Pre-, Post- and Intraoperative Radiation Therapy in Adult Liposarcomas

Abstract

Radiation therapy is an integral part of the treatment of soft tissue sarcomas in adults. The indication for additional radiation therapy has usually been based on known general prognostic factors, such as tumour size, localisation, grading and (anticipated) resection margin. Increasing attention has recently been paid to the role of the histological subtype. Moreover, radiation therapy techniques have distinctly improved, so that in some localisations adequate treatment has become possible for the first time. This review firstly summarises general treatment principles of radiation therapy in soft tissue sarcomas - separately for the extremities and trunk and the retroperitoneum. We discuss the available evidence for the administration of additional radiation per se, the preferred timing (pre- vs. postoperative) and fundamental technical principles, including alternative boosting techniques like intraoperative radiation therapy. Moreover, we provide a detailed discussion of the indication and procedure for additional radiation therapy in liposarcomas. We describe fundamental differences between liposarcomas and other soft tissue sarcomas as well as between the subgroups of liposarcoma (well differentiated, dedifferentiated, myxoid, pleomorphic), and how this affects the indication and procedure for additional radiation therapy, in order to provide a panoramic aid to orientation.