Frontline extended surgery is associated with improved survival in retroperitoneal low- to intermediate-grade soft tissue sarcomas

Gronchi, Alessandro; Miceli, Rosalba; Colombo, Chiara; Stacchiotti, Silvia; Collini, Paola; Mariani, Luigi; Sangalli, Claudia; Radaelli, Stefano; Sanfilippo, Roberta; Fiore, Marco; Casali, Paolo G.

doi:10.1093/annonc/mdr323

Cited by 194 publications

(125 citation statements)

References 16 publications

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“…However, the local recurrence rate in this series is very high compared with reported European series from centers where CCR are performed regularly. 9,10 In this current series, when looking exclusively at the primary RPS group with unifocal disease, the local recurrence rate is 68 % (64/94 patients), with a median follow-up of 47 months. Two recently reported European series 9,10 of primary RPS report local recurrence rates of 19 % (n = 48/ 249 patients; follow-up 37 months) and a 5-year LR rate of 21 % (n = 136 patients; follow-up 48 months), respectively.…”

Section: Complete Compartmental Resection Outcomesmentioning

confidence: 81%

“…There remains significant controversy regarding the benefit and associated morbidity of multivisceral resection; however, reported short-term morbidities are in line with most other reported series reporting on outcomes of RPS. 9 Prospective data on shortand long-term morbidities, oncological outcomes, and quality of life comparing these two surgical strategies are urgently needed. Reported oncological results are very promising.…”

Section: Complete Compartmental Resection Outcomesmentioning

confidence: 99%

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Patterns of Recurrence in Retroperitoneal Liposarcomas: Reflecting Surgical Approach or Tumor Biology?

Strauß

2014

Ann Surg Oncol

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Complete surgical resection remains the mainstay of curative treatment for retroperitoneal sarcomas (RPS) and provides the only hope for long-term survival. Unfortunately, the major mode of failure leading to poor outcome for retroperitoneal liposarcoma is intra-abdominal locoregional recurrence. The cause for the high rate of local recurrence following resection of retroperitoneal liposarcomas in contrast to limb sarcoma is customarily attributed to the specific anatomical site, containing vital neural and vascular structures, axial skeleton, and visceral organs limiting the ability to perform a wide resection. In addition, inherent tumor biology of liposarcomas has to be considered. The biological behavior of retroperitoneal liposarcomas are unpredictable. Clinically, some well-differentiated (WD) RPS behave in an indolent fashion over many years and never develop a dedifferentiated (DD) component. Other DD RPS develop de novo without a documented WD component. Some WD RPS can recur with a mainly DD component and vice versa. Although WD and DD RPS have a common genetic feature associated with genomic amplification which include amplification in 12q13-15 resulting in MDM2 and CDK4 overexpression, the specific genetic and molecular events leading to the unpredictable behavior is still not clear.

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Section: Complete Compartmental Resection Outcomesmentioning

confidence: 81%

Section: Complete Compartmental Resection Outcomesmentioning

confidence: 99%

Patterns of Recurrence in Retroperitoneal Liposarcomas: Reflecting Surgical Approach or Tumor Biology?

Strauß

2014

Ann Surg Oncol

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“…[42][43][44][45][46][47][48] Surgery should be aimed at achieving macroscopically complete resection and minimizing microscopically positive margins. 19 This is best done by resecting the tumor en bloc with adherent structures, even if they are not overtly infiltrated (Fig.…”

Section: Sts Of the Retroperitoneummentioning

confidence: 99%

Surgical management of localized soft tissue tumors

Gronchi

Colombo

Raut

2014

Cancer

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Soft tissue tumors are rare and can arise from a variety of soft tissues and viscera in a variety of body sites. Their management requires a thorough understanding of the biology of the different histologies and molecular subtypes as well as the constraints of specific anatomic sites. The surgical approach has undergone significant changes thanks to a better understanding of the natural history of the different histologic subtypes, the importance of site, and the different sensitivity to available drugs. The soft tissue tumor family includes 3 major, distinct categories: desmoid-type fibromatosis, soft tissue sarcoma, and gastrointestinal stromal tumor. In general, limb-sparing and function-sparing approaches should be used when feasible for tumors located in the extremities and girdles. Resections of adherent structures/viscera, which may be close but not invaded, may be needed in tumors arising in the retroperitoneum/abdomen to minimize microscopic intralesional margins, maximize local tumor control, and possibly improve survival. Margins of resection and the use of adjuvant/neadjuvant radiation therapy and/or chemotherapy are contingent on an accurate histologic diagnosis. Treatment planning should include multidisciplinary consultation to determine optimal therapy, taking into consideration tumor histology, site and extent of the disease, its natural history and sensitivity to available treatments, surgical challenges, and-of course-quality of life. Cancer 2014;120:2638-48.

