1
|
Lee PJ, Kim TJ, Ye L, Wu YS, Steffens D, Karunaratne S, Brown W, Karim R, Grimison P, Hong AM. SPARC - A multi-disciplinary team program for retroperitoneal sarcoma: the Royal Prince Alfred Hospital and Chris O'Brien Lifehouse Collaboration. ANZ J Surg 2024. [PMID: 38783787 DOI: 10.1111/ans.19102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/12/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The Royal Prince Alfred Hospital (RPAH) and Chris O'Brien Lifehouse (COBLH) established a formal Sarcoma of the Pelvic and Abdominal Retroperitoneum Collaboration (SPARC) in November 2020. An established multidisciplinary team (MDT) with the aims to centralise patient referrals and treatment, establish database and research, coordinate surgical resections is critical in improving patient outcomes and quality of life. METHODS A prospective database was established in October 2021. Clinical, pathological and radiological data points were recorded for all patients since the inception of SPARC. Quality of Life questionnaires were included and follow-up planned regularly for 5 years. RESULTS From November 2020 to Feb 2024, 294 new referrals were discussed at the MDT meeting. Majority were from the metropolitan area (182) followed by regional NSW (87), interstate (20) and five internationals. 141 operations were performed during this period compared to 119 operations from 2010 to November 2020 in RPAH. The inception of the SPARC program has resulted in exponential growth in operations, improving from the previous rate of 15 cases annually to 35. Liposarcomas followed by leiomyosarcomas are the most common types of sarcomas resected. The majority were extended resections (81.6%) and 22% were pelvic exenterations. Overall R0 rate is 54.6%, R1 38.3% and R2 1.4% (131 (92.9%) had R0/R1 resections. Overall complication rate is 35.5% with one in-hospital mortality. CONCLUSION Success and expansion of a robust retroperitoneal sarcoma program requires a collaborative surgical approach, an MDT meeting, centralized referral process, and a research team in specialized tertiary institutions.
Collapse
Affiliation(s)
- Peter J Lee
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Department of Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and University of Sydney, Sydney, New South Wales, Australia
| | - Tae Jun Kim
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Department of Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health Science, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Lylee Ye
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Yu Sunny Wu
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health Science, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sacha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health Science, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Wendy Brown
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rooshdiya Karim
- Department of Pathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Peter Grimison
- Faculty of Medicine and Health Science, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Angela M Hong
- Faculty of Medicine and Health Science, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Fan P, Tao P, Wang J, Wang Z, Hou Y, Zhou Y, Lu W, Ma L, Zhang Y, Tong H. Clinical and surgical effectiveness of the multi-disciplinary standardized management model in the treatment of retroperitoneal liposarcoma: Evidence-based clinical practice experience from Fudan Zhongshan. Surgery 2024; 175:1368-1376. [PMID: 38395638 DOI: 10.1016/j.surg.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/26/2023] [Accepted: 09/14/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND To assess the correlation between clinical outcomes and diagnostic accuracy of evaluations carried out by a preoperative multidisciplinary team versus standard surgical care for patients with retroperitoneal liposarcoma undergoing surgery. METHODS This comparative study was conducted retrospectively at a specialist assessment center within Zhongshan Hospital, Fudan University, China, between April 2011 and March 2021. Patients were assigned to a multidisciplinary team or nonmultidisciplinary team cohort based on referral to the multidisciplinary team. The primary outcome measured was long-term clinical prognosis, with other outcomes including diagnostic accuracy, 30-day reoperation, duration of stay, perioperative mortality, and medical complications. To mitigate selection bias, we conducted propensity-score matching. Uni- and multivariable Cox proportional hazard models were then used to evaluate the effect of multidisciplinary teams on postoperative survival. The previously specified questionnaire was used to measure the enhancement of awareness and treatment adherence facilitated by multidisciplinary team management. Data analysis was carried out between January 2023 and August 2023. RESULTS Of the 521 records that were screened, 139 patients were deemed eligible for inclusion and defined as the multidisciplinary team cohort. At the same time, 382 patients without multidisciplinary team management were also included during that period and defined as the nonmultidisciplinary team cohort. The multidisciplinary team cohort exhibited lower numbers of primary retroperitoneal liposarcoma but a higher tumor grade and a greater proportion of R2 resection. After propensity-score matching, the 1-, 3-, and 5-year overall survival rates were 89.5%, 70.5%, and 62.9%, respectively, in the multidisciplinary team cohort, and 77.1%, 49.8%, and 45.1% in the nonmultidisciplinary team cohort. The diagnostic consistency of the multidisciplinary team group was significantly superior to that of the nonmultidisciplinary cohort (92.5% vs 83.6%, P = .042). Although no significant links were shown with duration of stay (P = .232) and 30-day reoperation (P = .447), the multidisciplinary team participation was linked to a substantial decrease in perioperative mortality (P = .036) and postoperative complications (P = .002). Additionally, the multidisciplinary team group indicated stronger illness awareness and postoperative adherence among individuals with retroperitoneal liposarcoma. CONCLUSION The study's findings indicate that multidisciplinary team management could result in improved clinical outcomes, higher diagnostic accuracy, and reduced duration of postoperative stays, complications, and perioperative mortality. The intervention may also enhance disease awareness and postoperative compliance in retroperitoneal liposarcoma patients who undergo surgery. However, evidence quality was deemed low, and prospective studies with robust designs are required. Nonetheless, these results are worth considering.
Collapse
Affiliation(s)
- Peidang Fan
- School of Medicine, Anhui University of Science and Technology, Huainan, Anhui 232000, China
| | - Ping Tao
- Department of Laboratory Medicine, Shanghai Traditional Chinese Medicine-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiongyuan Wang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhenyu Wang
- Department of General Surgery, Jinshan Hospital, Fudan University, Shanghai, China
| | - Yingyong Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuhong Zhou
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weiqi Lu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lijie Ma
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yong Zhang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Department of General Surgery, Zhongshan Hospital (Xiamen), Fudan University; Xiamen Clinical Research Center for Cancer Therapy, Xiamen, China
| | - Hanxing Tong
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
3
|
Lawless A, Zhou DDX, McDonough J, Lo H, Mar J, Lazarakis S, Ward I, Connor J, Thompson SR, Coker D, Johnston A, Gyorki DE, Hong AM. The role of radiation therapy in the management of primary retroperitoneal sarcoma: A systematic review and clinical practice guidelines from the Australia and New Zealand Sarcoma Association. Cancer Treat Rev 2023; 120:102620. [PMID: 37657126 DOI: 10.1016/j.ctrv.2023.102620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/03/2023]
Abstract
While surgery is the mainstay of treatment for localised retroperitoneal sarcoma, the use of radiotherapy (RT) remains controversial. This systematic review aimed to evaluate the role of RT for retroperitoneal sarcoma. A systematic review using the population, intervention, comparison, and outcome model from 1990 to 2022 identified 66 studies (a mixture of preoperative and postoperative RT); one randomised controlled trial (RCT) with two publications, 18 registry studies, and 46 retrospective studies. In the RCT of preoperative RT, there was no difference in local/abdominal recurrence. The pooled analysis of this RCT and a retrospective study showed a significant abdominal recurrence free survival benefit with preoperative RT in low grade liposarcoma. The RCT and the majority of retrospective series found RT did not improve recurrence free survival (11 of 16 no difference in combined local and distant RFS, 11 of 13 no difference in distant metastasis free survival), disease specific survival (9 of 12 studies) or overall survival (33 of 49 studies). The majority of studies found no association between RT and perioperative morbidity. In summary, preoperative RT may improve local control for low grade (well-differentiated or grades 1-2 dedifferentiated) liposarcoma, but not other histological subtypes. There is no strong evidence that perioperative RT provides an overall survival benefit. Patients with low grade retroperitoneal liposarcoma can be considered for preoperative RT to improve abdominal recurrence free survival. The rationale and level of evidence in this scenario should be carefully discussed by the multidisciplinary team with patients. RT should not be routinely recommended for other histological subtypes.
Collapse
Affiliation(s)
- Anna Lawless
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Deborah Di-Xin Zhou
- NHMRC Clinical Trials Centre, The University of Sydney, NSW 2006, Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Joshua McDonough
- Mental Health and Suicide Prevention Research and Education Group, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Helen Lo
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Jasmine Mar
- Australia and New Zealand Sarcoma Association, Parkville, Victoria 3010, Australia
| | - Smaro Lazarakis
- Health Sciences Library, Royal Melbourne Hospital, Parkville, Victoria 3010, Australia
| | - Iain Ward
- Christchurch Hospital, Christchurch 8011, New Zealand
| | - Joanna Connor
- Te Pūriri o Te Ora, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - Stephen R Thompson
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia; School of Clinical Medicine, UNSW Sydney, Randwick Clinical Campus, Australia
| | - David Coker
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Australia; Department of Melanoma and Surgical Oncology, and Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Andrew Johnston
- North Island Sarcoma Service, Auckland City Hospital, Auckland 1023, New Zealand
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Angela M Hong
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia.
| |
Collapse
|
4
|
Sargos P, Stoeckle E, Ducassou A, Giraud A, Mervoyer A, Italiano A, Albert S, Ferron G, Bellera C, Kantor G. High dose (54 Gy) pre-operative helical tomotherapy for retroperitoneal liposarcoma: Results of a phase II multicenter study. Radiother Oncol 2023; 186:109791. [PMID: 37437608 DOI: 10.1016/j.radonc.2023.109791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/19/2023] [Accepted: 07/01/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE To evaluate efficacy and feasibility of high-dose intensity-modulated radiotherapy (RT) with pre-operative helical tomotherapy, delivering 54 Gy/30 fractions in patients with retroperitoneal liposarcomas (RPLS). MATERIALS AND METHODS Patients with operable, biopsy-proven, RPLS were included in this phase II multicenter study (ClinicalTrials.gov: NCT01841047). The primary objectives were to analyze loco-regional relapse free survival (LRFS), overall survival (OS) and toxicities, graded according to CTCAE V3.0. RESULTS From April 2009 to September 2013, 48 patients were included. Histological types were: 20 well differentiated and 28 dedifferentiated liposarcomas. Median clinical target volume (CTV) was 2570 cc (range, 230-8734 cc). The radio-surgical schedule was completed as planned in all patients apart from one. A monobloc wide excision was achieved for all patients. Surgical margins were R0 (16; 34%), R1 (28; 60%), R2 (2; 4%) or missing (1, 2%).With a median follow-up of 5.5 years, 3-year LRFS rate was 74.2% (95%CI: [59.1%; 84.5%]). At 5 years, cumulative incidence of loco-regional relapse for well differentiated and dedifferentiated RPLS was 10% and 18%, respectively. The 5-year OS was 73.9% [95%CI: 58.7-84.3%]. During RT, the most common grade 3-4 adverse events were hematological (N = 20; 41.6%). After surgery and during follow-up, 17 patients (35.4%) presented a grade 3-4 toxicity. Two patients (4.1%) died due to a duodenal toxicity. Nine second cancers were observed. CONCLUSION From this phase II trial of preoperative RT in RPLS patients, the dose level proposed cannot be considered safe, leading to non-negligible toxicity and second cancers rates. Our results, combined with STRASS-1 study, suggest that the ideal indication of RT for patients with RPLS still remains to be determined.
