A critical narrative review of radiotherapy for retroperitoneal soft tissue sarcoma

Abstract

Retroperitoneal sarcomas (RPSs) are rare diseases, and the 5-year overall survival rate remains low. Management of RPSs is challenging, and the quality of treatment strategy is a crucial prognostic factor.Treatment decisions and the treatment department to which the patients is referred must be centralized.Overall survival rate is positively correlated with the number of patients treated in the centers. En bloc surgery is the standard of care for effective treatment and potential for cure, whereas perioperative chemotherapy or radiotherapy has not yet been validated. Pre-or postoperative radiotherapy was considered controversial, but the STRASS trial publication illustrated that preoperative radiation could be useful in some conditions.Retroperitoneal liposarcoma might become a future target of prospective trials. Furthermore, some retrospective studies have shown that preoperative radiotherapy increases the rate of R0-R1 resections. This article reviews the role of external beam radiotherapy in the management of RPS and highlights the optimal volumes, doses, and radiotherapy techniques for the treatment of RPS. As accurately predicting prognosis in patients with RPS is challenging, we also emphasize the utility of nomograms in the field of radiotherapy.However, these nomograms do not include radiotherapy as a predictive factor. Although some authors could conclude that use of radiotherapy should be avoided based on the results of the STRASS trial, some data argue that radiotherapy still has utility in select cases.

Effects of marital status on survival of retroperitoneal liposarcomas stratified by age and sex: A population‐based study

“…For most patients with RPLs, early diagnosis and complete surgical resection are effective methods to improve survival. However, RPLs are unresponsive to most chemotherapeutic agents, and the use of radiation therapy is significantly restricted due to tissue toxicity, preventing the delivery of an adequate dose 7–10 . In addition, recent studies have demonstrated that novel therapeutic strategies, including targeted drugs, are effective for treating RPLs 11,12 .…”

“…However, RPLs are unresponsive to most chemotherapeutic agents, and the use of radiation therapy is significantly restricted due to tissue toxicity, preventing the delivery of an adequate dose. 7 , 8 , 9 , 10 In addition, recent studies have demonstrated that novel therapeutic strategies, including targeted drugs, are effective for treating RPLs. 11 , 12 Despite recent advances in surgery, radiotherapy, and novel treatment strategies, the overall 5‐year survival rate of patients with RPLs remains at approximately 50%.…”

"Assessment of Target Volume Definition for Contemporary Radiotherapeutic Management of Retroperitoneal Sarcoma: An Original Article"

“…Surgery has been the principal mode of management for retroperitoneal sarcomas, however, complete surgical removal may not be achievable particularly in the setting of large tumor sizes and involvement of nearby critical structures. In an attempt to improve therapeutic outcomes, the use of radiation therapy (RT) has been addressed [1][2][3][4][5][6][7]. Surgical resection with negative margins may be challenging to achieve in some circumstances and neoadjuvant or adjuvant therapeutic strategies may be considered.…”

“…Surgical resection with negative margins may be challenging to achieve in some circumstances and neoadjuvant or adjuvant therapeutic strategies may be considered. RT may be utilized as a local treatment option, however, adverse radiation effects should be considered [1][2][3][4][5][6][7]. Critical advances in the millennium era for improved RT outcomes include sophisticated technologies along with state of the art irradiation techniques .…”

Application of an indocyanine green-mediated fluorescence imaging navigation system in detecting mice tumors

“…Cancer causes nearly 10 million deaths globally on an annual basis (1) and imposes a huge economic burden on society (2,3). The treatment of cancer is often difficult, and current methods include surgery, radiotherapy, systemic therapy, interventional therapy, and local ablation (4)(5)(6). While surgical resection is considered the most common and effective method, there are also many difficulties in surgery, including the precise positioning of tumor tissue in the preoperative detection process and the precise resection of tumor mass in the surgical process.…”