Advances in Radiotherapy for Soft Tissue Sarcomas in 2025: A Review

PURPOSE OF REVIEW: This review aims to synthesize and critically appraise the most impactful advances in radiotherapy (RT) for soft tissue sarcomas (STSs) reported in 2025, with a focus on technological innovations, fractionation paradigms, combination strategies, and personalized approaches. RECENT FINDINGS: The year 2025 has witnessed the increasing acceptance of hypofractionated RT as an effective alternative in multiple settings, offering non-inferior efficacy with improved convenience. Prospective and real-world evidence consistently validates preoperative moderately hypofractionated radiotherapy for extremity/superficial trunk STS, with mature local control and acceptable toxicity. Stereotactic body radiotherapy and particle therapy have expanded their roles, particularly in recurrent, metastatic, or pediatric STS. Robust evidence supports synergistic combinations of RT with targeted agents (e.g., PARP inhibitors, pazopanib) and immunotherapy, especially in high-risk subtypes. Advances in multiparametric MRI and pathological biomarkers (e.g., hyalinization, tumor-infiltrating monocytes) enable early response assessment and prognostication, paving the way for adaptive, personalized RT. Radiotherapy for STSs in 2025 is characterized by personalized, precision-based approaches that improve local control, reduce toxicity, and preserve quality of life. Continued integration of advanced technologies, biomarker-guided strategies, and novel systemic combinations will further optimize outcomes. Future efforts should focus on validating surrogate endpoints, enhancing global access, and incorporating artificial intelligence into adaptive workflows. Careful attention to RT-related toxicities is critical for balancing efficacy and safety in practice.