Collapse
Affiliation(s)
- Paul Sargos
- Department of Radiotherapy, Institut Bergonie, 229 cours de l'Argonne, 33076 Bordeaux, France.
| | - Eberhard Stoeckle
- Department of Surgery, Institut Bergonie, 229 cours de l'Argonne, 33076 Bordeaux, France
| | - Anne Ducassou
- Department of Radiotherapy, Institut Claudius Regaud- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Antoine Giraud
- Clinical and Epidemiological Research Unit, INSERM CIC1401, Institut Bergonié, Comprehensive Cancer Center, F-33000 Bordeaux, France
| | - Augustin Mervoyer
- Department of Radiotherapy, Institut de Cancerologie de l'Ouest, Nantes, France
| | - Antoine Italiano
- Department of Medical Oncology, Institut Bergonie, 229 cours de l'Argonne, 33076 Bordeaux, France
| | - Sabrina Albert
- Clinical and Epidemiological Research Unit, INSERM CIC1401, Institut Bergonié, Comprehensive Cancer Center, F-33000 Bordeaux, France
| | - Gwenael Ferron
- Department of Surgical Oncology, INSERM CRCT19 (Oncogenesis of Sarcoma), Institut Claudius Regaud- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Carine Bellera
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, F-33000 Bordeaux, France; Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, F-33000 Bordeaux, France.
| | - Guy Kantor
- Department of Radiotherapy, Institut Bergonie, 229 cours de l'Argonne, 33076 Bordeaux, France
| |
Collapse
|
5
|
Corn S, Nessim C, Roland CL, Gronchi A, Freeman C, Dumitra S. Data Dissemination of the Role of Neoadjuvant Radiation in Retroperitoneal Sarcoma: A CTOS and CSSO Survey. Curr Oncol 2023; 30:5807-5815. [PMID: 37366917 DOI: 10.3390/curroncol30060434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 05/23/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
Consensus guidelines call for complete resection of retroperitoneal sarcoma with consideration of neoadjuvant radiation for curative-intent treatment. The 15-month delay from the initial presentation of an abstract to the final publication of the STRASS trial results assessing the impact of neoadjuvant radiation led to a dilemma of how patients should be managed in the interim. This study aims to (1) understand perspectives regarding neoadjuvant radiation for RPS during this period; and (2) assess the process of integrating data into practice. A survey was distributed to international organizations including all specialties treating RPS. Eighty clinicians responded, including surgical (60.5%), radiation (21.0%) and medical oncologists (18.5%). Low kappa correlation coefficients on a series of clinical scenarios querying individual recommendations before and after initial presentation as an abstract indicate considerable change. Over 62% of respondents identified a practice change; however, most also noted discomfort in adopting changes without a manuscript available. Of the 45 respondents indicating discomfort with practice changes without a full manuscript, 28 (62%) indicated that their practice changed in response to the abstract. There was substantial variability in recommendations for neoadjuvant radiation between the presentation of the abstract and the publication of trial results. The difference in the proportion of clinicians describing comfort with changing practice based on the presentation of the abstract versus those that had done so shows that indications for proper integration of data into practice are not clear. Endeavors to resolve this ambiguity and expedite availability of practice-changing data are warranted.
Collapse
Affiliation(s)
- Sarah Corn
- Department of Surgical Oncology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Surgery, University of Kansas School of Medicine, Wichita, KS 67214, USA
| | - Carolyn Nessim
- Department of Surgery, The Ottawa Hospital and Research Institute, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, 20133 Milan, Italy
| | - Carolyn Freeman
- Department of Radiation Oncology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Sinziana Dumitra
- Department of Surgical Oncology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| |
Collapse
|
6
|
Danieli M, Swallow CJ, Gronchi A. How to treat liposarcomas located in retroperitoneum. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1068-1080. [PMID: 35623985 DOI: 10.1016/j.ejso.2022.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/15/2022] [Accepted: 04/25/2022] [Indexed: 12/28/2022]
Abstract
Almost half of retroperitoneal (RP) sarcomas are liposarcomas (LPS). The large majority of RP LPS are either well-differentiated LPS (WDLPS) or dedifferentiated LPS (DDLPS), these latter further classified according to grading in G2 and G3 DDLPS. Surgery is the only potentially curative treatment to achieve local control and possibly cure in primary localized disease. Over the last decade, a better delineation of the different histology-specific patterns of failure and the development of nomograms predictors of outcome has led to a better management of these rare tumors, with a special focus on non-surgical treatments. Available evidences - although far from exhaustive - show that radiation therapy might have a role, if any, as neoadjuvant treatment in locally aggressive histologies (i.e. WDLPS and G2 DDLPS), while it does not seem beneficial for histologies with a higher metastatic risk (i.e. G3 DDLPS and leiomyosarcoma). Neoadjuvant chemotherapy, instead, can be considered to reduce the risk of distant metastasis while waiting for the results of an ongoing RCT (STRASS-2) evaluating its effect in these tumors. However, given the rarity of these diseases and the subsequent lack of strong evidences to guide treatment, outcome improvement in these patients remains a challenge. Patients' referral to a sarcoma center where a dedicated specialized multidisciplinary team tailor optimal treatment on a case-by-case basis is crucial to ensure these patients the best outcome. Refining available nomograms - e.g including molecular variables - and identifying predictors of response/toxicity to chemotherapy and immunotherapy might be significantly helpful in tailoring treatments to the patient's characteristics. Also, new systemic agents are eagerly awaited for improving the management further.
Collapse
Affiliation(s)
- Maria Danieli
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carol J Swallow
- Division of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| |
Collapse
|
7
|
Zeh RD, Konieczkowski D, Shen C, Tsilimigras DI, Kim A, Grignol VP, Contreras CM, Welliver M, Tsung A, Pawlik TM, Pollock RE, Beane JD. Prognostic factors in patients receiving surgery and radiation therapy for retroperitoneal sarcoma: A machine-learning analysis. Surgery 2023; 173:640-644. [PMID: 36369098 DOI: 10.1016/j.surg.2022.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/30/2022] [Accepted: 08/24/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The addition of radiation therapy to surgery for retroperitoneal sarcoma remains controversial. Improved patient selection may help identify optimal candidates for multimodality treatment. The aim of this analysis was to define prognostic factors among patients who receive radiation therapy and surgery to aid in patient selection for multimodal therapy. METHODS Patients who received radiation therapy and underwent curative-intent resection for retroperitoneal sarcoma between 2004 and 2016 were identified from a national cohort in the United States (National Cancer Database). A machine-based classification and regression tree model was used to generate similar groups of patients relative to overall survival based on preoperative factors. RESULTS A total of 1,443 patients received radiation therapy in addition to surgery. Median age was 61 years old and 55.0% were female. Most patients (66%) received care at an academic or integrated network cancer program. With a median follow-up of 84 months, receipt of radiation therapy was not associated with improved overall survival (P = .81). Classification and regression tree analysis revealed a significant association between overall survival and American Joint Committee on Cancer stage group, age, tumor histology, and Charlson comorbidity score. Application of these parameters via machine learning stratified patients into 5 cohorts with distinct survival outcomes. In the most favorable cohort (Cohort 1: American Joint Committee on Cancer stage group ≤II, age ≤61, histology including fibrosarcoma, well differentiated liposarcoma, myxoid liposarcoma, and leiomyosarcoma), the 5-year overall survival was 81.7% and median overall survival was not reached; in the least favorable cohort (Cohort 6: American Joint Committee on Cancer stage group >II, age >68) where the 5-year survival was 41.3% and median overall survival was 45.2 months (P < .001 versus Cohort 1). CONCLUSION In the absence of a defined survival benefit, patients with advanced American Joint Committee on Cancer stage group, older age, and medical comorbidities have relatively unfavorable overall survival after combined modality therapy and therefore stand the least to gain from the addition of radiation therapy to surgery. In contrast, younger patients with good performance status and retroperitoneal sarcoma histologies with a higher propensity for local recurrence may have the greatest opportunity to benefit from radiation therapy.
