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onclusion
Bone and soft tissue tumors of the limbs are diseases with
very variable presentation (histology, stage, volume of
disease and location). Surgery is the treatment of choice
and, because of the highly variable locations, it may not
be feasible in many cases or it may be performed with
minimally recommendable oncological principles.
The disease is a challenge for treatment and it is
highly unlikely that randomized trials testing radiother-
apy techniques will be performed anywhere in the world.
There will probably never be high quality level 1 evidence
for a decision on the radiotherapy technique and, thus,
other criteria should be used for recommendations.
Conventional technique does not allow the physician
to properly view the region being treated, nor the organs
at risk. It does not allow international and national rec-
ommendations for doses in organs at risk because it is
not possible to assess distribution. It is also subject to
gross target location errors due to rotations of the limb
that will be irradiated, which places the muscle bundle
in an unconventional position. In any service that has the
possibility of guiding the treatment using CT scans, we
strongly recommend that the conventional technique be
definitively abandoned as it has been for many years in
developed countries.
If available, IMRT is superior to the others and po-
tentially has a greater ability to control disease with
lower toxicity. Due to a lack of clinical evidence, the min-
imally recommended radiotherapy technique to preserve
the safety of patients with soft tissue tumors of the limbs
is the conformal one.
C
onflict
of
interest
The authors declare no conflict of interest.
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