What is your approach to extremity STS (G2-3) after an initial unplanned (non-oncologic) surgery who is planned for oncologic re-excision?

I, too, usually offer pre-operative radiation therapy in these cases with plans for re-resection by our sarcoma surgeons. I am generally a proponent of neoadjuvant therapy as the volumes are smaller, there is less confusion of the field in need of treatment, the dose is less, and, as I see patients who do develop radiation induced sarcomas after RT for other tumors, I believe neoadjuvant RT with re-excision decreases the volume of tissue I am exposing to this risk.

With a grade 2-3 STS following a non-oncologic resection, our preference is to consider pre-operative RT. These cases may not have had a pre-operative MRI prior to first resection, so we obtain this and use it to help with treatment planning. However re-resection (with imaging prior) followed by post-op is another way to go.