Management of retroperitoneal sarcomas: Does dose escalation impact on locoregional control?

Fein, Douglas A.; Corn, Benjamin W.; Lanciano, Rachelle; Herbert, Scott H.; Hoffman, John P.; Coia, Lawrence R.

doi:10.1016/0360-3016(94)e0302-z

Cited by 92 publications

(53 citation statements)

References 22 publications

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“…1,11,44,45 Concerning postoperative RT, there may be a dose response and better local control rates with doses >55 Gy. 14 Modern technologies, such as IMRT, tomotherapy, and intensity-modulated arc therapy, should be the technologies of choice, because they combine dose escalation with sparing of the organs at risk and, consequently, are less toxic. 25,57,58 Even more promising are the results obtained with carbon ions, which have produced OS and local control rates at 5 years of 50% and 69%, respectively, with no severe intestinal toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…8,[10][11][12][13] After undergoing macroscopically complete surgery alone, local recurrences develop in 20% to 75% of patients, and these can occur even after 5 years of follow-up. 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.…”

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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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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Voorde

Delrue

Eijkeren

et al. 2011

Cancer

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“…Heslin et al 18 reported on 198 adult patients with RPS who underwent surgery and had a follow-up Ն 5 years; in those patients, the addition of RT significantly reduced the likelihood of local recurrence. Fein et al 13 reported on 21 patients who underwent surgery and received adjuvant preoperative RT (2 patients) or postoperative RT (19 patients) with curative intent at the Fox Chase Cancer Center and the University of Pennsylvania (Philadelphia) between 1965 and 1992. Patients had follow-up from 14 months to 340 months, and no patients were lost to follow-up.…”

Section: Local Controlmentioning

confidence: 99%

“…It has been shown that RT reduces the likelihood of local recurrence, but it has not been shown that RT provides a definite survival benefit. [12][13][14][15][16] A problem asso- ciated with adjuvant RT is that the dose is limited by the tolerance of the surrounding normal tissues, primarily the small bowel, to 45-50 grays (Gy) over 5 weeks. It has been shown that these doses are effective in extremity sarcomas when they are administered preoperatively but are lower than doses traditionally administered postoperatively (60 -65 Gy over 6 -7 weeks).…”

Section: Treatmentmentioning

confidence: 99%

Retroperitoneal soft tissue sarcoma

Mendenhall

Zlotecki

Hochwald

et al. 2005

Cancer

149

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The objective of the current study was to define the optimal treatment for patients with retroperitoneal soft tissue sarcomas (RPS). The authors conducted a review of the pertinent literature and found that the majority of patients had locally advanced RPS at the time of diagnosis. Surgery was the mainstay of treatment, and macroscopic total excision was feasible in approximately 50 -67% of patients. The 5-year probability of local control was approximately 50%, and the likelihood of developing distant metastasis was approximately 20 -30%. The 5-year survival rate was approximately 50%, and deaths due to recurrent RPS continued to occur after 5 years. Postoperative radiotherapy (RT) decreased the likelihood of local recurrence, although it demonstrated no impact on survival. Adjuvant chemotherapy had no proven efficacy. The factor that was found to have the greatest impact on the prognosis for patients with RPS was the ability to achieve a macroscopic total resection. The authors concluded that RPS usually is advanced at the time of diagnosis. The optimal treatment was complete resection. Most patients experienced recurrent disease after surgery, and the most common site of failure was local. Adjuvant RT reduced the risk of local recurrence, but its impact on survival was questionable. Cancer 2005;104:669 -75.

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“…However, despite the limitation imposed by radiation tolerance, postoperative radiotherapy was considered indicated in most of these patients. The development of techniques such as intraoperative brachytherapy or IOeRT allows administration of higher doses to the tumour bed without compromising the integrity of organs and should be considered in the treatment of retroperitoneal sarcomas [11].…”

mentioning

confidence: 99%

Multidisciplinary management of soft tissue sarcomas: it’s time to make a team!

Ángel

2010

Clin Transl Oncol

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Management of retroperitoneal sarcomas: Does dose escalation impact on locoregional control?

Cited by 92 publications

References 22 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

Retroperitoneal soft tissue sarcoma

Multidisciplinary management of soft tissue sarcomas: it’s time to make a team!

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