ROLE OF RADIATION IN THE MANAGEMENT OF ADULT PATIENTS WITH SARCOMA OFSOFT-TISSUE

Radiation in moderate dose levels, viz. 60-65 Gy at 2 Gy/fraction, adm inistered in combination with conservative surgery, yields local contr ol frequencies at least comparable to those achieved by radical resect ional surgery alone. The clinical interest in this management strategy is the reduction in the scope of the resection and a consequent gain in cosmetic and functional status. This combined approach is favored f or sarcomas so situated that resection with wide margin, greater-than- or-equal-to 2 cm at the most narrow, cannot be realized unless there i s a clinically important loss in function. Where radical surgery is pl anned, there must be great care in assessment of the probability of ac hieving good margins. The patient is ill served if there is radical su rgery and then, because of close margins, postoperative radiation is r equired. There appears to be clinical gain for the patient with a larg e sarcoma by administering the radiation preoperatively. Advantages in clude smaller treatment volume and higher local control rates. The man agement of the surgical wound in the irradiated patient is discussed. Also, brief consideration is given to current use of brachytherapy, hi gh linear energy transfer (LET) radiation, and combination of radiatio n and chemotherapy. (C) 1994 Wiley-Liss, Inc.