What do you consider a curative radiation dose for a sarcoma?

This is a difficult predicament. We would certainly try to re-resect if at all possible; if not, a consideration could always be made for an amputation, but we try to avoid this if at all possible. Other options during the time of resection are consideration for brachytherapy. We would also discuss ...

Unresectable means either extensive or terrible location. Subtotal resection won’t help and will likely contaminate adjacent tissues. Plus the tumor may be displacing OAR. So use as much dose as you can get away with, and reasonably minimize the risk of a disastrous complication. There will be no sa...

With gross residual disease that is unresectable, the question is whether there is a curative dose per se. It's reasonable to consider 70 gy. While not in this clinical situation, there is some data on sbrt for oligometastatic sarcoma for gross disease.

Excellent question and I agree with all the above points. SBRT is an excellent choice for smaller lesions, <5 cm.

Targeting 70 Gy is reasonable with modern intensity modulated RT. There are some data to be aware of that can assist in formulating a strategy:

• Harvard series of unresected sarcoma shows ...

Recurrence: I agree with the above. It’s challenging to speak with certainty without details. In general: in this situation we prefer not to radiate gross residual disease. We would likely use chemotherapy to cytoreduce, then reresect or radiate.

Gross residual disease: this situation is exceptiona...