Image-Guided Intensity-Modulated Proton or Photon Beam Radiation Therapy with Boost in Treating Patients with Primary or Locally Recurrent Soft Tissue Sarcoma

Inclusion Criteria

• Participants must have histologically proven primary (or locally recurrent after prior surgery) soft tissue sarcoma of the retroperitoneum; patients in the phase II portion of the trial will be primary soft tissue sarcomas only; extraskeletal chondrosarcoma is allowed; pathology must be reviewed prior to study entry; NOTE: for patients with retroperitoneal neoplasms that have ambiguous histological and/or immunohistochemical findings, the diagnoses of carcinoma, melanoma, and lymphoma should be excluded by immunohistochemical studies with antibodies to broad spectrum cytokeratin (AE1/AE3), S-100, cluster of differentiation (CD)45, or LCA (leucocyte common antigen), respectively; if these diagnoses are excluded by immunohistochemistry, then patients presenting with primary non-visceral retroperitoneal masses that are felt to be "consistent with sarcoma" shall be considered eligible for this trial
• Participants must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as >= 20 mm with conventional techniques or as >= 10 mm with spiral CT scan
• No prior radiation therapy for retroperitoneal sarcoma is allowed
• Age 18 years or older. Children are excluded from this study but may be eligible for pediatric sarcoma trials of radiation therapy.
• Life expectancy of greater than 2 years
• Eastern Cooperative Group (ECOG) performance status =< 1
• Leukocytes >= 3,000/mcL
• Absolute neutrophil count >= 1,500/mcL
• Platelets >= 100,000/mcL
• Hemoglobin >= 8.0 g/dl (Note: the use of transfusion or other intervention to achieve hemoglobin [Hgb] > 8.0 g/dl is acceptable)
• Total bilirubin within normal institutional limits
• Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/ alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x institutional upper limit of normal
• For women of childbearing potential, negative urine or serum pregnancy test within 6 weeks prior to study entry
• No distant metastases, based upon the following minimum diagnostic workup: * History and physical exam including a detailed description of the location, size and stage of the sarcoma, within 10 weeks prior to study entry * CT or magnetic resonance imaging (MRI) with contrast of the abdomen and pelvis within 8 weeks prior to study entry; the maximal dimension of the primary tumor will be measured in CT and MRI images; and * CT scan of the chest within 8 weeks prior to study entry
• The effects of radiation therapy on the developing human fetus have been known to be teratogenic; women of child-bearing potential and men must agree to use adequate contraception (i.e. hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study treatment; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately
• The ability to understand and the willingness to sign a written informed consent document
• Participant must be evaluated by surgical oncologist and felt to have potentially resectable tumor and be medically fit for proposed surgery

Exclusion Criteria

• Participants who have had chemotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to study entry or those with adverse events due to agents administered more than 4 weeks earlier that have not resolved to =< grade 1 per Common Terminology Criteria for Adverse Events (CTCAE) version (v.) 4
• Participants may not be receiving any other investigational agents
• Participants with sarcoma of head and neck, lung, heart or extremity origin; or histopathology demonstrating rhabdomyosarcoma, extraosseous primitive neuroectodermal tumor (PNET) soft tissue Ewing's sarcoma, osteosarcoma, Kaposi's sarcoma, angiosarcoma, aggressive fibromatosis (desmoid tumor), or dermatofibrosarcoma protuberans or chondrosarcoma other than extraskeletal chondrosarcoma; or well differentiated liposarcoma where the target volume cannot be adequately distinguished from the normal retroperitoneal fat are excluded
• Participants with multifocal disease, lymph node or distant metastases; Note: multiple pulmonary nodules < 8 mm without a histological diagnosis detected incidentally in a non-screening CT scan may not be a basis for study exclusion because of the sensitivity/specificity of the CT scans of the chest/abdomen/pelvis
• History of sensitivity to, or history of conditions that are known to cause sensitivity to, radiation therapy
• Participants for whom intraoperative or post-operative radiation therapy is planned as part of the overall primary tumor treatment
• Uncontrolled, intercurrent illness including but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
• Pregnant women are excluded from this study because radiation is known to have teratogenic effects
• Individuals with a history of a different invasive malignancy are eligible per the discretion of the treating investigator and review by the principal investigator
• Human immunodeficiency virus (HIV)-positive individuals on combination antiretroviral therapy are ineligible because of the potential for increased sensitivity to radiation therapy