Collapse
Affiliation(s)
- Ryan D Zeh
- Department of Surgery, Division of Surgical Oncology, James Cancer Center, The Ohio State University, Columbus, OH; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David Konieczkowski
- Department of Radiation Oncology, James Cancer Center, The Ohio State University, Columbus, OH
| | - Chengli Shen
- Department of Surgery, Division of Surgical Oncology, James Cancer Center, The Ohio State University, Columbus, OH
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, James Cancer Center, The Ohio State University, Columbus, OH
| | - Alex Kim
- Department of Surgery, Division of Surgical Oncology, James Cancer Center, The Ohio State University, Columbus, OH
| | - Valerie P Grignol
- Department of Surgery, Division of Surgical Oncology, James Cancer Center, The Ohio State University, Columbus, OH
| | - Carlo M Contreras
- Department of Surgery, Division of Surgical Oncology, James Cancer Center, The Ohio State University, Columbus, OH
| | - Meng Welliver
- Department of Radiation Oncology, James Cancer Center, The Ohio State University, Columbus, OH
| | - Allan Tsung
- Department of Surgery, Division of Surgical Oncology, James Cancer Center, The Ohio State University, Columbus, OH
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, James Cancer Center, The Ohio State University, Columbus, OH
| | - Raphael E Pollock
- Department of Surgery, Division of Surgical Oncology, James Cancer Center, The Ohio State University, Columbus, OH
| | - Joal D Beane
- Department of Surgery, Division of Surgical Oncology, James Cancer Center, The Ohio State University, Columbus, OH.
| |
Collapse
|
8
|
Erstad DJ, Chiang YJ, Witt RG, Cope B, Nassif EF, Scally CP, Torres KE, Feig BW, Hunt KK, Bishop AJ, Guadagnolo BA, Roland CL, Keung EZ. Clinical Impact of External Beam Radiotherapy for Surgically Resected Primary Retroperitoneal Liposarcoma. Ann Surg Oncol 2023; 30:926-940. [PMID: 36115928 DOI: 10.1245/s10434-022-12487-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/13/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION EORTC-62092 (STRASS) was a phase 3, randomized study that compared surgery alone versus surgery plus neoadjuvant radiotherapy (RT) for retroperitoneal sarcomas. RT was not associated with improved abdominal recurrence-free survival, the primary outcome measure, although on subanalysis, there may have been benefit for well-differentiated (WD) liposarcoma. This study investigated the real-world use and outcomes of RT (neoadjuvant and adjuvant) for the management of retroperitoneal liposarcoma. METHODS We queried the National Cancer Database (NCDB) (2004-2017) for patients with nonmetastatic, primary retroperitoneal liposarcoma treated with resection with or without RT (n = 3911). Patients were stratified by treatment type and histology [WD (n = 2252), dedifferentiated (DD) (n = 1659)]. Propensity score (PS) matching was used before comparison of treatment groups. Overall survival (OS) was the primary outcome measure. RESULTS Median follow-up time was 4.1 years, and median OS was 10.7 years. There was no association between RT and OS for either WDLPS or DDLPS cohorts. We performed a subgroup analysis of neoadjuvant RT only, similar to STRASS. For WDLPS after PS matching (n = 208), neoadjuvant RT was not associated with OS (hazard ratio [HR] 1.01, p = 0.0523) but was associated with longer postoperative hospital stay (p = 0.012). For DDLPS after PS matching (n = 290), neoadjuvant RT was not associated with OS (HR 1.02, p = 0.889). For both WD-LPS and DD-LPS, utilization of neoadjuvant RT was associated with treatment at high-volume (≥ 10 cases/year) and academic/network facilities. CONCLUSIONS For primary retroperitoneal liposarcoma treated with surgical resection, radiotherapy was not associated with an overall survival benefit in this propensity-matched, adjusted analysis of the NCDB.
Collapse
Affiliation(s)
- Derek J Erstad
- Department of Surgical Oncology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX, USA.
| | - Yi-Ju Chiang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Russell G Witt
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brandon Cope
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elise F Nassif
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher P Scally
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keila E Torres
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Barry W Feig
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly K Hunt
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew J Bishop
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - B Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily Z Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
9
|
Xia H, Fang F, Yuan H, Tu Y. Survival of a patient with multiple-recurrent giant retroperitoneal dedifferentiated liposarcoma for 15 years: A case report. Front Surg 2022; 9:916802. [DOI: 10.3389/fsurg.2022.916802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
BackgroundRetroperitoneal liposarcoma (RPLS) is a variety of soft tissue sarcoma that originates from mesenchymal cells. A tumor measuring greater than 30 cm is called a “giant liposarcoma.” A part of the neoplasm tends to grow in size, recur locally, or metastasize distantly. In those with such a condition, long-term survival is uncommon. Therefore, it is necessary to present a uniform and optimized program to improve the prognosis.MethodsBy successfully treating a multiple-recurrent giant retroperitoneal dedifferentiated liposarcoma (RP DDLPS) in July 2010, we hope to devise more comprehensive strategies to improve diagnosis, therapy, and outcome.ResultsIn July 2010, we thoroughly resected a giant multifocal RPLS with a concomitant part of the gastric wall. The histopathological examination revealed a high-grade (grade III) dedifferentiated liposarcoma. The patient was discharged uneventfully on the 15th postoperative day. She relapsed after 16 months and needed another complete excision. After 9 months, she died after the fourth recidive. The patient had experienced four recurrences and underwent operations with 15 years of follow-up.ConclusionsThe above demonstrates that we were able to successfully treat the multirecurrent giant RPLS, despite the patient’s poor medical condition, with meticulous management. Moreover, this indicates that long-term survival could be achieved for high-grade RP DDLPS.
Collapse
|
10
|
Patkar S, Kattepur AK, Khanna N, Bajpai J. Retroperitoneal Sarcomas: a Current Review on Management. Indian J Surg Oncol 2022; 13:542-558. [PMID: 36187536 PMCID: PMC9515254 DOI: 10.1007/s13193-022-01520-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/08/2022] [Indexed: 11/25/2022] Open
Abstract
Retroperitoneal sarcomas are heterogeneous tumours with variable disease biology and outcomes. The prognosis is primarily related to tumour histology and grade as well as the ability to achieve margin negative resection. Surgery involves compartment or contiguous organ resection to achieve the above goal. Careful utilization of neoadjuvant and adjuvant strategies like radiotherapy and/or chemotherapy can lead to improvement in margin status, thereby contributing to better local control and possibly reducing systemic dissemination. Use of targeted therapies has paved newer pathways of treatment integration centred on molecular and genetic targets. The aim of this review is to update the reader on all aspects of retroperitoneal sarcoma management including emphasis on pertinent and landmark trials in this regard.
Collapse
Affiliation(s)
- Shraddha Patkar
- Department of Gastrointestinal Oncology, Hepatobiliary Services, Tata Memorial Centre and HBNI, Dr Ernst Borges Marg, Parel, Mumbai 400012 India
| | - Abhay K. Kattepur
- Department of Surgical Oncology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Centre and HBNI, Dr Ernst Borges Marg, Parel, Mumbai India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre and HBNI, Dr Ernst Borges Marg, Parel, Mumbai India
| |
Collapse
|
11
|
Salerno KE, Baldini EH. Role of Radiation Therapy in Retroperitoneal Sarcoma. J Natl Compr Canc Netw 2022; 20:845-849. [PMID: 35830885 DOI: 10.6004/jnccn.2022.7035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022]
Abstract
Retroperitoneal sarcoma comprises a small subset of all soft tissue sarcoma and includes various histopathologic subtypes, each with unique patterns of behavior and differential risks for local recurrence and hematogenous metastatic spread. The primary treatment modality is surgery, although even with complete macroscopic resection, recurrence is common. The rationale for the addition of radiotherapy to resection is to improve local control; however, the use of radiation therapy for retroperitoneal sarcoma is controversial, and existing data are suboptimal to guide management. Treatment decisions should be determined with multidisciplinary input and shared decision-making. When used in selected patients, radiation therapy should be delivered preoperatively; postoperative treatment is not recommended.
Collapse
Affiliation(s)
- Kilian E Salerno
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; and
| | - Elizabeth H Baldini
- Harvard Medical School, and.,Sarcoma Center, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
12
|
Abstract
Radiation therapy is an integral component of local management with oncologic resection for soft tissue sarcoma. Radiotherapy is indicated in patients at an increased risk of local recurrence so that improved local control may be achieved. Sequencing of radiotherapy and resection should be determined by multidisciplinary input before treatment initiation. For most patients, preoperative delivery of radiation therapy is preferred. In patients initially thought to be at low risk for local recurrence and found to have unexpected adverse pathologic features at resection, postoperative radiation therapy is indicated. The use of radiation therapy for retroperitoneal sarcoma is controversial; when used, preoperative delivery of radiation is recommended.
Collapse
|
13
|
Bredbeck BC, Delaney LD, Kathawate VG, Harter CA, Wilkowski J, Chugh R, Cuneo KC, Dossett LA, Sabel MS, Angeles CV. Factors associated with disease-free and abdominal recurrence-free survival in abdominopelvic and retroperitoneal sarcomas. J Surg Oncol 2022; 125:1292-1300. [PMID: 35239187 PMCID: PMC9313796 DOI: 10.1002/jso.26828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 11/07/2022]
Abstract
Background and Objectives Retroperitoneal and abdominopelvic sarcomas are rare heterogeneous malignancies. The only therapy proven to improve disease‐free survival (DFS) is R0/R1 surgical resection. We sought to analyze whether additional factors such as radiation and systemic therapy were associated with DFS and abdominal recurrence‐free survival (RFS). Methods Retrospective review of adults (≥18) with resectable abdominopelvic and retroperitoneal sarcomas who underwent intent‐to‐cure surgery at a high‐volume tertiary referral center between 1998 and 2015. The main outcome measures were DFS and abdominal RFS. Results Overall, 159 patients met the criteria for inclusion. Median follow‐up was 4.8 years (range 0.1–18.9 years). The most common histology was liposarcoma (49%). Systemic therapy was administered to 48% of patients and was not associated with improved outcomes. The neoadjuvant radiotherapy group (11%) had improved adjusted DFS (5.46 years, 95% CI [3.68, 7.24] vs. 3.1 years, 95% CI [2.48, 3.73]) and abdominal RFS (6.14 years, 95% CI [4.38, 7.89] vs. 3.22 years, 95% CI [2.61, 3.84]). The adjuvant radiotherapy group (19%) had no improvement. Conclusions In a cohort of patients undergoing resection for retroperitoneal or abdominopelvic sarcoma, neoadjuvant radiation improved DFS and abdominal RFS. A follow‐up of over three years was needed to appreciate a difference in outcomes.
