Would you give full post-operative dose radiation for an undifferentiated high grade pleomorphic sarcoma of the extremity with close surgical margins if the patient had previously received <20Gy preoperatively?

If the patient stopped at 16Gy preoperatively, I doubt they would accept 60-66 Gy postoperatively. Accordingly, I would follow the patient closely with MRI imaging, CT chest, and physical exam. If they developed local relapse without distant mets, I would deliver 45-50 Gy preoperatively (discussing ...

The following response was drafted together with @Dr. First Last:

We would offer post-operative RT to 50 Gy via shrinking field technique, delivering 34 Gy to a CTV1 similar to that given pre-operatively (as described below, because of the pre-operative RT, the post-operative CTV1 does not need to in...

I would simulate the patient and then try to fuse preop scan. Much of what received 16 Gy is excised, so I would look at the dose to the bone. I would then plan to give 60-66 Gy and look at the composite dose to bone while sparing the strip to avoid lymphedema. I would counsel the patient on a poten...