Impact of chemotherapy on survival in surgically resected retroperitoneal sarcoma

Miura, John T.; Charlson, John; Gamblin, T. Clark; Eastwood, Dan; Banerjee, Anirban; Johnston, Fabian M.; Turaga, Kiran K.

doi:10.1016/j.ejso.2015.07.014

Cited by 74 publications

(48 citation statements)

References 28 publications

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“…Chemotherapy was more frequently given to patients with tumors classified as intermediate-/high-grade, leiomyosarcoma, or UPS histology, and to patients who had R2 resection. After propensity score matching, perioperative chemotherapy was associated with shorter OS (40 vs. 52 months; p=0.002) [19]. However, owing to innate selection bias associated with this retrospective analysis, the clinical benefit of perioperative therapy remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Recurrence patterns of retroperitoneal leiomyosarcoma and impact of salvage surgery

Ikoma

Torres

Lin

et al. 2017

Journal of Surgical Oncology

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Background Optimal treatment strategies for retroperitoneal leiomyosarcoma (RPLMS), particularly recurrent disease, are unknown. Methods We searched the tumor registry at The University of Texas MD Anderson Cancer Center (MDACC) to identify patients with RPLMS treated between 1994 and 2013. Results We identified 172 patients with a diagnosis of a RPLMS. Among the 85 patients who underwent complete resection included in the survival analysis, the median overall survival (OS) was 8.3 years (95% confidence interval [CI], 5.7–12.3), 5-year local recurrence rate was 21%, and 5-year distant metastasis rate was 47%. Among 114 patients who experienced recurrence, patients who underwent salvage surgery for recurrent disease had longer OS after recurrence than patients who did not undergo salvage surgery (median survival after recurrence 5.6 vs. 3.3 years, 3-year OS rates after recurrence 72.6% vs. 58.1%, HR 0.402 [95% CI, 0.243–0.666]; p=0.0004). Whether salvage surgery was performed for local or distant recurrence was not associated with OS. Patients who had a longer disease-free interval (≥12 months) had better progression-free survival after salvage surgery than those who had a shorter interval (HR, 0.437 [95% CI, 0.244–0.783]; p=0.0055). Conclusions We recommend that salvage surgery be considered for selected patients with local or distant recurrence of RP LMS.

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Section: Discussionmentioning

confidence: 99%

Recurrence patterns of retroperitoneal leiomyosarcoma and impact of salvage surgery

Ikoma

Torres

Lin

et al. 2017

Journal of Surgical Oncology

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“…In a large study by Miura et al out of 8663 patients that underwent surgery for retroperitoneal sarcoma over a period of 13 years, 1525 (17.6%) received chemotherapy, 163 (10.6%) in the neoadjuvant setting. Among the factors associated with the receipt of chemotherapy was leiomyosarcoma with an odd ratio of 1.8.…”

Section: Leiomyosarcomamentioning

confidence: 99%

Systemic therapy in retroperitoneal sarcoma management

Constantinidou

Jones

2017

Journal of Surgical Oncology

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There is paucity of randomized controlled data on the role of systemic therapy in retroperitoneal sarcomas. The type of systemic therapy used is guided by the histological subtype. The majority of retroperitoneal sarcomas comprising liposarcomas and leiomyosarcomas are by and large chemotherapy insensitive. There is an urgent need for more efficacious systemic therapies in the management of early and advanced stage retroperitoneal sarcomas.

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“…Although patients with high-grade RPS are at risk for distant recurrence, there is no level-one evidence that adjuvant chemotherapy mitigates this risk 12 . Given the uncertain benefit of adjuvant chemotherapy for RPS, it remains investigational 12 …”

Section: Introductionmentioning

confidence: 99%

Phase 1 trial of preoperative image guided intensity modulated proton radiation therapy with simultaneously integrated boost to the high risk margin for retroperitoneal sarcomas

DeLaney

Chen

Baldini

et al. 2017

Advances in Radiation Oncology

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PurposeTo conduct phase 1 and 2 trials with photon intensity modulated radiation therapy and intensity modulated proton therapy (IMPT) arms to selectively escalate the retroperitoneal sarcoma preoperative radiation dose to tumor volume (clinical target volume [CTV] 2) that is judged to be at a high risk for positive margins and aim to reduce local recurrence. We report on the IMPT study arm in phase 1.Methods and materialsPatients aged ≥18 years with primary or locally recurrent retroperitoneal sarcoma were treated with preoperative IMPT, 50.4 GyRBE in 28 fractions, to CTV1 (gross tumor volume and adjacent tissues at risk of subclinical disease) with a simultaneous integrated boost to CTV2 to doses of 60.2, 61.6, and 63.0 GyRBE in 28 fractions of 2.15, 2.20, and 2.25 GyRBE, respectively. The primary objective of the phase 1 study was to determine the maximum tolerated dose to CTV2, which will be further tested in the phase 2 study.ResultsEleven patients showed increasing IMPT dose levels without acute dose limiting toxicities that prevented dose escalation to maximum tolerated dose. Acute toxicity was generally mild with no radiation interruptions. No unexpected perioperative morbidity was noted. Eight months postoperatively, one patient developed hydronephrosis that was treated by stent with ureter dissected off tumor and received 57.5 GyRBE. Retained ureter(s) was (were) subsequently constrained to 50.4 GyRBE without further problem. With an 18-month median follow-up, there were no local recurrences.ConclusionsIMPT dose escalation to CTV2 to 63 GyRBE was achieved without acute dose limiting toxicities. The phase 2 study of IMPT will accrue patients to that dose. Parallel intensity modulated radiation therapy phase 1 arm is currently accruing at the initial dose level. Ureters that undergo a high dose radiation and/or surgery are at risk for late hydro-ureter. Future studies will constrain retained ureters to 50.4 GyRBE to avoid ureteral stricture.

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Impact of chemotherapy on survival in surgically resected retroperitoneal sarcoma

Cited by 74 publications

References 28 publications

Recurrence patterns of retroperitoneal leiomyosarcoma and impact of salvage surgery

Recurrence patterns of retroperitoneal leiomyosarcoma and impact of salvage surgery

Systemic therapy in retroperitoneal sarcoma management

Phase 1 trial of preoperative image guided intensity modulated proton radiation therapy with simultaneously integrated boost to the high risk margin for retroperitoneal sarcomas

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