Collapse
Affiliation(s)
- Brooke C Bredbeck
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Lia D Delaney
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | | | - Jodi Wilkowski
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Rashmi Chugh
- Department of Medicine, University of Michigan , Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Kyle C Cuneo
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA.,Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael S Sabel
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Christina V Angeles
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
14
|
Comparison of preoperative chemoradiation with radiation or chemotherapy alone in patients with non-metastatic, resectable retroperitoneal sarcoma. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Aim:
Optimal preoperative therapy regimen in the treatment of resectable retroperitoneal sarcoma (RPS) remains unclear. This study compares the impact of preoperative radiation, chemoradiation and chemotherapy on overall survival (OS) in RPS patients.
Materials and Methods:
The National Cancer Database (NCDB) was queried for patients with non-metastatic, resectable RPS (2006–15). The primary endpoint was OS, evaluated by Kaplan–Meier method, log-rank test, Cox multivariable analysis and propensity score matching.
Results:
A total of 1,253 patients met the inclusion criteria, with 210 patients (17%) receiving chemoradiation, 850 patients (68%) receiving radiation and 193 patients (15%) receiving chemotherapy. On Cox multivariable analysis, when compared to preoperative chemoradiation, preoperative radiation was not associated with improved OS (hazards ratio [HR] 0·98, 95% CI 0·76–1·25, p = 0·84), while preoperative chemotherapy was associated with worse OS (HR 1·64, 95% CI 1·24–2·18, p < 0·001). Similar findings were observed in 199 and 128 matched pairs for preoperative radiation and chemotherapy, respectively, when compared to preoperative chemoradiation.
Findings:
Our study suggested an OS benefit in using preoperative chemoradiation compared to chemotherapy alone, but OS outcomes were comparable between preoperative chemoradiation and radiation alone.
Collapse
|
15
|
Villano AM, Farma JM. ASO Author Reflections: Retroperitoneal Soft Tissue Sarcoma: A Call for Collaboration and Scientific Inquiry. Ann Surg Oncol 2021; 29:2286-2287. [PMID: 34657199 DOI: 10.1245/s10434-021-10914-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Anthony M Villano
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| |
Collapse
|
16
|
Villano AM, Vidri RJ, Vo ET, Greco SH, Howell KJ, von Mehren M, Farma JM. National Trends in Treatment for Retroperitoneal Soft Tissue Sarcoma: A Modern Appraisal of Variability in Therapeutic Strategies. Ann Surg Oncol 2021; 29:2275-2285. [PMID: 34635978 DOI: 10.1245/s10434-021-10908-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/31/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Little level 1 evidence exists to guide multimodality treatment in retroperitoneal soft tissue sarcoma (RPS), which may lead to significant variation in therapeutic approaches. This analysis aimed to describe national RPS treatment trends and explore potential variability among low-/high-volume hospitals (LVH/HVHs). PATIENTS AND METHODS In total, 5992 patients who underwent resection for primary RPS were retrospectively identified in the National Cancer Database (2004-2017). Time trend analyses examined rates of multivisceral resection (MVR), radiation, and chemotherapy use. LVHs were defined as those carrying out fewer than ten resections per year (N = 5433), whereas HVHs were defined as those carrying out ten or more (N = 559). Descriptive statistics and logistic regression models compared trends between groups. RESULTS MVR was more frequent at HVHs (63.7% versus 43.5%, p < 0.001). Use of radiation varied widely by hospital volume. HVHs more frequently employed preoperative radiation as compared with LVHs (14.7% versus 8.1%, p < 0.001). Throughout the study period, LVHs increased utilization of preoperative radiation (2.6% to 12.0%, p < 0.001) whereas rates at HVHs remained stable. Overall, LVHs utilized postoperative radiation significantly more frequently as compared with HVHs (14.7% versus 2.7%, respectively, p < 0.001). Postoperative radiation at LVHs remained stable until 2013 and sharply declined thereafter (16.7% to 6.9%, p < 0.001). Rates of postoperative radiation use at HVHs remained lower than those at LVHs at all time points. CONCLUSIONS Strategies for resection and radiation use at LVHs have trended towards those of HVHs. Current national implementation of preoperative radiation, MVR, and chemotherapy remains heterogeneous. These findings inform future trial design and support standardization of care.
Collapse
Affiliation(s)
- Anthony M Villano
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Roberto J Vidri
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Elaine T Vo
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Stephanie H Greco
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Krisha J Howell
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Margaret von Mehren
- Department of Hematology and Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| |
Collapse
|
17
|
Multidisciplinary Management of Retroperitoneal Sarcoma: Diagnosis, Prognostic Factors and Treatment. Cancers (Basel) 2021; 13:cancers13164016. [PMID: 34439171 PMCID: PMC8392612 DOI: 10.3390/cancers13164016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/06/2021] [Indexed: 01/07/2023] Open
Abstract
Simple Summary The management of retroperitoneal sarcomas can be challenging due to the variety of their presentation, histopathological types, and behaviours. This literature review provides a comprehensive and practical overview of the management of retroperitoneal sarcomas, focusing on diagnostic challenges, prognostic factors, multidisciplinary aspects of treatment and new research perspectives. Abstract Retroperitoneal sarcomas (RPS) are rare cancers whose management can be challenging due to various presentation patterns, multiple organ involvement, and a high local and distant recurrence rate. Histopathology and prognostic factors analysis are essential to predict the behaviour of the disease and plan the best therapeutic strategy. To date, surgery is still the main therapeutic option that guarantees a chance of cure from the primary disease. While chemotherapy and radiotherapy seem to be good options for controlling metastatic and recurrent irresectable disease, their role in the treatment of primary RPS remains unclear. This literature review aims to provide a comprehensive overview of the multidisciplinary aspects of RPS management in high-volume centres, summarising the diagnostic path, the prognostic factors, and the most suitable therapeutic options.
Collapse
|
18
|
[A rare tumor manifestation in the head and neck region]. HNO 2021; 70:401-404. [PMID: 34160625 DOI: 10.1007/s00106-021-01071-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 10/21/2022]
|
19
|
Bachmann R, Eckert F, Gelfert D, Strohäker J, Beltzer C, Ladurner R. Perioperative strategy and outcome in giant retroperitoneal dedifferentiated liposarcoma-results of a retrospective cohort study. World J Surg Oncol 2020; 18:296. [PMID: 33183309 PMCID: PMC7664077 DOI: 10.1186/s12957-020-02069-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/27/2020] [Indexed: 12/25/2022] Open
Abstract
Background and objectives Retroperitoneal liposarcoma (RPLS) are common soft tissue sarcomas of adulthood. The aim of this study is to show resectability of even giant liposarcomas and to identify factors associated with recurrence and survival in primary retroperitoneal liposarcomas. Methods We retrospectively reviewed the records of patients with retroperitoneal liposarcoma. Seventy-seven patients met inclusion criteria. Out of these 10 patients with primary giant, dedifferentiated retroperitoneal liposarcomas were operated with en bloc compartment resection with intention of radical resection. Treatment consisted of neoadjuvant radiochemotherapy and surgical resection or surgical resection. Results In 6 patients, neoadjuvant radiochemotherapy was performed; 3 patients were treated with surgical resection alone and 1 patient received adjuvant chemotherapy. The median diameter of tumor size was 360 mm (300 to 440 mm). Operative outcome showed complete resection in all 10 patients. Local tumor free survival was in median 19 month. Tumor recurrence was seen in 3 of 4 patients (75%) without neoadjuvant radiochemotherapy, and in 2 of 6 patients (33%) after neoadjuvant radiochemotherapy in 2 years follow-up. Conclusion Even in case of giant retroperitoneal liposarcoma, complete resection is possible and remains the principal treatment. The rate of recurrence was improved in patients with neoadjuvant radiochemotherapy.
Collapse
Affiliation(s)
- Robert Bachmann
- Department of General, Visceral and Transplantation Surgery, University of Tübingen, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany.
| | - Franziska Eckert
- Department of Radiation Oncology, University of Tübingen, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany
| | - Daniel Gelfert
- Department of General, Visceral and Transplantation Surgery, University of Tübingen, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany
| | - Jens Strohäker
- Department of General, Visceral and Transplantation Surgery, University of Tübingen, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany
| | - Christian Beltzer
- Department of General, Visceral and Transplantation Surgery, University of Tübingen, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany
| | - Ruth Ladurner
- Department of General, Visceral and Transplantation Surgery, University of Tübingen, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany
| |
Collapse
|
20
|
Ptok H, Schalk E, Hass P, Heinze C, Brunner T, Croner RS. Multimodale Therapie primärer, nicht metastasierter retroperitonealer Sarkome. Zentralbl Chir 2020; 145:405-416. [DOI: 10.1055/a-1132-3760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungWeichteilsarkome sind eine heterogene Gruppe von Tumoren mesenchymalen Ursprungs, die teilweise ein sehr unterschiedliches biologisches Verhalten zeigen. Retroperitoneale Weichteilsarkome (RSTS) machen 10 – 15% aller Weichteilsarkome aus. Behandlungsempfehlungen für RSTS basieren auf vorrangig retrospektiven Analysen mit geringer Evidenz, die in dieser Übersichtsarbeit dargestellt werden. Zentraler Pfeiler in der Behandlung des lokalisierten, nicht metastasierten RSTS ist die chirurgische Resektion im Sinne einer Kompartment-Resektion. Ziel ist dabei immer die allseitig vollständige Tumorentfernung mit mikroskopisch freien Resektionsrändern. Ist das Erreichen dieses Behandlungsziels mit der alleinigen Kompartment-Resektion fraglich oder besteht eine hohe Wahrscheinlichkeit für eine lokale Tumorrekurrenz bei high-grade Sarkomen, so sollte eine neoadjuvante Bestrahlung, gegebenenfalls mit intraoperativem Boost, im Rahmen eines multimodalen Therapieansatzes durchgeführt
werden. Die in Analogie zu den Extremitätensarkomen zu favorisierende Anthrazyklin-basierte Chemotherapie hat ihren Stellenwert vorrangig in der Adjuvanz. Auch wenn ein onkologischer Vorteil durch eine adjuvante Chemotherapie für RSTS bisher nicht nachgewiesen ist, sollte bei high-grade Sarkomen die Indikation diskutiert werden. In Kenntnis der unterschiedlichen Krankheitsverläufe werden zunehmend an die unterschiedlichen histologischen Subtypen adaptierte Therapiekonzepte diskutiert und in Studien untersucht. Valide Empfehlungen lassen sich jedoch bisher nicht ableiten. Die Behandlung von RSTS-Patienten wie überhaupt von Patienten mit Sarkomen in Zentren mit entsprechender Expertise ist mit einer signifikanten Verbesserung der Prognose assoziiert und ist unbedingt anzustreben.
