Radiation Therapy for Treatment of Soft Tissue Sarcoma in Adults

Publication Date: July 25, 2021
Last Updated: March 3, 2023



This patient summary means to discuss key recommendations from the American Society for Radiation Oncology (ASTRO) for Radiation Therapy for Treatment of Soft Tissue Sarcoma in Adults. It is limited to adults 18 years of age and older and should not be used as a reference for children.



  • Sarcomas (which are a separate class of cancers) compose about 1% of all adult malignancies.
  • We will use the abbreviation RT to refer to radiation therapy.
  • There are no known causes for sarcomas.
  • A painless lump or swelling is the only early symptom. As it grows it can cause pain or problems with any organ it pushes on.
  • This patient summary focuses on sarcomas in soft tissues in the extremities and trunk of adults — muscle, fat, blood vessels, nerves, tendons, and connective tissue.



  • ASTRO recommends that many different specialties form your treatment team.
  • RT is recommended for patients at increased risk of local recurrence after surgical removal.
  • Prior to surgery, RT is recommended if the sarcoma is very close to important normal tissue.
  • If surgery removes a mass before it is identified as a sarcoma, ASTRO recommends further surgery rather than RT.
    • If RT is indicated, ASTRO recommends RT before surgery.
    • If surgery is not feasible, RT is recommended.

Surgical-Radiation Sequencing
  • ASTRO recommends that RT precede surgery, rather than follow it, unless:
    • the mass shows high-risk features on examination.
    • urgency indicates a better outcome if surgery is first.
    • special circumstances increase the risk radiation poses to surgical wound healing.

Radiation Details
Note: the total dose of radiation cannot be given in a single session.
  • The timing of separate doses, the size of each dose, the method of focusing the radiation on cancer tissue and avoiding normal tissue, the inclusion of nearby lymph nodes, patient positioning during treatments, and unique arrangements necessary for rare locations of your sarcoma – all must be considered in the treatment plan.

This ASTRO Guideline details the latest information available to your treatment team for each circumstance, allowing for your health, your risk factors, and your individual choice among available options.


  • ASTRO: American Society For Radiation Oncology
  • RT: Radiation Therapy

Source Citation

Salerno KE, Alektiar KM, Baldini EH, Bedi M, Bishop AJ, Bradfield L, Chung P, DeLaney TF, Folpe A, Kane JM, Li XA, Petersen I, Powell J, Stolten M, Thorpe S, Trent JC, Voermans M, Guadagnolo BA. Radiation Therapy for Treatment of Soft Tissue Sarcoma in Adults: Executive Summary of an ASTRO Clinical Practice Guideline. Pract Radiat Oncol. 2021 Sep-Oct;11(5):339-351. doi: 10.1016/j.prro.2021.04.005. Epub 2021 Jul 26. PMID: 34326023.


The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.