Radiotherapy for soft tissue sarcoma: 50 years of change and improvement

Radiotherapy for soft tissue sarcoma (STS) has advanced significantly over the past 50 years. This review focuses briefly on the period from 1964 to 1999 and more substantially on the changes of the past 15 years, such as IMRT and image-guided radiotherapy (IG-RT), especially when brought together (IG-IMRT) in the same planning and delivery process to treat localized STS. In particular, the introduction of IG-RT, target volume definitions for IG-RT, and review of recent clinical trials using IG-RT to treat localized STS in extremity will be reviewed. Finally, potential investigational agents combined with IG-RT to improve outcomes in patients with localized STS are discussed. Soft tissue sarcomasmay originate in any connective tissuesite within the human body, and present with amultitude of histologies. Even so, these various histologic categories and anatomic locations are united by a common natural his-tory and clinical biology. For all STS, important prognostic factors include histologic grade, tumor size, and superfıcial versus deep anatomic location. STS commonly presents as an enlarging, painless mass and symptoms, when they occur, are related to the anatomic site, tumor size, and compression of adjacent tissues and organs. Deeply arising STS generall