Collapse
Affiliation(s)
- Henry Ptok
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - Enrico Schalk
- Universitätsklinik für Hämatologie und Onkologie, Zentrum für Innere Medizin, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - Peter Hass
- Universitätsklinik für Strahlentherapie, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - Constanze Heinze
- Universitätsklinik für Radiologie und Nuklearmedizin, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - Thomas Brunner
- Universitätsklinik für Strahlentherapie, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - Roland S. Croner
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Otto-von-Guericke-Universität Magdeburg, Deutschland
| |
Collapse
|
21
|
What Is the Role of Neoadjuvant Radiation Therapy for Retroperitoneal Sarcoma? Adv Surg 2020; 54:273-284. [PMID: 32713436 DOI: 10.1016/j.yasu.2020.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
22
|
Wiseman JT, Ethun CG, Cloyd JM, Shelby R, Suarez-Kelly L, Tran T, Poultsides G, Mogal H, Clarke C, Tseng J, Roggin KK, Chouliaras K, Votanopoulos K, Krasnick B, Fields R, Walle KV, Ronnekleiv-Kelly S, Howard JH, Cardona K, Grignol V. Analysis of textbook outcomes among patients undergoing resection of retroperitoneal sarcoma: A multi-institutional analysis of the US Sarcoma Collaborative. J Surg Oncol 2020; 122:1189-1198. [PMID: 32696475 DOI: 10.1002/jso.26136] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 07/10/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The novel composite metric textbook outcome (TO) has increasingly been used as a quality indicator but has not been reported among patients undergoing surgical resection for retroperitoneal sarcoma (RPS) using multi-institutional collaborative data. METHODS All patients who underwent resection for RPS between 2000 to 2016 from eight academic institutions were included. TO was defined as a patient with R0/R1 resection that discharged to home and was without transfusion, reoperation, grade ≥2 complications, hospital-stay >50th percentile, or 90-day readmission or mortality. Univariate and multivariable analyses were performed. RESULTS Among 627 patients, 56.1% were female and the median age was 59 years. A minority of patients achieved a TO (34.9%). Factors associated with achieving a TO were tumor size <20 cm and low tumor grade, while ASA class ≥3, history of a prior cardiac event, resection of left colon/rectum, distal pancreatic resection, major venous resection and drain placement were associated with not achieving a TO (all P < .05). Achievement of a TO was associated with improved survival (median:12.7 vs 5.9 years, P < .01). CONCLUSIONS Among patients undergoing resection for RPS, failure to achieve TO is common and associated with significantly worse survival. The use of TO may inform patient expectations and serve as a measure for patient-level hospital performance.
Collapse
Affiliation(s)
- Jason T Wiseman
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Cecilia G Ethun
- Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jordan M Cloyd
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Rita Shelby
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | | | - Thuy Tran
- Department of Surgery, Stanford University, Stanford, California
| | | | - Harveshp Mogal
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Callisia Clarke
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer Tseng
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Kevin K Roggin
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | | | | | - Bradley Krasnick
- Department of Surgery, Washington University, St. Louis, Missouri
| | - Ryan Fields
- Department of Surgery, Washington University, St. Louis, Missouri
| | - Kara Vande Walle
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Sean Ronnekleiv-Kelly
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | | | - Kenneth Cardona
- Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Valerie Grignol
- Department of Surgery, The Ohio State University, Columbus, Ohio
| |
Collapse
|
23
|
Turner BT, Hampton L, Schiller D, Mack LA, Robertson-More C, Li H, Quan ML, Bouchard-Fortier A. Neoadjuvant radiotherapy followed by surgery compared with surgery alone in the treatment of retroperitoneal sarcoma: a population-based comparison. ACTA ACUST UNITED AC 2019; 26:e766-e772. [PMID: 31896947 DOI: 10.3747/co.26.5185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Retroperitoneal sarcoma (rps) encompasses a heterogeneous group of malignancies with a high recurrence rate after resection. Neoadjuvant radiotherapy (nrt) is often used in the hope of sterilizing margins and decreasing local recurrence after excision. We set out to compare local recurrence-free survival (lrfs) and overall survival (os) in patients treated with or without nrt before resection. Methods Patients diagnosed with rps from February 1990 to October 2014 were identified in the Alberta Cancer Registry. Patients with complete gross resection of rps and no distant disease were included. Patient, tumour, treatment, and outcomes data were abstracted in a primary chart review. Baseline characteristics were compared using the Wilcoxon nonparametric test for continuous data and the Fisher exact test for dichotomous and categorical data. Survival was analyzed using Kaplan-Meier curves with log-rank test. Cox regression was performed to control for age, sex, tumour size, tumour grade, date of diagnosis, multivisceral resection, and intraoperative rupture. Results Resection alone was performed in 62 patients, and resection after nrt, in 40. Use of nrt was associated with multivisceral resection and negative microscopic margins. On univariate analysis, nrt was associated with superior median lrfs (89.3 months vs. 28.4 months, p = 0.04) and os (119.4 months vs. 75.9 months, p = 0.04). On multivariate analysis, nrt, younger age, and lower tumour grade predicted improved lrfs and os; sex, tumour size, date of diagnosis, multivisceral resection, and tumour rupture did not. Conclusions In this population-based study, nrt was associated with superior lrfs and os on both univariate and multivariate analysis. When feasible, nrt should be considered until a randomized controlled trial is completed.
Collapse
Affiliation(s)
- B T Turner
- Department of Surgery, University of Calgary, Calgary, AB
| | - L Hampton
- Cumming School of Medicine, Calgary, AB
| | - D Schiller
- Department of Surgery, Royal Alexandra Hospital, Edmonton, AB
| | - L A Mack
- Department of Surgery, University of Calgary, Calgary, AB
| | - C Robertson-More
- General Surgery Residency Program, University of Calgary, Calgary, AB
| | - H Li
- Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, AB
| | - M L Quan
- Department of Surgery, University of Calgary, Calgary, AB.,Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, AB
| | | |
Collapse
|
24
|
Chouliaras K, Senehi R, Ethun CG, Poultsides G, Grignol V, Clarke CN, Roggin KK, Fields RC, Schwartz PB, Ronnekleiv-Kelly SM, D'Agostino R, Johnson EN, Levine EA, Cardona K, Votanopoulos KI. Role of radiation therapy for retroperitoneal sarcomas: An eight-institution study from the US Sarcoma Collaborative. J Surg Oncol 2019; 120:1227-1234. [PMID: 31486096 DOI: 10.1002/jso.25694] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/25/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND The use of radiation therapy in the treatment of retroperitoneal sarcomas has increased in recent years. Its impact on survival and recurrence is unclear. METHODS A retrospective propensity score matched (PSM) analysis of patients with primary retroperitoneal soft tissue sarcomas, who underwent resection from 2000 to 2016 at eight institutions of the US Sarcoma Collaborative, was performed. Patients with metastatic disease, desmoid tumors, and palliative resections were excluded. RESULTS Total 425 patients were included, 56 in the neoadjuvant radiation group (neo-RT), 75 in the adjuvant radiation group (adj-RT), and 294 in the no radiotherapy group (no-RT). Median age was 59.5 years, 186 (43.8%) were male with a median follow up of 31.4 months. R0 and R1 resection was achieved in 253 (61.1%) and 143 (34.5%), respectively. Overall 1:1 match of 46 adj-RT and 59 neo-RT patients was performed using histology, sex, age, race, functional status, tumor size, grade, resection status, and chemotherapy. Unadjusted recurrence-free survival (RFS) was 35.9 months (no-RT) vs 33.5 months (neo-RT) and 27.2 months (adj-RT), P = .43 and P = .84, respectively. In the PSM, RFS was 17.6 months (no-RT) vs 33.9 months (neo-RT), P = .28 and 19 months (no-RT) vs 27.2 months (adj-RT), P = .1. CONCLUSIONS Use of radiotherapy, both in adjuvent or neoadjuvent setting, was not associated with improved survival or reduced recurrence rate.
