Should adjuvant radiotherapy be administered in addition to front-line aggressive surgery (FAS) in patients with primary retroperitoneal sarcoma?

Péchoux, C. Le; Musat, E.; Baey, Charlotte; Mokhles, H. Al; Terrier, Philippe; Dômont, Julien; Cesne, Axel Le; Laplanche, Agnès; Bonvalot, Sylvie

doi:10.1093/annonc/mds516

Cited by 73 publications

(44 citation statements)

References 29 publications

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“…8,15,[29][30][31] This represents the first study known to us that shows a survival benefit of RT in patients with high-grade RPS; other histologic grades were not analyzed as previous data have shown that high-grade disease was an independent predictor of mortality. 9 Although we could not assess local control (LC) in the SEER database, previous systemic review has shown "good evidence" that RT is associated with improved LC.…”

Section: Discussionmentioning

confidence: 99%

“…A French retrospective analysis showed an increase in 5-year abdominal relapse-free survival in patients treated with surgery and adjuvant RT compared with surgery alone (hazard ratio [HR] = 0.43, P = 0.02); however, there was no improvement in OS. 15 In addition, multiple previous analyses of the Surveillance, Epidemiology, and End Results (SEER) database have shown that RT does not improve OS in patients with RPS. 7,9,16 As with other sarcomas, grade has prognostic significance.…”

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confidence: 99%

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The Benefit of Adjuvant Radiotherapy in High-grade Nonmetastatic Retroperitoneal Soft Tissue Sarcoma

Bates

Dhakal

Mazloom

et al. 2018

American Journal of Clinical Oncology

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The Benefit of Adjuvant Radiotherapy in High-grade Nonmetastatic Retroperitoneal Soft Tissue Sarcoma

Bates

Dhakal

Mazloom

et al. 2018

American Journal of Clinical Oncology

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“…Several retrospective reports have shown improved local control rates associated with the use of RT in addition to surgery for RPS, but these trials are subject to the inherent biases of retrospective series (2,18,1,(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Furthermore, several other retrospective reports have failed to show any benefit to adjuvant RT (3,(22)(23)(24). The American College of Surgeons Oncology Group opened an important prospective randomized trial (ACOSOG Z9031; ClinicalTrials.gov identifier NCT00091351) to assess the role of preoperative RT for RPS, but unfortunately, the trial closed due to poor accrual (25).…”

Section: Introductionmentioning

confidence: 99%

Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel

Baldini

Wang

Haas

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

106

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“…Nevertheless, this has never been demonstrated in any prospective trial. Radiotherapy appears to improve local control as reported in several retrospective studies; 9,10 however, this potential advantage must be weighed against potential side effects. Most series favor the use of external beam RT in the preoperative setting, because it is well tolerated and can be administered at a total dose of 50.4 Gy.…”

Section: Radiation Therapymentioning

confidence: 92%

Quality of Local Treatment or Biology of the Tumor: Which are the Trump Cards for Loco-regional Control of Retroperitoneal Sarcoma?

Gronchi

Pollock

2013

Ann Surg Oncol

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Surgery remains the mainstay of curative therapy for retroperitoneal sarcoma (RPS). Local control is critical to achieve this objective, yet is not possible to achieve even initially in as many as 50 % of patients. Unlike sarcoma arising at other sites, anatomical constraints in the retroperitoneum limit the ability to achieve wide resection margins. As a consequence, local recurrences in RPS are more frequent than in extremity sarcoma and comprise the leading cause of death especially for low-to-intermediate grade tumors, e.g., liposarcoma, the histopathological subtype of approximately one-half of sarcomas arising at this site. Conceptually, adjuvant radiation therapy (RT) is attractive, but this modality also is limited by anatomical constraints as well as the typically large size of these tumors at presentation. RT benefits in RPS remain to be conclusively demonstrated; its application is reserved for selected cases. In the report by McBride et al.1 an interesting approach is proposed, consisting of external preoperative therapy followed by intraoperative dose escalation with brachytherapy. This is an appealing concept, with the caveat that the justification for this strategy is tempered by the retrospective nature of their analysis and the small numbers of patients in their series. Moreover, patients presenting with recurrent tumor whose outcome is usually worse and less likely to be affected by any treatment modalities were nonetheless included in this study. With recurrence, the likelihood of definitive local control reduces to the anecdotal; therefore, the initial therapeutic intervention is critical if durable control (let alone cure) is to result. McBride and colleagues used this opportunity to investigate possible predictors of survival, identifying multifocality as the only determinant of outcome. This finding is not surprising in that multifocality may be a reflection of an especially unfavorable underlying biology of RPS, with obvious prognostic impact, as we and others also have reported.2 Understanding the relative contributions of the effectiveness of local therapy against the inherent biology of specific RPS subtypes will be critical if we are to move a new set-point in RPS, in which specifically useful treatment options can be tailored to the individual patient. QUALITY OF LOCAL THERAPY Surgical StrategySome authors have advocated for the widest possible surgical resection at presentation, a strategy at variance with past recommendations advocating grossly complete extirpation in which the need or utility of resecting adjacent organs was limited to unequivocal direct tumor involvement.3,4 These retrospective analyses have favored a more aggressive adjacent organ resection approach, reporting greater than 75 % local control at 5 years. The need to standardize these seemingly disparate surgical strategies has been addressed recently by a panel of European and North American experts who have described how these tumors might be optimally approached. In essence, this surgical strategy consists of l...

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Should adjuvant radiotherapy be administered in addition to front-line aggressive surgery (FAS) in patients with primary retroperitoneal sarcoma?

Cited by 73 publications

References 29 publications

The Benefit of Adjuvant Radiotherapy in High-grade Nonmetastatic Retroperitoneal Soft Tissue Sarcoma

The Benefit of Adjuvant Radiotherapy in High-grade Nonmetastatic Retroperitoneal Soft Tissue Sarcoma

Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel

Quality of Local Treatment or Biology of the Tumor: Which are the Trump Cards for Loco-regional Control of Retroperitoneal Sarcoma?

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