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About radiotherapy for soft tissue sarcoma

Radiotherapy uses high energy waves to treat cancer. After surgery for soft tissue sarcoma, you may have radiotherapy to try to stop the sarcoma coming back. Radiotherapy can also be used to shrink cancers before surgery. Radiotherapy can also be used to try to slow the growth of advanced sarcomas and relieve symptoms.

How you have radiotherapy

If you have radiotherapy after or before surgery, you are likely to have treatment once a day, from Monday to Friday, for up to 7 weeks. At your first visit, your doctor takes X-rays or scans to help work out where to give the treatment. You will have marks made on your skin, which the radiographer uses to line up the radiotherapy machine. Each treatment only takes a few minutes. It doesn't hurt. Radiotherapy does not make you radioactive.

If the radiotherapy is to control symptoms you may have one treatment a day for a few days. Or you may have several treatments with a few days break between each.

What are the side effects?

Radiotherapy usually causes tiredness, reddening or soreness of the skin in the treatment area, and hair loss. The hair only falls out in the treatment area but it may be permanent. If you have radiotherapy to your abdomen or pelvis, you may feel sick or have diarrhoea. Radiotherapy to the head or neck area can cause a sore dry mouth.

Treatment to a joint can make it stiff. It is important to keep using the joint as normally as you can, to stop it stiffening up. Months or years after radiotherapy, some people develop swelling called lymphoedema. If you do get swelling in your hand or foot after radiotherapy to that limb, tell your specialist straight away.


CR PDF Icon You can view and print the quick guides for all the pages in the Treating soft tissue sarcoma section.



When you may have radiotherapy for soft tissue sarcoma

Radiotherapy uses high energy rays to cure cancer. For soft tissue sarcoma, your doctor may suggest radiotherapy for any of the following reasons.

  • After surgery, to try to stop the sarcoma coming back
  • To shrink cancers before surgery
  • To shrink secondary cancers
  • To shrink and slow the growth of advanced sarcomas and relieve symptoms

Many people with soft tissue sarcoma have radiotherapy after surgery to remove the tumour. This lowers the chance of the sarcoma coming back in that area. 

In the UK, radiotherapy after surgery is the standard treatment for

  • High grade sarcomas
  • Sarcomas larger than 5cm
  • Sarcomas that could not be completely removed

Radiotherapy before surgery treats a smaller area and so can be helpful if there are body structures near to the sarcoma that could be harmed if they were included in the treatment area. We also know that radiotherapy before surgery can sometimes shrink the tumour so that it is easier to remove. This is known as down staging a sarcoma.


Radiotherapy after surgery

Radiotherapy is often used after surgery to kill off any sarcoma cells that may have been left behind. This is called adjuvant radiotherapy. You usually have between 6 and 7 weeks of treatments each weekday, with a rest at weekends. The treatment begins after your wound has completely healed. Radiotherapy given sooner could slow down the healing process.

At the moment, doctors give radiotherapy to quite a large area after surgery for sarcoma. The VORTEX trial is looking at giving radiotherapy to a smaller area to see if this causes fewer side effects. The trial is now closed and we are waiting for the results.


Radiotherapy before surgery

Sometimes, the doctor may suggest you have radiotherapy before surgery. It is called neoadjuvant radiotherapy. Radiotherapy can shrink the sarcoma and make it easier to remove. You may then be able to have a smaller operation. Radiotherapy before surgery may also reduce the risk of the cancer coming back in the future by killing off any cells in the area that have broken away from the main tumour.

Some research into radiotherapy before surgery has shown that it can increase the risk of wound complications after your operation, particularly for sarcomas in the leg. But it may be the best choice of treatment for sarcomas in some parts of the body. 

The dose of radiotherapy given before surgery is lower than when it is given after surgery. Do ask your specialists if you have any questions about why they have recommended a particular type of treatment for you.


Radiotherapy for advanced sarcomas

If your cancer has spread or come back after it was first treated, it may not be possible to get rid of it completely. But it may be possible for your doctor to control the growth of the cancer for a while with radiotherapy and sometimes chemotherapy.

A growing cancer can cause symptoms by pressing on nerves and other body tissues. Radiotherapy can relieve these symptoms by shrinking the tumour and so relieving the pressure. This type of radiotherapy is called palliative treatment and you may just have a small number of treatments. You may have one treatment a day for a few days. Or you may have several treatments with a few days break between each.


How you have radiotherapy

You have radiotherapy treatment in the hospital radiotherapy department. If you are having radiotherapy after surgery, you may have treatment once a day from Monday to Friday, with a rest at the weekends, for between 6 and 7 weeks.

If you are having radiotherapy for symptoms, you may only have a small number of treatments so that you do not have to keep going back to the hospital. 


Planning your treatment

Before you begin your treatment, the radiotherapy team carefully plan your external beam radiotherapy. This means working out how much radiation you need to treat the cancer and exactly where you need it. 

Your planning appointment may take from 15 minutes up to a couple of hours. You will have a planning CT scan. The scan shows the cancer and the structures around it.

