Locoregional recurrence of retroperitoneal soft tissue sarcoma: second chance of cure for selected patients

Dalen, T van; Hoekstra, Harald J.; Geel, A.N. van; Coevorden, Frits van; Albus‐Lutter, Ch.; Slootweg, Piet J.; Hennipman, A.

doi:10.1053/ejso.2001.1166

Cited by 90 publications

(69 citation statements)

References 11 publications

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“…Table 2 analyzes, patient-bypatient, tumor characteristics. According to the American Joint Committee staging system for soft-tissue sarcomas [11], the patients, in our series, were classified as follows: 8 patients (17.78 %) were classified as stage I, 20 patients (44.44 %) were classified as stage II, 10 patients (22.22 %) were classified as stage III, and 7 patients (15.56 %) were classified as stage IV. Five patients had regional lymph node involvement and four patients showed distant metastases at presentation, in liver (one patient) and lung (three patients), respectively.…”

Section: Resultsmentioning

confidence: 99%

“…It is generally recognized that the major factor influencing the survival outcome is the complete resection of the tumor mass [2,5,11]. The rate of complete resection has varied in the literature from 38 [10] to 74 % [12], with other reports falling in between [3][4][5]13], while the average complete respectability rate in a collective review was 53 % [2].…”

Section: Discussionmentioning

confidence: 99%

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Challenges in the Surgical Treatment of Retroperitoneal Sarcomas

et al. 2015

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The objective of this study is to assess long-term prognosis and patterns of failure in patients with retroperitoneal sarcoma who underwent surgery with curative intent at a single institution. We also provide a thorough review of the literature including several series and widely variable data regarding local and distant failure. During a 25-year period , 45 consecutive patients who underwent surgery for retroperitoneal sarcoma at a single referral center were reviewed retrospectively. We recorded and analyzed the presenting symptoms, type of surgical excision, and the 5-year survival rate as well as the local recurrence rate of patients with complete tumor resection. Overall survival is significantly diminished in patients in whom resection margins are not adequate. In our series, 5-year recurrence rate for patients with complete and incomplete resection of the tumor was 30.76 and 68.42 %, respectively. The 5-year survival rate was 51.12 %, and the 5-year survival rate according to type of resection was 76.93 % for complete and 15.79 % for incomplete resections. Local recurrence after first surgery and high-grade malignancy are associated with poor survival. The role of radiation therapy and chemotherapy in the treatment of retroperitoneal sarcoma (RPS) should be investigated further. Complete en bloc resection of the tumor mass and adjacent structures is the single most important factor that improves survival.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Challenges in the Surgical Treatment of Retroperitoneal Sarcomas

et al. 2015

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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%

“…1,8,10,[14][15][16][17][18][19] The estimated survival rate at 5 years varies between 12% and 75%, 6,13,20,21 and the cause of death for these patients usually is local recurrence, which is in sharp contrast to outcomes for patients with sarcoma of the extremities. 8,22 There is much controversy concerning the role of radiotherapy (RT) in the treatment of RSTS. Opponents argue that the lack of an overall survival (OS) benefit renders RT a treatment of little value.…”

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confidence: 99%

“…Opponents argue that the lack of an overall survival (OS) benefit renders RT a treatment of little value. 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.…”

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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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Volumetric‐modulated arc therapy versus intensity‐modulated radiotherapy for large volume retroperitoneal sarcomas: A comparative analysis of dosimetric and treatment delivery parameters

Taggar

Graham

Kurien

et al. 2017

J Applied Clin Med Phys

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PurposeTo compare dosimetric and treatment delivery parameter differences between volumetric‐modulated arc radiotherapy (VMAT) and intensity‐modulated radiotherapy (IMRT) for large volume retroperitoneal sarcomas (RPS).Materials and MethodsBoth VMAT and IMRT planning were performed on CT datasets of 10 patients with RPS who had been previously treated with preoperative radiotherapy. Plans were optimized to deliver ≥95% dose to the PTV and were evaluated for conformity and homogeneity. Dose to the organs at risk (OARs) (kidney, liver, spinal cord, and bowel space), unspecified tissue, and dose evaluation volumes (DEVs) at 1, 2, and 5 cm from PTV were calculated and compared. Monitor units (MUs) and treatment delivery times were recorded and compared between the two techniques. The deliverability of the large volume RPS VMAT plans was verified by portal dosimetry on a Truebeam™ linac.Results VMAT and IMRT plans were equivalent for PTV coverage and homogeneity (P > 0.05); however, VMAT plans had slightly better conformity index, CI (P < 0.001). Doses to the OARs were not significantly different between VMAT and IMRT plans (P > 0.05). Mean doses to the unspecified tissue as well as at 1, 2, and 5 cm DEVs were lower with VMAT compared with IMRT, P = 0.04 and P < 0.01, respectively. MUs and average beam‐on times were both significantly lower in the VMAT vs IMRT plans, P < 0.001 and P = 0.001, respectively. All VMAT plans passed portal dosimetry delivery verification with an average gamma passing rate of 99.6 ± 0.4%.Conclusions VMAT planning for large volume RPS improved CI, and achieved comparable OAR sparing, as compared with IMRT. As treatment delivery time was lower, the use of VMAT for RPS may translate into improved treatment delivery efficiency.

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Locoregional recurrence of retroperitoneal soft tissue sarcoma: second chance of cure for selected patients

Cited by 90 publications

References 11 publications

Challenges in the Surgical Treatment of Retroperitoneal Sarcomas

Challenges in the Surgical Treatment of Retroperitoneal Sarcomas

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

Volumetric‐modulated arc therapy versus intensity‐modulated radiotherapy for large volume retroperitoneal sarcomas: A comparative analysis of dosimetric and treatment delivery parameters

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