Aggressive Surgical Policies in a Retrospectively Reviewed Single-Institution Case Series of Retroperitoneal Soft Tissue Sarcoma Patients

Gronchi, Alessandro; Vullo, Salvatore Lo; Fiore, Marco; Mussi, Chiara; Stacchiotti, Silvia; Collini, Paola; Lozza, Laura; Pennacchioli, Elisabetta; Mariani, Luigi; Casali, Paolo G.

doi:10.1200/jco.2008.17.8871

Cited by 423 publications

(333 citation statements)

References 25 publications

(16 reference statements)

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“…Local recurrence is the major cause of mortality and continues to occur after 5 years of followup, as stated previously by the National Cancer Institute Sarcoma Progress Review Group. [20][21][22][24][25][26][27][28]44,45,47,48,[52][53][54][55] This is in contrast to the cause of death from extremity sarcomas, which almost always is a consequence of metastases. This difference may be explained by differences in anatomic location and tumor biology.…”

Section: Discussionmentioning

confidence: 99%

“…In general, there are 2 ''surgery schools'': School 1 defends aggressive surgery, including reoperation and debulking in unresectable RSTS 2,23,34,35 ; whereas School 2 does not take this aggressive approach. 24,36,37 Subgroup analysis from the study by Gronchi et al demonstrated a benefit from aggressive surgery only for patients who received additional RT. 24,26 A median OS of 33 to 49 months was reported among patients who underwent surgery alone, 31,38 and the recurrence-free survival rate dropped to only 23%.…”

Section: Surgery Alonementioning

confidence: 99%

“…24,36,37 Subgroup analysis from the study by Gronchi et al demonstrated a benefit from aggressive surgery only for patients who received additional RT. 24,26 A median OS of 33 to 49 months was reported among patients who underwent surgery alone, 31,38 and the recurrence-free survival rate dropped to only 23%. 32 Depending on resection status, the 5-year local recurrence-free survival (LRFS) rate varied between 55% and 62%.…”

Section: Surgery Alonementioning

confidence: 99%

“…26 Several other reports lacked critical details regarding the number of patients who underwent surgery as single treatment modality. In general, there is a clear trend toward using RT-preferably in the preoperative setting-to reduce the local recurrence rate 23,24,26,[39][40][41] and, in some publications, even improvement of OS. 24,41 Postoperative RT The advantage of postoperative RT is that surgery can be performed without delay, and histology and tumor grade can be assessed in detail.…”

Section: Surgery Alonementioning

confidence: 99%

“…6,9,22,23 Defenders argue that RT is associated with a significant improvement in local control and even an OS benefit compared with surgery alone. [24][25][26][27] A major challenge for radiation oncologists is to combine the delivery of an effective radiation dose with an acceptable rate of radiation side effects. 19 The objective of this review was to define the exact role of RT in the management of RSTS.…”

mentioning

confidence: 99%

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Radiotherapy and surgery—An indispensable duo in the treatment of retroperitoneal sarcoma

Voorde

Delrue

Eijkeren

et al. 2011

Cancer

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The authors undertook a systematic review to designate the role that radiotherapy (RT) might play in the treatment of retroperitoneal sarcomas. Correlating with recent literature, the objective of this review was to evaluate whether there was enough evidence for the authors to develop an institutional treatment protocol concerning the use of RT in the treatment of retroperitoneal sarcoma. Furthermore, this was a call for surgeons to talk to radiation oncologists before performing surgery. The 2 objectives of this review were: 1) to determine the benefit of RT in terms of local control and/or survival in the treatment of retroperitoneal sarcomas and 2) to discover the optimal timing of RT in the treatment sequence. A computerized literature search was performed in the PubMed database, the Cochrane Library database, and reference lists; and journals also were searched by hand to identify all retrospective and prospective reports published since 1998 relating to RT treatment of adult retroperitoneal sarcoma. Mainly, analyses were sought that were based on a 5-year local control rate (LCR), 5-year disease-free survival, and 5-year overall survival (OS). If only 2 years follow-up were available, then the authors also noted this outcome. Toxicity data were collected and analyzed separately. The synthesis of the literature was based on 9 prospectively nonrandomized studies and 10 retrospective studies that, together, reviewed a total of 1426 patients. The 5-year LCR varied from 27% to 62%, and the results from other reports fell in between those values. The 5-year OS rate ranged from 12% to 90%, and complete resection and tumor grade were the most important prognostic factors in most studies. This review resulted in 7 recommendations concerning the use of RT in the treatment of retroperitoneal sarcoma. The authors concluded that there is good evidence from multiple single-institutions studies that RT improves the LCR in patients with retroperitoneal sarcoma. Until now, there has not been a translation of this approach into survival benefit. The current results indicated that preoperative external-beam RT followed by radical surgery seems to be the preferred sequence, and adding intraoperative RT is a safe procedure for dose escalation in the upper abdomen. Cancer 2011;117:4355-

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Section: Discussionmentioning

confidence: 99%

Section: Surgery Alonementioning

confidence: 99%

Section: Surgery Alonementioning

confidence: 99%

Section: Surgery Alonementioning

confidence: 99%

mentioning

confidence: 99%

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Radiotherapy and surgery—An indispensable duo in the treatment of retroperitoneal sarcoma

Voorde

Delrue

Eijkeren

et al. 2011

Cancer

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Surgery and Radiotherapy for Retroperitoneal and Abdominal Sarcoma

Zhou

McDade²,

Simons³

et al. 2010

Arch Surg

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In a national cohort of retroperitoneal and abdominal sarcomas, surgical resection was associated with significant survival benefits for AJCC disease stages I to III. Radiotherapy provided additional benefit for patients with stage I disease. Resection should be offered to reasonable surgical candidates with nonmetastatic retroperitoneal/abdominal sarcomas; radiotherapy may most benefit patients with early-stage disease.

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Mesenchymal and Non‐Epithelial Tumors of the Pelvis

Schwarzkopf¹,

Boland²

2021

Surgical Management of Advanced Pelvic Cancer

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Aggressive Surgical Policies in a Retrospectively Reviewed Single-Institution Case Series of Retroperitoneal Soft Tissue Sarcoma Patients

Cited by 423 publications

References 25 publications

Radiotherapy and surgery—An indispensable duo in the treatment of retroperitoneal sarcoma

Radiotherapy and surgery—An indispensable duo in the treatment of retroperitoneal sarcoma

Surgery and Radiotherapy for Retroperitoneal and Abdominal Sarcoma

Mesenchymal and Non‐Epithelial Tumors of the Pelvis

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