Collapse
Affiliation(s)
- Konstantinos Chouliaras
- Division of Surgical Oncology, Department of Surgery, Wake Forest University, Winston-Salem, North Carolina
| | - Rebecca Senehi
- Division of Surgical Oncology, Department of Surgery, Wake Forest University, Winston-Salem, North Carolina
| | - Cecilia G Ethun
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | - Valerie Grignol
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Callisia N Clarke
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kevin K Roggin
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Ryan C Fields
- Department of Surgery, Washington University, St. Louis, Missouri
| | | | | | - Ralph D'Agostino
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Emily N Johnson
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Edward A Levine
- Division of Surgical Oncology, Department of Surgery, Wake Forest University, Winston-Salem, North Carolina
| | - Kenneth Cardona
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | |
Collapse
|
25
|
Predictors of Disease-Free and Overall Survival in Retroperitoneal Sarcomas: A Modern 16-Year Multi-Institutional Study from the United States Sarcoma Collaboration (USSC). Sarcoma 2019; 2019:5395131. [PMID: 31281208 PMCID: PMC6589263 DOI: 10.1155/2019/5395131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/18/2019] [Accepted: 04/03/2019] [Indexed: 01/08/2023] Open
Abstract
Background Retroperitoneal sarcomas (RPS) comprise approximately 15% of all soft-tissue sarcomas and frequently associated with significant morbidity and as little as 30% 5-year survival. Here, we provide a large, contemporary, and multi-institutional experience to determine which tumor, patient, and treatment characteristics are associated with long-term outcomes in RPS. Methods 571 patients with primary RPS were identified from the United States Sarcoma Collaboration (USSC). RPS patients who underwent resection from January 2000 to April 2016 were included with patient, tumor, and treatment-specific variables investigated as independent predictors of survival. Survival analyses for disease-free and overall survival were conducted using Kaplan–Meier and Cox proportional hazards model methods. Results The study cohort was 55% female, with a median age of 58.9 years (IQR: 48.6–70.0). The most common tumor histiotypes were liposarcoma (34%) and leiomyosarcoma (28%). Median follow-up was 30.6 months (IQR: 11.2–60.4). Median disease-free survival was 35.3 months (95% CI: 27.6–43.0), with multivariate predictors of poorer disease-free survival including higher grade tumors, nodal-positive disease, and multivisceral resection. Median overall survival was 81.6 months (95% CI: 66.3–96.8). Multivariate predictors of shorter overall survival included higher grade tumors, nodal-positive and multifocal disease, systemic chemotherapy, and grossly positive margins (R2) following resection. Conclusions The strongest predictors of disease-free and overall survival are tumor-specific characteristics, while surgical factors are less impactful. Nonsurgical therapies are not associated with improved outcomes despite persistent interest and utilization. Complete macroscopic resection (R0/R1) remains a persistent potentially modifiable risk factor associated with improved overall survival in patients with retroperitoneal sarcomas.
Collapse
|
26
|
Kirste S, Landenberger N, Scholber J, Henne K, Wittel UA, Grosu AL. Retroperitoneal soft tissue sarcoma: low-dose neoadjuvant radiation therapy followed by surgery with or without intraoperative radiotherapy and adjuvant radiation therapy. Strahlenther Onkol 2019; 195:558-565. [PMID: 30972454 DOI: 10.1007/s00066-019-01464-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND We describe the clinical history, outcome, and toxicity of five patients with high-grade retroperitoneal soft tissue sarcoma (RSTS) who were treated with neoadjuvant low-dose radiotherapy (RT) followed by resection with or without intraoperative radiotherapy (IORT), followed by adjuvant RT. We aim to provide additional evidence for the various treatment options that exist for this rare tumor entity. METHODS Most patients presented with mild abdominal symptoms. Diagnosis was confirmed by biopsy. Additional imaging was done by sonography, magnetic resonance imaging (MRI), and/or positron emission tomography (PET)/computed tomography (CT). All patients were treated with neoadjuvant RT of 19.8 Gy in 1.8-Gy fractions followed by resection and postoperative RT up to 45 Gy with a median interval between resection and start of postoperative RT of 5 weeks. Two patients received additional IORT. Median follow-up was 61 months. RESULTS One patient developed a local recurrence that was diagnosed 30 months after the start of the first therapy. He was treated with a salvage resection and had no evidence of disease at the last follow-up. Another patient developed a right-sided RSTS on the contralateral side from the primary radiation field with pelvic bone infiltration 56 months after the start of RT. He was treated again by RT and resection and was without evidence of disease at last follow-up. Radiotherapy was well tolerated without major toxicity. CONCLUSION The treatment of RSTS by low-dose neoadjuvant RT, resection with IORT and adjuvant RT seems to be a feasible and effective treatment approach. Further studies comparing neoadjuvant with adjuvant RT are necessary to find the best treatment option.
Collapse
Affiliation(s)
- Simon Kirste
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Straße 6, 79106, Freiburg, Germany. .,Partner Site Freiburg (DKTK), German Cancer Consortium, Freiburg, Germany.
| | - Nicole Landenberger
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Straße 6, 79106, Freiburg, Germany.,Partner Site Freiburg (DKTK), German Cancer Consortium, Freiburg, Germany
| | - Jutta Scholber
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Straße 6, 79106, Freiburg, Germany.,Partner Site Freiburg (DKTK), German Cancer Consortium, Freiburg, Germany
| | - Karl Henne
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Straße 6, 79106, Freiburg, Germany.,Partner Site Freiburg (DKTK), German Cancer Consortium, Freiburg, Germany
| | - Uwe A Wittel
- Department of General and Visceral Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Straße 6, 79106, Freiburg, Germany.,Partner Site Freiburg (DKTK), German Cancer Consortium, Freiburg, Germany
| |
Collapse
|
27
|
Peacock O, Patel S, Simpson JA, Walter CJ, Humes DJ. A systematic review of population-based studies examining outcomes in primary retroperitoneal sarcoma surgery. Surg Oncol 2019; 29:53-63. [PMID: 31196494 DOI: 10.1016/j.suronc.2019.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/09/2019] [Accepted: 03/02/2019] [Indexed: 12/24/2022]
Abstract
Retroperitoneal sarcomas (RPS) are rare mesenchymal tumours. Their rarity challenges our ability to understand expected outcomes. The aim of this systematic review was to examine 30-day morbidity and mortality, overall survival rates and prognostic predictors from population-based studies for patients undergoing curative resection for primary RPS. A systematic literature review of EMBASE, MEDLINE, PUBMED and the Cochrane library was performed using PRISMA for population-based studies reporting from nationally registered databases on primary RPS surgical resections in adults. The main outcomes evaluated were 30-day morbidity and mortality and overall survival rates. The use of additional treatment modalities and predictors of overall survival were also examined. Fourteen studies (n = 12 834 patients) reporting from 3 national databases, (Surveillance, Epidemiology and End Results (SEER), the United States National Cancer Database (US NCDB) and the American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP)) were analysed. The reported overall 30-day morbidity and mortality were 23% (n = 191/846) and 3% (n = 278/10 181) respectively. Reported use of perioperative radiotherapy was 28%. No study reported loco-regional recurrence rates. Overall reported 5-year survival ranged from 52% to 62%. Independent predictors of overall survival were age of the patient, resection margin, tumour grade and size, histological subtype and receipt of radiotherapy. This review of population-based data demonstrated relatively low 30-day morbidity rates in patients undergoing curative surgical resections for primary RPS. Thirty-day mortality rates were similar to other abdominal tumour groups. There remains a paucity of data reporting recurrence rates, however 5-year survival rates ranged from 52 to 62%.
Collapse
Affiliation(s)
- Oliver Peacock
- Colorectal Surgery Unit, Queen's Medical Centre Campus, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, United Kingdom.
| | - Shailen Patel
- Colorectal Surgery Unit, Queen's Medical Centre Campus, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, United Kingdom
| | - Jonathan A Simpson
- Colorectal Surgery Unit, Queen's Medical Centre Campus, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, United Kingdom
| | - Catherine J Walter
- Colorectal Surgery Unit, Queen's Medical Centre Campus, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, United Kingdom
| | - David J Humes
- Colorectal Surgery Unit, Queen's Medical Centre Campus, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, United Kingdom; NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, University of Nottingham, Queen's Medical Centre Campus, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, United Kingdom
| |
Collapse
|
28
|
Radiation Therapy for Retroperitoneal Sarcomas: Influences of Histology, Grade, and Size. Sarcoma 2018; 2018:7972389. [PMID: 30631245 PMCID: PMC6304833 DOI: 10.1155/2018/7972389] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/26/2018] [Accepted: 11/14/2018] [Indexed: 01/30/2023] Open
Abstract
Perioperative radiation therapy (RT) has been associated with reduced local recurrence in patients with retroperitoneal sarcomas (RPS); however, selection criteria remain unclear. We hypothesized that perioperative RT would improve survival in patients with RPS and would be associated with pathological factors. The National Cancer Database (NCDB) from 2004 to 2012 was reviewed for patients with nonmetastatic RPS undergoing curative intent resection. Tumor size was dichotomized at 15 cm based on 8th edition American Joint Committee on Cancer (AJCC) staging. Patients with the highest comorbidity score were excluded. Unadjusted Kaplan–Meier and adjusted Cox proportional hazards modeling analyzed overall survival (OS). Multivariable logistic regression modeled margin positivity. A total of 2,264 patients were included; 727 patients (32.1%) had perioperative radiation in whom 203 (9.0%) had radiation preoperatively. Median (IQR) RPS size was 17.5 [11.0–27.0] cm. Histopathology was high grade in 1048 patients (43.7%). Multivariable analysis revealed that perioperative radiation was independently associated with decreased mortality (HR 0.72, 95% confidence intervals (CIs) 0.62–0.84, p < 0.001), and preoperative RT was associated with reduced margin positivity (HR 0.72, 95% CI 0.53–0.97, p=0.032). Stratified survival analysis showed that radiation was associated with prolonged median OS for RPS that were high-grade (64.3 vs. 43.6 months, p < 0.001), less than 15 cm (104.1 vs. 84.2 months, p=0.007), and leiomyosarcomatous (104.8 vs. 61.8 months, p < 0.001). Perioperative radiation is independently associated with decreased mortality in patients with high-grade, less than 15 cm, and leiomyosarcomatous tumors. Preoperative radiation is independently associated with margin-negative resection. These data support the selective use of perioperative radiation in the multidisciplinary management of RPS.
Collapse
|
29
|
Neoadjuvant and adjuvant strategies in retroperitoneal sarcoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2018; 44:571-579. [PMID: 29472043 DOI: 10.1016/j.ejso.2018.02.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/15/2018] [Accepted: 02/02/2018] [Indexed: 11/23/2022]
Abstract
Extended surgery remains the mainstay of treatment in retroperitoneal sarcoma, although conflicting data exist on the benefit of neoadjuvant and adjuvant therapies, particularly with regard to tumour grade and histological type. Experience of radiotherapy and chemotherapy in extremity soft tissue sarcoma can inform treatment strategies, however these data cannot be universally extrapolated to the retroperitoneum where disease biology and anatomical considerations are different. The present review sets a historical context before discussing recent evidence and on-going multi-centre trials in retroperitoneal sarcoma. Promising data on histologically- and molecularly-targeted chemotherapy are discussed and the need for centralisation of retroperitoneal sarcoma services in order to facilitate large international collaborative trials is emphasised.
