Prognostic Factors in Extremity Soft Tissue Sarcomas Treated with Radiotherapy: Systematic Review of the Literature

Simple Summary Soft tissue sarcomas of the extremities are rare tumors with various prognostic factors. The gold standard curative treatment relies on surgery with negative margins. However, some prognostic factors of these tumors, or patients, may require additional RT treatment to improve oncological outcomes. We present a systematic review following the PRISMA guidelines, summarizing the pertinent literature on eSTS treated with RT. The great heterogeneity among these studies and the lack of statistical power have made it difficult to clearly identify significant prognostic factors that would benefit from this treatment. An analysis of these factors is proposed and provides valuable insights to optimize radiotherapy treatments for patients with eSTS. Based on our review, the acute and chronic serious adverse effects of multimodal treatment combining limb-sparing surgery and RT remain low, leading to favorable functional outcomes.Abstract Soft tissue sarcomas of the extremities are rare tumors with various prognostic factors. Their management is debatable due to their inconsistent results within the literature and the lack of large prospective studies. The objective of this systematic review is to analyze the available scientific data on prognostic factors concerning the characteristics of the patients, the disease and the treatments performed, as well as their potential complications, on studies with a median follow-up of 5 years at minimum. A search of articles following the "PRISMA method" and using the PubMed search engine was conducted to select the most relevant studies. Twenty-five articles were selected, according to preestablished criteria. This review provides a better understanding of the prognosis and disease outcome of these tumors. Many factors were described comparing the frequency of occurrence according to the studies, which remain heterogeneous between them. Significant factors that could orient patients to radiotherapy were highlighted. These positive prognostic factors provide valuable insight to optimize radiotherapy treatments for patients treated for soft tissue sarcoma of the extremities.