All patients with large, localised, soft tissue tumours should be considered for radiation therapy by a radiation oncologist with experience in treating sarcomas and involvement in multidisciplinary care. For smaller tumors under 5 cm and lower grade tumours in more difficult anatomic sites, consideration should still be given to radiation therapy, given the implications of local recurrence in these anatomic sites (Pisters et al. 2016).

For soft tissue sarcoma, radiation therapy (external beam, brachytherapy, intensity-modulated radiation therapy, particle beam) must be considered before or after surgery.

The timing of radiation therapy needs to be individualised dependent upon resection and reconstructive considerations.

In general, radiation therapy for bone sarcomas is mainly used for palliation (ESMO 2014a). In Ewing’s sarcoma, radiation therapy may be considered as part of the treatment protocol.

Training, experience and treatment centre characteristics

Training and experience required of the appropriate specialist(s):

• radiation oncologist (Fellowship of the Royal Australian and New Zealand College of Radiologists or equivalent) with adequate training and experience with institutional credentialling and agreed scope of practice in sarcoma (ACSQHC 2004)
• adequate training including subspecialty training at a national or international centre of excellence with continued practice as part of a recognised multidisciplinary team.

Radiation oncology centre characteristics for providing safe and quality care include:

• radiation therapists and medical physicists with experience in sarcoma care
• access to radiation therapy nurses, allied health professionals (especially for nutrition health and advice) occupational therapists and psychological support
• access to CT and MRI scanning for simulation and planning.