。现代放射技术，如调强放疗、图像引导放疗或立体定向体部放疗，以及术中放疗、近距离放疗或粒子治疗等特殊应用，拓宽了治疗窗口，使得要么通过提高疗效来增加剂量，要么通过改善功能结局来减少副作用。本综述总结了成人STS中RT的当前证据，包括典型适应证、结局、副作用、剂量和分割方案，以及基于肿瘤定位和危险因素的靶区定义。它涵盖了不同的总体治疗方法，包括RT作为多模式治疗策略的一部分或作为单一治疗，即其在可切除STS中作为手术辅助治疗（围手术期RT）、在不可切除肿瘤中作为主要治疗（根治性RT）、在寡转移疾病中作为局部治疗方式或作为姑息治疗。由于已知临床过程、一般治疗选择以及因此取决于病变部位的结局存在差异，围手术期RT的主要部分根据身体部位（肢体/躯干壁、腹膜后和头颈部STS）分为三个部分，包括对特别适用于该区域的放射技术特殊应用的讨论。对当前证据的综述还伴随着对正在进行的临床研究的总结，指出了STS中RT的未来方向。
