Radiation therapy in retroperitoneal sarcoma management

Haas, Rick L.; Baldini, Elizabeth H.; Chung, Peter; Coevorden, Frits van; DeLaney, Thomas F.

doi:10.1002/jso.24892

Cited by 27 publications

(15 citation statements)

References 43 publications

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“…National data showed that radical resections combined with radiotherapy were only adopted in a minority of stage I RPS patients. Due to a potential increase in overall mortality and long-term dysfunctions ( 18 ), determining the impact of radical resections and radiotherapy in combination is crucial ( 19 ). Given its potential toxicity and poor evidence, radiotherapy shows a narrow indication in RPS-related guidelines ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Radical Versus Non-Radical Resection for Early-Stage Retroperitoneal Sarcoma: A Propensity Score-Matched Analysis

et al. 2021

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BackgroundThe appropriate surgical procedure for early-stage retroperitoneal sarcoma (RPS) is unclear. Thus, we used a national database to compare the outcomes of radical and non-radical resection in patients with early stage RPS.MethodsThis retrospective study included 886 stage I RPS patients from 2004 to 2015 in the SEER database. Outcomes were compared using the multivariate Cox proportional hazards models and the results were presented as adjusted hazards ratio (AHR) with corresponding 95% confidence intervals (95%CIs). Propensity score-matched analyses were also performed for sensitive analyses.ResultsFor the 886 stage I RPS patients, 316 underwent radical resection, and 570 underwent non-radical resection, with a median follow-up of 4.58 (2.73-8.35) years. No difference was observed in overall mortality (AHR 0.84, 95%CI 0.62-1.15; P = 0.28) or RPS-specific mortality (AHR 0.88, 95%CI 0.57-1.36; P = 0.56) between groups. The results were similar in propensity score-matching analyses. However, subgroup analysis revealed that radical resection was associated with significantly decreased risks of overall mortality in male (AHR 0.61, 95%CI 0.38-0.98; P = 0.04) and in patients with radiotherapy (AHR 0.56, 95%CI 0.32-0.98; P = 0.04).ConclusionRadical resection did not improve midterm survival outcomes compared with non-radical resection in overall patients with early stage RPS. However, male patients or patients who received radiotherapy might benefit from radical resection with improved overall survival.

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Section: Discussionmentioning

confidence: 99%

Radical Versus Non-Radical Resection for Early-Stage Retroperitoneal Sarcoma: A Propensity Score-Matched Analysis

et al. 2021

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“…An international collaborative phase III trial (EORTC 1809 STRASS II) assessing neoadjuvant chemotherapy in dedifferentiated liposarcoma and leiomyosarcoma will be of great interest, noting that these were the most common histologies in our cohort. Adjuvant radiotherapy following R0/R1 resection is not of proven benefit, and is associated with substantial toxicity 23,24 . Adjuvant chemotherapy after complete resection is not of proven benefit in RPS 25 ; there may be a role in selected cases following consideration within experience multidisciplinary units 15 .…”

Section: Discussionmentioning

confidence: 99%

Survival and morbidity outcomes after pelvic exenteration for pelvic sarcoma: an institutional series

Lee

Meshkat

Sasidharan

et al. 2021

ANZ Journal of Surgery

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Background To describe our institutional experience in the management of locally advanced primary, and recurrent pelvic sarcoma through pelvic exenteration (PE). Methods Patients undergoing PE for locally advanced primary or recurrent pelvic sarcoma between 2003 and 2017 were identified from a prospectively maintained database at a single quaternary referral hospital in Sydney, Australia were eligible for review. The primary outcomes measured were surgical resection margin and survival. Secondary outcome measures included 30‐day morbidity, in hospital length of stay (LOS) and return to theatre. Results There were 29 patients who underwent PE for pelvic sarcoma during the study period, with 55% (n = 16) having advanced primary tumours and 45% (n = 13) having recurrent disease. The R0 resection rate was 52% (n = 15); and five‐year‐survival of 38% (n = 11). The R0 resection was noted to be higher in patients having primary advanced tumours (56%) compared to those with recurrent disease (46%), however this failed to reach statistical significance in this cohort. There was no recorded 30‐day mortality. Grade 3 or higher Clavien‐Dindo complications were uncommon (14%), but more likely in patients undergoing surgery for recurrent disease (75%). Conclusion In our cohort of patients with locally advanced and recurrent disease, more than 50% achieved an R0 resection. Recurrent disease makes R0 resection more difficult and can lead to higher morbidity, need for 30‐day re‐intervention and longer in hospital LOS. PE surgery remains the only curative option for locally advanced, and recurrent sarcoma in the pelvis, and can be performed with acceptable survival and morbidity outcomes.

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“…3 Although preoperative radiotherapy has been shown to decrease the local recurrence in a few studies, their role is not definite so far. 6 Prognosis varies with the histological subtypes, tumour grade and completeness of the surgical resection. 3 Twitter Souradeep Dutta @souradeep Contributors The idea for the article by MT.…”

Section: Descriptionmentioning

confidence: 99%