Collapse
|
30
|
Cosper PF, Olsen J, DeWees T, Van Tine BA, Hawkins W, Michalski J, Zoberi I. Intensity modulated radiation therapy and surgery for Management of Retroperitoneal Sarcomas: a single-institution experience. Radiat Oncol 2017; 12:198. [PMID: 29216884 PMCID: PMC5721605 DOI: 10.1186/s13014-017-0920-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peri-operative radiation of retroperitoneal sarcomas (RPS) is an important component of multidisciplinary treatment. All retrospective series thus far included patients treated with older radiation therapy (RT) techniques including 2D and 3DRT. Intensity modulated radiation therapy (IMRT) allows for selective dose escalation while sparing adjacent organs. We therefore report the first series of patients with RPS treated solely with IMRT, surgery and chemotherapy. We hypothesized that IMRT would permit safe dose escalation and superior rates of local control (LC) in this high-risk patient population. METHODS Thirty patients with RPS treated with curative intent between 2006 and 2015 were included in this retrospective study. RT was administered either pre- or post-operatively and IMRT was used in all patients. Statistical comparisons, LC, distant metastasis (DM), and overall survival (OS) were calculated by Kaplan-Meier analysis and univariate Cox regression. RESULTS Median follow-up time after completion of RT was 36 months (range 1.4-112). Median tumor size was 14 cm (range 3.6 - 28 cm). The most prevalent histologies were liposarcoma in 10 (33%) patients and leiomyosarcoma in 10 (33%) with 21 patients (70%) having high-grade disease. Twenty-eight (93%) patients had surgical resection with 47% having positive margins. Chemotherapy was administered in 9 (30%) patients. RT was delivered pre-operatively in 11 (37%) patients, and post-operatively in 19 (63%) with 60% of patients receiving a simultaneous integrated boost. Pre-operative median RT dose to the high-risk area was 55 Gy (range, 43-66 Gy) while median post-operative dose was 60.4 Gy (range, 45-66.6 Gy). There was one acute grade 3 and one late grade 3 toxicity and no grade 4 or 5 toxicities. Three year actuarial LC, freedom from DM, and OS rates were 84%, 64%, and 68% respectively. Positive surgical margins were associated with a higher risk of local recurrence (p = 0.02) and decreased OS (p = 0.04). Pre-operative RT was associated with improved LC (p = 0.1) with a 5-year actuarial LC of 100%. Administration of chemotherapy, timing of RT, histology or grade was not predictive of OS. CONCLUSIONS Patients with RPS treated with peri-operative IMRT at our institution had excellent local control and low incidences of toxicity.
Collapse
Affiliation(s)
- Pippa F Cosper
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey Olsen
- Department of Radiation Oncology, University of Colorado, Aurora, CO, USA
| | - Todd DeWees
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Brian A Van Tine
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - William Hawkins
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.
| |
Collapse
|
31
|
De Sanctis R, Giordano L, Colombo C, De Paoli A, Navarria P, Sangalli C, Buonadonna A, Sanfilippo R, Bertola G, Fiore M, Marrari A, Navarria F, Bertuzzi A, Casali PG, Basso S, Santoro A, Quagliuolo V, Gronchi A. Long-term Follow-up and Post-relapse Outcome of Patients with Localized Retroperitoneal Sarcoma Treated in the Italian Sarcoma Group-Soft Tissue Sarcoma (ISG-STS) Protocol 0303. Ann Surg Oncol 2017; 24:3872-3879. [DOI: 10.1245/s10434-017-6105-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Indexed: 12/17/2022]
|
32
|
Maurice MJ, Yih JM, Ammori JB, Abouassaly R. Predictors of surgical quality for retroperitoneal sarcoma: Volume matters. J Surg Oncol 2017; 116:766-774. [DOI: 10.1002/jso.24710] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/13/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Matthew J. Maurice
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland Ohio
| | - Jessica M. Yih
- Urology Institute; University Hospitals Cleveland Medical Center; Cleveland Ohio
| | - John B. Ammori
- Department of Surgery; University Hospitals Cleveland Medical Center; Cleveland Ohio
| | - Robert Abouassaly
- Urology Institute; University Hospitals Cleveland Medical Center; Cleveland Ohio
- Division of Urology; Louis Stokes Cleveland VA Medical Center; Cleveland Ohio
| |
Collapse
|
33
|
Miller BJ, Gao Y, Duchman KR. Does surgery or radiation provide the best overall survival in Ewing's sarcoma? A review of the National Cancer Data Base. J Surg Oncol 2017; 116:384-390. [DOI: 10.1002/jso.24652] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/28/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Benjamin J. Miller
- Department of Orthopaedics and Rehabilitation; University of Iowa Hospitals and Clinics; Iowa City Iowa
| | - Yubo Gao
- Department of Orthopaedics and Rehabilitation; University of Iowa Hospitals and Clinics; Iowa City Iowa
| | - Kyle R. Duchman
- Department of Orthopaedics and Rehabilitation; University of Iowa Hospitals and Clinics; Iowa City Iowa
| |
Collapse
|
34
|
Can Abdominal Computed Tomography Imaging Help Accurately Identify a Dedifferentiated Component in a Well-Differentiated Liposarcoma? J Comput Assist Tomogr 2017; 40:872-879. [PMID: 27454788 DOI: 10.1097/rct.0000000000000462] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the ability of computed tomography (CT) to differentiate an atypical lipomatous tumor/well-differentiated liposarcoma (WDLPS) from a WDLPS with a dedifferentiated component (DDLPS) within it. MATERIALS AND METHODS Forty-nine untreated patients with abdominal atypical lipomatous tumors/well-differentiated liposarcomas who had undergone contrast-enhanced CT were identified using an institutional database. Three radiologists who were blinded to the pathology findings evaluated all the images independently to determine whether a dedifferentiated component was present within the WDLPS. The CT images were evaluated for fat content (≤25% or >25%); presence of ground-glass density, enhancing and/or necrotic nodules; presence of a capsule surrounding the mass; septations; and presence and pattern of calcifications. A multivariate logistic regression model with generalized estimating equations was used to correlate imaging features with pathology findings. Kappa statistics were calculated to assess agreement between the three radiologists. RESULTS On the basis of pathological findings, 12 patients had been diagnosed with DDLPS within a WDLPS and 37 had been diagnosed with WDLPS. The presence of an enhancing or a centrally necrotic nodule within the atypical lipomatous tumor was associated with dedifferentiated liposarcoma (P = 0.02 and P = 0.0003, respectively). The three readers showed almost perfect agreement in overall diagnosis (κ r = 0.83; 95% confidence interval, 0.67-0.99). CONCLUSIONS An enhancing or centrally necrotic nodule may be indicative of a dedifferentiated component in well-differentiated liposarcoma. Ground-glass density nodules may not be indicative of dedifferentiation.
Collapse
|
35
|
Effect of intraoperative radiotherapy in the treatment of retroperitoneal sarcoma. Int J Clin Oncol 2017; 22:563-568. [PMID: 28074298 DOI: 10.1007/s10147-016-1086-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/29/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Current National Comprehensive Cancer Network guidelines for the treatment of retroperitoneal sarcomas (RPS) endorse surgical resection, but the role of radiotherapy (RT) is less clear. We investigate the utilization and benefits of intraoperative RT (IORT) in the treatment of RPS. METHODS We queried the Surveillance, Epidemiology and End Results (SEER) database (1988-2013) for the utilization of IORT and perioperative external beam RT (EBRT) in patients who underwent surgical resection of RPS. Groups were defined as any IORT (aIORT), IORT alone (IORT-), IORT with EBRT (IORT+) and preoperative and/or postoperative EBRT without IORT (EBRT). Demographics, tumor characteristics, extent of disease, and survival were compared between groups. RESULTS We identified 908 patients with RPS who underwent surgical resection with perioperative RT. Demographics of age, sex, and race were similar between groups. There was no difference in baseline tumor characteristics of mean size, tumor grade, or histological subtype between groups. A higher percentage of patients receiving aIORT had tumors >20 cm in size, and extension beyond local tissues. Liposarcoma and leiomyosarcoma were the most common subtypes overall and in each subgroup. Patients with liposarcoma undergoing IORT and EBRT (IORT+) demonstrated a survival benefit over both IORT alone (IORT-) and EBRT alone. CONCLUSION IORT was used infrequently for RPS but generated equivalent outcomes compared to EBRT, despite being utilized more often for larger tumors and those with peri-tumoral soft-tissue invasion. Patients with the most common subtype (liposarcoma) may benefit from combination IORT with adjuvant EBRT versus other regimens.
