Clinical Investigations Surgery combined with brachytherapy in patients with retroperitoneal sarcomas

Abstract

PurposeThe primary aim of this work was to analyze feasibility of combined treatment of retroperitoneal sarcomas (RS): surgery (S) and intraoperative brachytherapy (IOBRT). The secondary aim was to analyze results and complications after this treatment.Material and methods84 patients with retroperitoneal sarcomas were qualified for combined treatment (S and IOBRT) between June 1998 and September 2006. 65 of the patients (77.4%) had local recurrences. Sarcomas with intermediate and high grade of histological malignancy (G2, G3 – 76.2%) were the most frequent within the all surgically treated patients. Resection ability (R0/R1) in analyzed group of patients was estimated as 85% (74 cases). After intraoperative evaluation, 57 (67.8%) patients were qualified for IOBRT. Since 2000, in 34 patients (60%) an adjuvant postoperative external beam radiation therapy (EBRT) in dose of 50 Gy was applied. Median follow-up of the surviving patients was 40 months.ResultsOn the basis of the univariate analysis, relevant aspects negatively influencing overall survival rate within the RS group treated with IOBRT were as follows: surgery of sarcoma recurrence (p = 0.002), higher grade of histological malignancy (p = 0.05), histological type different than liposarcoma (p = 0.05) as well as no adjuvant EBRT (p = 0.05). On the basis of multivariate analysis one can ascertain that relevant factors negatively influencing LRFS in RS patients treated with IOBRT were: surgery due to recurrence of sarcoma (p = 0.008) and lack of EBRT (p = 0.01).ConclusionsCombined treatment (surgery and brachytherapy) was possible to be carried out on 68% of RS patients. The overall number of complications was quite high, however acceptable, taking into consideration the application of extensive, multi-organ treatments in case of sarcoma recurrences in this localization. The results suggest that the method of treatment will improve the final outcome when most of patients will be qualified for treatment of primary sarcomas in experienced centre.

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

“…Patients who received the combination of HDR-IORT and EBRT had a significant improvement in local recurrence-free survival compared with patients who received HDR-IORT alone. 50,51 Toxicity IOERT IOERT induces severe complications in up to 37% of patients; and neuropathy, hydronephrosis, gastrointestinal fistula, small bowel obstruction, and vaginal and ureteroarterial fistula are the most frequent. 17,45,49 To limit the risk of grade 3 neuropathy, the RT dose should kept below 15 Gy.…”

“…10,47,50,51 Ballo et al did not use Radiation Therapy Oncology Group criteria for toxicity, but all 5 of their patients (10% at 5 years) who developed RT-related complications had received postoperative EBRT. 47 Preoperative RT Alone or in Combination With Other Forms of RT There are several theoretical advantages for preoperative RT compared with postoperative RT.…”