S3051
Invited Speaker
ESTRO 2026
References: Allignet B et al. Long-term outcomes after definitive radiotherapy with modern techniques for unresectable soft tissue sarcoma. Radiother Oncol 2022. Sobiborowicz A et al. Definitive RT in non- resectable/residual retroperitoneal sarcoma. Cancer Control 2021. Imai R et al. Carbon Ion Radiotherapy for Retroperitoneal Sarcoma. 2025. van Meekeren M et al. Pazopanib plus RT in high-risk localized STS. Acta Oncol 2021. Sanfilippo R et al. Trabectedin and RT for myxoid liposarcoma. JAMA Oncol 2023. Bryant JM et al. HARD for unresected soft tissue sarcoma. Adv Radiat Oncol 2024; Radiother Oncol 2025. Majercakova K et al. LATTICE treatment in inoperable bulky soft-tissue sarcomas. Cancers 2025. 5540 Technical innovations and how they impact patients Harshani M Green Uro-Oncological Cancers, Royal Marsden Hospital, London, United Kingdom. Radiotherapy, Institute of Cancer Research, London, United Kingdom Technical innovation in radiotherapy is rapidly reshaping cancer care. Advances in imaging, targeted treatment delivery, artificial intelligence (AI), digital health, molecular profiling and drug-radiotherapy combinations hold exciting promise to improve efficacy outcomes and toxicity profiles 1 alongside workflow efficiency. However, development of innovative solutions should consider a patient-centred approach 2 ; anticipating the impact on patient experience and how it aims to contribute to realistic and clinically meaningful benefits, along the treatment pathway 3 . Advanced imaging, delivery platforms and technologies aim to enable accurate tumour delineation, more precise delivery and real-time assessment of treatment response. More adaptive, accurate and individualised radiotherapy strategies may lead to improved tumour control and reduced toxicity. AI-driven tools hold promise to enhance workflow efficiency and outcome prediction to enable more informed, personalised clinical decision-making and shorter treatment delays. 1,3 Hypofractionated treatment, delivering fewer but higher-dose fractions, is an example where innovation can be utilised to increase treatment efficiency, reduce cost and treatment burden. 4,5,6 Biologically-guided and targeted treatments have the potential to optimise outcomes whilst minimising unnecessary toxicity 1 . Digital health
When surgery isn’t an option: radiotherapy strategies for unresectable, non-metastatic sarcomas Management of unresectable, non-metastatic sarcomas remains a major multidisciplinary challenge. Although complete surgical resection is the cornerstone of cure for most localized soft tissue sarcomas, a meaningful subgroup of patients present with disease that is technically unresectable, medically inoperable, or associated with prohibitive functional morbidity. In this setting, radiotherapy (RT) becomes a central local treatment modality, with goals ranging from durable local control and symptom relief to long- term organ preservation and, in selected cases, definitive disease eradication. This presentation reviews the evolution of RT strategies for unresectable non-metastatic sarcomas, integrating classic evidence with recent literature and emerging technical advances. Historically, definitive RT has been limited by the relative radioresistance of sarcomas and by the challenge of delivering tumoricidal doses near critical organs. Nevertheless, conventional fractionated RT to doses of 66–70 Gy has achieved meaningful local control in selected patients, particularly when delivered with high-quality imaging, accurate target definition, and careful multidisciplinary selection. More recent series suggest that outcomes have improved with intensity-modulation (IMRT), image guidance, adaptive planning, and better integration with systemic therapy. Hypofractionated regimens, simultaneous integrated boost approaches, and dose- painting concepts are also being explored. For anatomically complex sites such as the retroperitoneum, spine, pelvis, skull base, and paraspinal region, modern RT planning has expanded the therapeutic window while highlighting the need for individualized risk-benefit assessment. Novel technical solutions including carbon-ion therapy and spatially fractionated techniques may improve biological effectiveness in selected cases. In parallel, the role of RT in combination with standard and emerging systemic agents is evolving. Cytotoxic chemotherapy remains relevant in chemosensitive subtypes, while antiangiogenic agents, DNA damage response modifiers, and immunotherapy are being investigated as radiosensitizing or synergistic partners. Early clinical data support cautious optimism, but toxicity, sequencing, and patient selection remain critical issues. Overall, treatment of unresectable localized sarcomas should not be viewed as uniformly palliative. With modern RT platforms, thoughtful fractionation, and increasingly sophisticated systemic combinations, durable local control is achievable for a subset of patients. The key message is that treatment should be histology-aware, anatomy-adapted, and delivered through expert multidisciplinary collaboration.
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