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“…Such extended surgery may indeed confer an increased potential for cure in low-and intermediate-grade tumors in which survival largely depends on local control. 6 However, as intuitive as it may be, the final utility of this approach needs to be confirmed. In high-grade tumors, which generally have a more aggressive biology characterized by metastatic avidity, it can be anticipated that extended surgery alone will probably not significantly impact overall or disease-free survival.…”

Section: Surgical Strategymentioning

confidence: 99%

Quality of Local Treatment or Biology of the Tumor: Which are the Trump Cards for Loco-regional Control of Retroperitoneal Sarcoma?

Gronchi

Pollock

2013

Ann Surg Oncol

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Surgery remains the mainstay of curative therapy for retroperitoneal sarcoma (RPS). Local control is critical to achieve this objective, yet is not possible to achieve even initially in as many as 50 % of patients. Unlike sarcoma arising at other sites, anatomical constraints in the retroperitoneum limit the ability to achieve wide resection margins. As a consequence, local recurrences in RPS are more frequent than in extremity sarcoma and comprise the leading cause of death especially for low-to-intermediate grade tumors, e.g., liposarcoma, the histopathological subtype of approximately one-half of sarcomas arising at this site. Conceptually, adjuvant radiation therapy (RT) is attractive, but this modality also is limited by anatomical constraints as well as the typically large size of these tumors at presentation. RT benefits in RPS remain to be conclusively demonstrated; its application is reserved for selected cases. In the report by McBride et al.1 an interesting approach is proposed, consisting of external preoperative therapy followed by intraoperative dose escalation with brachytherapy. This is an appealing concept, with the caveat that the justification for this strategy is tempered by the retrospective nature of their analysis and the small numbers of patients in their series. Moreover, patients presenting with recurrent tumor whose outcome is usually worse and less likely to be affected by any treatment modalities were nonetheless included in this study. With recurrence, the likelihood of definitive local control reduces to the anecdotal; therefore, the initial therapeutic intervention is critical if durable control (let alone cure) is to result. McBride and colleagues used this opportunity to investigate possible predictors of survival, identifying multifocality as the only determinant of outcome. This finding is not surprising in that multifocality may be a reflection of an especially unfavorable underlying biology of RPS, with obvious prognostic impact, as we and others also have reported.2 Understanding the relative contributions of the effectiveness of local therapy against the inherent biology of specific RPS subtypes will be critical if we are to move a new set-point in RPS, in which specifically useful treatment options can be tailored to the individual patient. QUALITY OF LOCAL THERAPY Surgical StrategySome authors have advocated for the widest possible surgical resection at presentation, a strategy at variance with past recommendations advocating grossly complete extirpation in which the need or utility of resecting adjacent organs was limited to unequivocal direct tumor involvement.3,4 These retrospective analyses have favored a more aggressive adjacent organ resection approach, reporting greater than 75 % local control at 5 years. The need to standardize these seemingly disparate surgical strategies has been addressed recently by a panel of European and North American experts who have described how these tumors might be optimally approached. In essence, this surgical strategy consists of l...

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Frontline extended surgery is associated with improved survival in retroperitoneal low- to intermediate-grade soft tissue sarcomas

Cited by 194 publications

References 16 publications

Patterns of Recurrence in Retroperitoneal Liposarcomas: Reflecting Surgical Approach or Tumor Biology?

Patterns of Recurrence in Retroperitoneal Liposarcomas: Reflecting Surgical Approach or Tumor Biology?

Surgical management of localized soft tissue tumors

Quality of Local Treatment or Biology of the Tumor: Which are the Trump Cards for Loco-regional Control of Retroperitoneal Sarcoma?

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