You lie on the scanner couch with the treatment area exposed. The radiographers will put some markers on your skin. You need to lie very still. Once you are in position the radiographers move the couch up and through the scanner. The scanner is a doughnut shape. 

The radiographers leave the room and the scan starts. It takes up to 5 minutes. You won't feel anything. The radiographers watch from the next door room.

Ink marks

Once the treatment team has planned your radiotherapy, they may put ink marks on your skin to make sure they treat exactly the same area every day. They may also make pin point sized tattoo marks in these areas.

Moulds or masks

If you are having treatment to your head or neck, you may need to have a mould (shell) made to keep you perfectly still while you have treatment. You may also have a mould if you have to keep an arm or leg perfectly still. If you have a mould made the staff may make the radiotherapy markings on the mould instead of on your skin.

The video shows you what happens at radiotherapy planning:

You can view a transcript of the video showing what happens at radiotherapy planning. The transcript opens in a new window.

After your planning session

You may have to wait a few days or up to 2 weeks before you start treatment. During this time the physicists and your radiotherapy doctor decide the final details of your plan. 

Your doctor will plan the areas that need treatment and outline areas to limit the dose to or avoid completely. They call this contouring. Then the physicists and staff called dosimetrists plan the treatment very precisely using advanced computers.


Having radiotherapy

Radiotherapy machines are very big. The machine may be fixed in one position or able to rotate around your body to give treatment from different directions. Before your first treatment your radiographers will explain what you will see and hear. The treatment rooms usually have docks for you to plug in music players. So you can listen to your own music.

You can't feel radiotherapy when you actually have the treatment. It takes anything from 15 to 30 minutes. It is important to lie in the same position each time, so the radiographers may take a little while to get you ready.

A photo of a linear accelerator, which gives radiotherapy

Once you are in the right position the staff leave you alone in the room for a few minutes. They watch you carefully on a closed circuit television screen.

Our page about having external radiotherapy has a video about having radiotherapy that you may want to watch.

External radiotherapy doesn't make you radioactive. It is perfectly safe to be with other people, including children, throughout your course of treatment.


General side effects of radiotherapy

Radiotherapy may cause the following effects.

  • Tiredness
  • Reddening of the skin
  • Loss of hair

Tiredness can occur, especially toward the end of a course of treatment. The tiredness wears off over a few weeks once the treatment ends.

Reddening of the skin can happen. If you are having a lot of treatment, or if your skin is sensitive to the radiation, it may peel as well as going red. If it gets very sore, your specialist may stop the treatment for a short time so your skin can recover. 

Remember not to put any creams or lotions on your skin. If it is sore, tell your nurse, radiographer or doctor and they will give you something that is safe to use. Your doctor can prescribe painkillers for you if you need them.

Hair loss happens in the treatment area. You will only have hair loss from your head if you are having radiotherapy to your head. You may lose body hair in the treatment area – for example, leg hair if your leg is being treated. 

The hair may grow back but sometimes doesn't. If it does grow back, it can take up to a year and it may be patchy. Whether the hair grows back and how long it takes depends on the amount of treatment you have had.


Specific side effects

Radiotherapy may cause specific side effects depending on which part of the body is treated. 

If you have radiotherapy to your abdomen or pelvis, you may feel sick or have diarrhoea. Or you may have some abdominal pain or bladder irritation.

Radiotherapy to the head and neck can cause a sore dry mouth. 

Other side effects from radiotherapy to the head and neck include thickened saliva, difficulty in swallowing, changes in taste, and feeling sick.

Women must tell their doctor or radiographer if they think they are, or could be pregnant, as radiotherapy can harm a developing baby.


Possible long term effects

Radiotherapy treatment to a joint, such as a knee or elbow, can make it stiff by causing hardening of tissues (fibrosis) in the treatment area. It is important to keep using the joint as normally as you can. Regular exercise will help you to be able to keep moving the joint and stop it from stiffening up.

Months or years after radiotherapy, some people develop lymphoedema. Lymphoedema is swelling in the area close to where the radiotherapy was given. The radiotherapy damages the small tubes that circulate tissue fluid around the body (the lymphatic vessels). Fluid builds up behind the blockage and causes swelling in the tissues. 

Doctors plan radiotherapy carefully to minimise the risk of lymphoedema developing. They now try to prevent it by leaving a column of untreated tissue along your arm or leg. So, they don't treat your arm or leg all the way round. If you do get swelling in your hand or foot after radiotherapy to that limb, tell your specialist. 

Lymphoedema can't be cured. But there is treatment to control lymphoedema. The earlier it is diagnosed, the easier it is to control.

People who have treatment to the pelvic area or top of the thighs may become unable to have children (infertile) due to the effects of treatment on the testes, or ovaries and womb. This can be very upsetting. Men may be able to store sperm in a sperm bank before they have treatment.  And doctors will try not to include a woman's ovaries in the treatment field where possible.


More about radiotherapy

Find out about


The VORTEX Trial

Stages of soft tissue sarcoma

Radiotherapy masks and moulds

Radiotherapy skin markings

Radiotherapy side effects

Cancer and sexuality

Treatiment to control lymphoedema

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Updated: 11 February 2015