Preoperative radiation therapy

Preoperative radiation therapy has been associated with excellent local control rates.[25-27] The advantages of this approach include treating smaller tissue volumes without the need to treat a postsurgical bed and somewhat lower radiation doses because relative hypoxia from surgical disruption of vasculature and scarring is not present. Preoperative radiation therapy has been associated with an increased rate of wound complications in adults, primarily in lower extremity tumors. However, the degree of these complications is questionable.[28] Conversely, preoperative radiation therapy may lead to less fibrosis than with postoperative approaches, perhaps because of the smaller treatment volume and dose.[29] Radiation techniques, like proton-beam radiation therapy can facilitate normal tissue sparing. Compared with 3-dimensional conformal radiation therapy, intensity-modulated radiation therapy may decrease radiation dose to the skin and epiphysis when irradiating extremity sarcomas, which can translate into decreased fibrosis or growth impairment.[30,31]