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Radiation Therapy for Soft Tissue Sarcomas
Radiation therapy uses high-energy x-rays or particles to kill cancer cells. It's a key part of soft tissue sarcoma treatment.
When is radiation therapy used?
Most of the time, radiation is given before surgery. This is called neoadjuvant treatment. It's done to kill any cancer cells at the edges of the tumor that the surgeon can't see. Radiation might also harden the tumor, making it easier to remove.
Radiation can affect wound healing. However, it can be given at a lower dose before surgery. In addition, the radiated tissue is usually removed during the surgery, which lowers the risk of developing radiation-related cancer later in life.
Radiation might also be used after surgery. This is called adjuvant treatment.
Radiation can be the main treatment for sarcoma in someone who isn't healthy enough to have surgery. Radiation therapy can also be used to help ease symptoms of sarcoma when it has spread. This is called palliative treatment.
Types of radiation therapy
This is the type of radiation therapy most often used to treat sarcomas. Treatments are often given daily, 5 days a week, usually for several weeks. In most cases, a technique called intensity modulated radiation therapy (IMRT) is used. This better focuses the radiation on the cancer and lessens the damage to healthy tissue.
This uses streams of protons instead of x-ray beams to treat the cancer. Although this has some advantages over IMRT in theory, it hasn’t been proven to be a better treatment for soft tissue sarcoma. Proton beam therapy is not widely available.
For this treatment, 1 large dose of radiation is given in the operating room after the tumor is removed but before the wound is closed.
Giving radiation this way means that it doesn’t have to travel through healthy tissue to get to the area that needs to be treated. It also allows nearby healthy areas to be shielded more easily from the radiation. Often, IORT is only one part of radiation therapy, and the patient gets some other type of radiation either before or after surgery.
This treatment places small pellets or seeds of radioactive material in or near the cancer. It is sometimes called internal radiation therapy. For soft tissue sarcoma, these pellets are put into catheters (very thin, soft tubes) that have been placed during surgery. Brachytherapy might be the only form of radiation therapy used or it can be combined with external beam radiation.
Possible side effects of radiation treatment
Side effects of radiation therapy depend on the part of the body treated and the dose given. Common side effects include:
- Skin changes where the radiation went through the skin, which can range from redness to blistering and peeling
- Fatigue
- Nausea and vomiting (more common with radiation to the belly)
- Diarrhea (most common with radiation to the pelvis and belly)
- Pain with swallowing (from radiation to the head, neck, or chest)
- Lung damage leading to problems breathing (from radiation to the chest)
- Bone weakness, which can lead to fractures or breaks years later
Radiation to large areas of an arm or leg can cause swelling, pain, and weakness in that limb.
Side effects of radiation therapy to the brain for metastatic sarcoma include hair loss, which can be permanent, headaches, and problems thinking.
If given before surgery, radiation might cause problems with wound healing. If given after surgery, it can cause long-term stiffness and swelling that can affect how well the limb works.
Many side effects improve or even go away after radiation is finished. Some though, like bone weakness and lung damage, can be permanent.
Chemoradiation
After surgery, some high-grade sarcomas might be treated with radiation and chemotherapy at the same time. This is called chemoradiation.
This might also be done before surgery in cases where the sarcoma cannot be removed or removing it would cause major damage. Sometimes, chemoradiation can shrink the tumor enough to take care of these issues so it can be removed.
Chemoradiation can cause major side effects. Not all experts agree on its value in treating soft tissue sarcomas. Radiation alone after surgery seems to work as well as chemoradiation. For some cases, this might be a treatment option to consider.
More information about radiation therapy
To learn more about how radiation is used to treat cancer, see Radiation Therapy.
To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.
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- References
Developed by the 黑料大湿Posts Cancer Society medical and editorial content team with medical review and contribution by the 黑料大湿Posts Society of Clinical Oncology (ASCO).
Helman LJ, Maki RG. Sarcomas of soft tissue. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE. Abeloff‘s Clinical Oncology. 6th ed. Philadelphia, PA. Elsevier: 2019.
National Cancer Institute. Adult Soft Tissue Sarcoma Treatment (PDQ?)–Health Professional Version. February 21, 2025. Accessed at www.cancer.gov/types/soft-tissue-sarcoma/hp/adult-soft-tissue-treatment-pdq on Dec 2, 2025.
National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology (NCCN Guidelines?), Soft Tissue Sarcoma, Version 1.2025 – May 2, 2025. Accessed at www.nccn.org/professionals/physician_gls/pdf/sarcoma.pdf on Nov 20, 2025.
Singer S, Maki R, O’Sullivan B. Soft tissue sarcoma In: DeVita VT, Heilman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.
Last Revised: February 9, 2026
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