Purpose

This guideline provides evidence-based recommendations addressing the indications for radiation therapy (RT), sequencing of local therapies, and appropriate dose and planning techniques for management of primary, operable, localized, soft tissue sarcoma (STS) in adults.

Methods

The American Society for Radiation Oncology convened a task force to address 5 key questions focused on the use of RT for management of STS. These questions included indications for RT for STS of the extremity and superficial trunk; considerations for sequencing of RT with respect to surgery, dose of RT, appropriate treatment volumes and techniques; and the role of RT in management of retroperitoneal sarcoma. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength.

Results

Multidisciplinary evaluation and decision making are recommended for all cases of STS. RT is recommended for patients in whom there is increased risk of local recurrence of resected STS, particularly if close or microscopically positive margins are anticipated or have occurred. When RT is indicated, preoperative RT is strongly recommended over postoperative RT. Postoperative RT is conditionally recommended in specific clinical circumstances (eg, uncontrolled pain or bleeding) or when the risk of wound complications outweighs that of late toxicity from RT. Routine use of RT in addition to oncologic resection for retroperitoneal sarcoma is conditionally not recommended. When RT is used for retroperitoneal sarcoma, preoperative RT is recommended, whereas postoperative RT is not recommended.

Conclusions

Based on currently published data, the American Society for Radiation Oncology task force has proposed evidence-based recommendations regarding the use of RT for STS in adults. Future studies will ascertain whether alterations in dosing and sequencing may optimize outcomes and quality of life.

中文翻译：

---

成人软组织肉瘤的放射治疗：ASTRO 临床实践指南执行摘要

目的

本指南提供了基于证据的建议，涉及放射治疗（RT）的适应症、局部治疗的顺序以及用于治疗成人原发性、可手术的局部软组织肉瘤（STS）的适当剂量和计划技术。

方法

美国放射肿瘤学会召集了一个工作组来解决 5 个关键问题，重点是使用放疗治疗 STS。这些问题包括四肢和浅表躯干 STS 的 RT 适应症；考虑手术顺序、放疗剂量、适当的治疗量和技术等放疗顺序；以及放疗在腹膜后肉瘤治疗中的作用。建议基于系统的文献综述，并使用预定义的共识构建方法和系统来对证据质量和推荐强度进行评级。

结果

建议对所有 STS 病例进行多学科评估和决策。对于切除的 STS 局部复发风险增加的患者，建议进行 RT，特别是在预期或已经发生切缘接近或镜下阳性的情况下。当需要放疗时，强烈建议术前放疗而不是术后放疗。在特定的临床情况下（例如，不受控制的疼痛或出血）或当伤口并发症的风险超过放疗的晚期毒性时，有条件地建议术后放疗。有条件地不建议在腹膜后肉瘤的肿瘤切除之外常规使用放疗。当放疗用于腹膜后肉瘤时，建议术前放疗，而不建议术后放疗。

结论

根据目前公布的数据，美国放射肿瘤学会工作组提出了关于成人放疗治疗 STS 的循证建议。未来的研究将确定剂量和测序的改变是否可以优化结果和生活质量。