Surgery is potentially curative for primary nonmetastatic extremity soft tissue sarcomas. After surgery alone, patients may remain at risk for local recurrences and/or metastatic disease. To reduce the likelihood of a local relapse, the addition of radiotherapy (RT) to limb-sparing surgery may result in higher local control rates of at least 85%. Generally, it can be stated that local control after both preoperative and postoperative RT is comparable, but that preoperative RT comes with a more favorable toxicity profile after prolonged follow-up, albeit at the cost of a higher wound complication rate. Furthermore, recent data suggest that preoperative RT is more cost effective. To reduce the risk of subsequent metastatic disease, systemic chemotherapy can be introduced early during the primary management of these patients. These systemic chemotherapy regimens can also be applied both preoperatively and postoperatively. Finally, with the aim of increasing the antitumor response of perioperative RT, these agents may even be combined with RT, concurrently and sequentially. While designing new preoperative combination regimens, responses should be carefully monitored by both sophisticated radiologic and pathologic evaluations. This article reviews all these aspects, in addition to limb-sparing surgery.

中文翻译：

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四肢软组织肉瘤的围手术期处理

手术可能治愈原发性非转移性肢体软组织肉瘤。单独手术后，患者可能仍处于局部复发和/或转移性疾病的风险中。为了降低局部复发的可能性，在保肢手术中加入放疗 (RT) 可能会提高至少 85% 的局部控制率。一般来说，可以说术前和术后放疗后的局部控制是可比的，但术前放疗在长期随访后具有更有利的毒性特征，尽管代价是伤口并发症发生率更高。此外，最近的数据表明术前放疗更具成本效益。为了降低后续转移性疾病的风险，可以在这些患者的主要治疗过程中尽早引入全身化疗。这些全身化疗方案也可以在术前和术后应用。最后，为了提高围手术期放疗的抗肿瘤反应，这些药物甚至可能与放疗同时和顺序联合。在设计新的术前联合方案时，应通过复杂的放射学和病理学评估仔细监测反应。除了保肢手术外，本文还回顾了所有这些方面。应通过复杂的放射学和病理学评估仔细监测反应。除了保肢手术外，本文还回顾了所有这些方面。应通过复杂的放射学和病理学评估仔细监测反应。除了保肢手术外，本文还回顾了所有这些方面。