Preoperative Radiotherapy for Sarcomas of the Extremities With Intensity-Modulation, Image-Guidance and Small Safety-margins

Inclusion Criteria:

Histologic and radiographic proof of localized high-risk soft tissue sarcoma meeting the following criteria:

* Lesion originates in extremity

  * upper extremity lesions may occur from the medial border of the scapula to tumors as far distal as the finger tips
  * lower extremity regions include hip girdle tumors commencing at the iliac crest, excluding lesions arising from within the pelvis, and extends to include lesions as far distal as the toes
* AJCC Stage II or III disease (except T1a-tumors or N1)
* Primary presentation or local recurrence
* after biopsy or inadequate surgery resulting in residual tumor in cross-sectional imaging
* Tumors must be considered resectable according to cross sectional imaging, or potentially resectable after preoperative radiotherapy
* ECOG Performance Status 0-2
* Informed Consent

Exclusion Criteria:

* Diagnosis of the following:

  * Primitive neuroectodermal tumor
  * Soft tissue Ewing's sarcoma
  * Extraskeletal osteo- or chondrosarcoma
  * Aggressive fibromatosis (desmoid tumors)
  * Dermatofibrosarcoma protuberans
* Regional nodal disease or unequivocal distant metastasis
* Life expectancy \< 1 year
* Pregnancy
* Major medical illness that would preclude study treatment
* History of major wound complication or recurrent skin infection
* Known HIV positivity
* \< 2 weeks elapsed from prior surgery or cytotoxic chemotherapy
* persisting acute toxicities \> grade 1 in tumor-bearing limb resulting from prior treatment with anti-cancer modalities
* Cytotoxic chemotherapy, targeted therapy or investigational agents concurrent to study treatment
* Prior radiotherapy to the site of present STS.
* Chronic requirement for treatment with immuno¬suppressive agents or steroids.