Predicting Outcome by Growth Rate of Locally Recurrent Retroperitoneal Liposarcoma

Abstract

Objective To identify the prognostic variables that predict disease-specific survival and second local recurrence-free survival in patients with recurrent retroperitoneal liposarcoma so as to guide clinical management. Summary Background Data Local recurrence following complete resection of primary retroperitoneal liposarcoma is a common clinical problem that frequently leads to morbidity and mortality. Factors that determine survival in patients with a local recurrence after complete resection of the primary and re-recurrence after resection of the first local recurrence have not been clearly defined. Methods From a prospective sarcoma database we selected 105 patients who had at least one local recurrence following complete resection of a primary retroperitoneal liposarcoma between July 1982 and December 2005. Of these patients, 61 underwent complete resection of their first local recurrence. Study end-points included second local recurrence-free survival for these 61 patients and disease-specific survival for all 105 patients. Univariate analysis was performed with the Kaplan-Meier method and log-rank test, and multivariate analysis with the Cox’s proportional hazards model and score test. Local recurrence growth rate was defined as the radiographic size of the local recurrence divided by the time to local recurrence from the primary resection. Results Median follow-up was 65 months. Local recurrence size, primary histologic variant and grade, and local recurrence growth rate were independent predictors of disease-specific survival. For those undergoing re-resection, local recurrence size and local recurrence growth rate independently influenced development of a second local recurrence. Only patients with local recurrence growth rates of less than 0.9 cm/month were associated with improved survival following aggressive resection of the local recurrence. Conclusions Local recurrence growth rate is strongly associated with disease-specific survival and local control for patients with completely resected locally recurrent retroperitoneal liposarcoma. Despite aggressive operative management patients with a local recurrence growth rate greater than 0.9 cm/month were associated with poor outcomes and should be considered for enrollment in clinical trials employing novel agents.

A retrospective, single‑center cohort study on 65�patients with primary retroperitoneal liposarcoma

“…For patients with recurrence who cannot undergo complete resection, the aim of treatment is to attenuate symptoms, remove oppression of the surrounding organs and obstruction of the tumor, maintain visceral function, extend survival time and improve the quality of life. A previous study indicated that if the speed of growth of a recurrent tumor is >0.9 cm per month, multiple surgeries do not improve the survival rate (50).…”

Giant Dedifferentiated Liposarcoma of the Retroperitoneum

“…There is limited data to guide the management of locally recurrent retroperitoneal liposarcoma following complete resection of the primary [11]. The efficacy of chemotherapy has not been demonstrated in any hitherto published study.…”

“…Local recurrence following complete resection of primary retroperitoneal liposarcoma is common with 50% of well-differentiated and 80% of dedifferentiated tumors recurring within 5 years, and most patients who die of retroperitoneal soft tissue sarcoma die from the effects of local recurrence [11]. There is limited data to guide the management of locally recurrent retroperitoneal liposarcoma following complete resection of the primary [11].…”

Surgical management of localized soft tissue tumors

“…Palliative surgery may have short-term symptomatic benefit, but this rarely lasts longer than 90 days. 50 …”

“…Surgery for locoregional recurrence may be offered on an individual basis, especially to patients who are affected by low-grade liposarcoma, those who have a long disease-free interval between initial resection and subsequent recurrence, 50 or those who experience a response to therapy. There is little benefit to incomplete resections for recurrent disease with the possible exception of patients who have well differentiated liposarcoma.…”