尽管手术是治疗局限性腹膜后肉瘤的主要方法，但放射治疗（RT）的应用仍存在争议。本系统综述的目的是评估RT在腹膜后肉瘤中的作用。我们使用1990年至2022年的人口、干预、对照和结果模型进行了系统综述，并找到了66项研究（包括术前和术后放疗），其中包括一项随机对照试验（RCT）有两篇发表的文章，18项登记研究和46项回顾性研究。在术前RT的RCT中，局部/腹部复发无差异。对这个RCT和一项回顾性研究进行的合并分析表明，术前RT在低级别脂肪肉瘤的腹部无复发生存上有显著的益处。RCT和大多数回顾性研究发现RT不能改善无复发生存（16项研究中有11项局部和远处无复发差异，13项研究中有11项无远处转移无复发差异），疾病特定生存（12项研究中有9项），以及总生存（49项研究中有33项）。大多数研究发现RT与围手术期发病率之间没有关联。总之，术前RT可能改善低级别（分化良好或1-2级去分化）脂肪肉瘤的局部控制，但不能改善其他组织学亚型的情况。目前没有强有力的证据表明围手术期RT有总生存益处。可以考虑为低级别背膜脂肪肉瘤患者进行术前RT以改善腹部无复发生存。在此情况下，多学科团队应与患者仔细讨论理论依据和证据水平。对其他组织学亚型的患者，不应常规推荐RT。Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.

While surgery is the mainstay of treatment for localised retroperitoneal sarcoma, the use of radiotherapy (RT) remains controversial. This systematic review aimed to evaluate the role of RT for retroperitoneal sarcoma. A systematic review using the population, intervention, comparison, and outcome model from 1990 to 2022 identified 66 studies (a mixture of preoperative and postoperative RT); one randomised controlled trial (RCT) with two publications, 18 registry studies, and 46 retrospective studies. In the RCT of preoperative RT, there was no difference in local/abdominal recurrence. The pooled analysis of this RCT and a retrospective study showed a significant abdominal recurrence free survival benefit with preoperative RT in low grade liposarcoma. The RCT and the majority of retrospective series found RT did not improve recurrence free survival (11 of 16 no difference in combined local and distant RFS, 11 of 13 no difference in distant metastasis free survival), disease specific survival (9 of 12 studies) or overall survival (33 of 49 studies). The majority of studies found no association between RT and perioperative morbidity. In summary, preoperative RT may improve local control for low grade (well-differentiated or grades 1-2 dedifferentiated) liposarcoma, but not other histological subtypes. There is no strong evidence that perioperative RT provides an overall survival benefit. Patients with low grade retroperitoneal liposarcoma can be considered for preoperative RT to improve abdominal recurrence free survival. The rationale and level of evidence in this scenario should be carefully discussed by the multidisciplinary team with patients. RT should not be routinely recommended for other histological subtypes.Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.