Collapse
|
36
|
DeLaney TF, Chen YL, Baldini EH, Wang D, Adams J, Hickey SB, Yeap BY, Hahn SM, De Amorim Bernstein K, Nielsen GP, Choy E, Mullen JT, Yoon SS. Phase 1 trial of preoperative image guided intensity modulated proton radiation therapy with simultaneously integrated boost to the high risk margin for retroperitoneal sarcomas. Adv Radiat Oncol 2017; 2:85-93. [PMID: 28740917 PMCID: PMC5514168 DOI: 10.1016/j.adro.2016.12.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/29/2016] [Accepted: 12/02/2016] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To conduct phase 1 and 2 trials with photon intensity modulated radiation therapy and intensity modulated proton therapy (IMPT) arms to selectively escalate the retroperitoneal sarcoma preoperative radiation dose to tumor volume (clinical target volume [CTV] 2) that is judged to be at a high risk for positive margins and aim to reduce local recurrence. We report on the IMPT study arm in phase 1. METHODS AND MATERIALS Patients aged ≥18 years with primary or locally recurrent retroperitoneal sarcoma were treated with preoperative IMPT, 50.4 GyRBE in 28 fractions, to CTV1 (gross tumor volume and adjacent tissues at risk of subclinical disease) with a simultaneous integrated boost to CTV2 to doses of 60.2, 61.6, and 63.0 GyRBE in 28 fractions of 2.15, 2.20, and 2.25 GyRBE, respectively. The primary objective of the phase 1 study was to determine the maximum tolerated dose to CTV2, which will be further tested in the phase 2 study. RESULTS Eleven patients showed increasing IMPT dose levels without acute dose limiting toxicities that prevented dose escalation to maximum tolerated dose. Acute toxicity was generally mild with no radiation interruptions. No unexpected perioperative morbidity was noted. Eight months postoperatively, one patient developed hydronephrosis that was treated by stent with ureter dissected off tumor and received 57.5 GyRBE. Retained ureter(s) was (were) subsequently constrained to 50.4 GyRBE without further problem. With an 18-month median follow-up, there were no local recurrences. CONCLUSIONS IMPT dose escalation to CTV2 to 63 GyRBE was achieved without acute dose limiting toxicities. The phase 2 study of IMPT will accrue patients to that dose. Parallel intensity modulated radiation therapy phase 1 arm is currently accruing at the initial dose level. Ureters that undergo a high dose radiation and/or surgery are at risk for late hydro-ureter. Future studies will constrain retained ureters to 50.4 GyRBE to avoid ureteral stricture.
Collapse
Affiliation(s)
- Thomas F. DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yen-Lin Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth H. Baldini
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Judith Adams
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shea B. Hickey
- Cancer Center Protocol Office, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Beow Y. Yeap
- Biostatistics/Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephen M. Hahn
- Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas
| | - Karen De Amorim Bernstein
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - G. Petur Nielsen
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edwin Choy
- Medical Oncology Section, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John T. Mullen
- Surgical Oncology Section, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sam S. Yoon
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
37
|
|
38
|
Ecker BL, Peters MG, McMillan MT, Sinnamon AJ, Zhang PJ, Fraker DL, Levin WP, Roses RE, Karakousis GC. Preoperative radiotherapy in the management of retroperitoneal liposarcoma. Br J Surg 2016; 103:1839-1846. [PMID: 27682864 DOI: 10.1002/bjs.10305] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/15/2016] [Accepted: 07/05/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Histological subtype influences both prognosis and patterns of treatment failure in retroperitoneal sarcoma. Previous studies on the efficacy of neoadjuvant radiotherapy (NRT) have incorporated multiple histological types with heterogeneous tumour biology. The survival impact of NRT specifically for patients with retroperitoneal liposarcoma is poorly defined. METHODS Patients who underwent resection with curative intent for retroperitoneal liposarcoma and who received NRT or surgery alone were identified in the US National Cancer Data Base (2004-2013). Cox regression was used to identify co-variables associated with overall survival. NRT and surgery-alone cohorts were matched 1 : 1 by propensity scores based on the survival hazard on Cox modelling. Overall survival was compared by Kaplan-Meier estimates. RESULTS A total of 2082 patients with retroperitoneal liposarcoma were identified; 1908 underwent surgery alone and 174 received NRT before surgical resection. Median tumour size was 22·0 cm and 34·9 per cent of tumours were high grade. In the unmatched cohort, NRT was not associated with improved overall survival (χ2 = 3·49, P = 0·062). In the propensity score-matched cohort, NRT was associated with an improvement in survival (median overall survival 129·2 versus 84·3 months; P = 0·046; hazard ratio (HR) 1·54, 95 per cent c.i. 1·01 to 2·36). This effect appeared most pronounced for tumours with adjacent organ invasion (median overall survival not reached versus 63·8 months; P = 0·044; HR 1·79, 1·01 to 3·19). CONCLUSION NRT improved survival in patients undergoing surgery for retroperitoneal liposarcoma, particularly those with high-risk pathological features.
Collapse
Affiliation(s)
- B L Ecker
- Departments of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M G Peters
- Departments of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M T McMillan
- Departments of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - A J Sinnamon
- Departments of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - P J Zhang
- Departments of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - D L Fraker
- Departments of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - W P Levin
- Departments of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - R E Roses
- Departments of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - G C Karakousis
- Departments of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
39
|
Gronchi A, Haas RL, Bonvalot S. Cancer registries and randomised clinical trials in rare tumours: At the two extremes of daily clinical practice. Eur J Cancer 2016; 64:113-5. [DOI: 10.1016/j.ejca.2016.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/29/2016] [Indexed: 11/17/2022]
|
40
|
Sargos P, Stoeckle E, Henriques de Figueiredo B, Antoine M, Delannes M, Mervoyer A, Kantor G. [Radiotherapy for retroperitoneal sarcomas]. Cancer Radiother 2016; 20:677-84. [PMID: 27568294 DOI: 10.1016/j.canrad.2016.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/27/2016] [Accepted: 07/02/2016] [Indexed: 10/21/2022]
Abstract
The management of retroperitoneal sarcoma can be very challenging, and the quality of initial treatment strategy appears to be a crucial prognostic factor. En bloc surgery is currently the standard of care for these rare tumours and perioperative treatments such as chemotherapy or radiotherapy have not been validated yet. However, local-regional relapse constitutes the most common disease course. While adjuvant radiotherapy is less and less common due to gastrointestinal toxicities, preoperative radiation therapy offers numerous advantages and is being evaluated as part of a national multicentre phase II study (TOMOREP trial) and is the subject of a European randomized phase III study (STRASS trial). The objective of this article is to present data on preoperative irradiation in terms of dose, volumes and optimal radiotherapy techniques for the treatment of this rare disease.
Collapse
Affiliation(s)
- P Sargos
- Département de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France.
| | - E Stoeckle
- Département de chirurgie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - B Henriques de Figueiredo
- Département de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - M Antoine
- Unité de physique médicale, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - M Delannes
- Département de radiothérapie, institut Claudius-Regaud, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - A Mervoyer
- Département de radiothérapie, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France
| | - G Kantor
- Département de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| |
Collapse
|
41
|
Nussbaum DP, Rushing CN, Lane WO, Cardona DM, Kirsch DG, Peterson BL, Blazer DG. Preoperative or postoperative radiotherapy versus surgery alone for retroperitoneal sarcoma: a case-control, propensity score-matched analysis of a nationwide clinical oncology database. Lancet Oncol 2016; 17:966-975. [DOI: 10.1016/s1470-2045(16)30050-x] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/30/2016] [Accepted: 03/30/2016] [Indexed: 12/20/2022]
|
42
|
The effect of microscopic margin status on survival in adult retroperitoneal soft tissue sarcomas. Eur J Surg Oncol 2016; 43:168-174. [PMID: 27335080 DOI: 10.1016/j.ejso.2016.05.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/14/2016] [Accepted: 05/24/2016] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Resection is the primary treatment for retroperitoneal (RP) soft tissue sarcomas (STS). Whether obtaining microscopically negative margins (R0) improves overall survival (OS) over microscopically positive margins (R1) remains unclear. METHODS Using the National Cancer Data Base, we identified adult patients diagnosed with RP STS after R0 or R1 resection from 1998 to 2011. We used a multivariable logistic regression model to identify clinicopathologic factors associated with margin status, including radiotherapy receipt. To assess differences in OS, the log-rank test, Cox proportional hazards regression, and propensity score matching were used. RESULTS We identified 4015 patients; 2593 (64.6%) underwent R0 resection and 1422 (35.4%) underwent R1 resection. The most common histology was liposarcoma (2,371, 59.1%), median age was 60 years, and median follow up was 67 months. Median OS for R0 vs. R1 patients was 92 and 70 months, respectively (log-rank p < .001). Pre-operative RT was associated with increased probability of R0 resection (68.0% vs. 57.2%, p = .012). Multivariable regression showed R0 vs. R1 resection (HR 0.70, 95% CI 0.60-0.81, p < .001) was associated with improved survival, a finding confirmed on propensity score matching. Other significant predictors of OS included low tumor grade, younger age, smaller tumor size, liposarcoma histology, and receipt of RT (HR 0.81, 95% CI 0.70-0.93, p = .016). CONCLUSIONS Patients who undergo R0 resection for RP STS appear to experience superior OS compared with patients who had R1 resections.
Collapse
|
43
|
Abstract
Sarcomas are a heterogeneous group of rare tumors that originate from mesenchymal tissue. Radical R0 resection is the only curative option, which is especially challenging in retroperitoneal or intra-abdominal sarcomas. This article describes the current data on optimal interdisciplinary and primarily surgical therapy of visceral sarcomas. Surgical resection of retroperitoneal sarcomas must be performed according to the principle of radical compartmental resection, i.e. with complete excision of the mass along with en bloc visceral resection of adjacent organs and tissues covering the tumor, which also contains any not obviously infiltrated neighboring organs. The main objective is R0 resection without opening the tumor capsule in the primary operation because the best long-term results can be achieved with this approach.
Collapse
Affiliation(s)
- J Kirchberg
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - J Weitz
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| |
Collapse
|
44
|
Lane WO, Cramer CK, Nussbaum DP, Speicher PJ, Gulack BC, Czito BG, Kirsch DG, Tyler DS, Blazer DG. Analysis of perioperative radiation therapy in the surgical treatment of primary and recurrent retroperitoneal sarcoma. J Surg Oncol 2015; 112:352-8. [DOI: 10.1002/jso.23996] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 07/18/2015] [Indexed: 01/16/2023]
Affiliation(s)
- Whitney O. Lane
- Department of Surgery; Duke University Medical Center; Durham North Carolina
| | - Christina K. Cramer
- Department of Radiation Oncology; Duke University Medical Center; Durham North Carolina
| | - Daniel P. Nussbaum
- Department of Surgery; Duke University Medical Center; Durham North Carolina
| | - Paul J. Speicher
- Department of Surgery; Duke University Medical Center; Durham North Carolina
| | - Brian C. Gulack
- Department of Surgery; Duke University Medical Center; Durham North Carolina
| | - Brian G. Czito
- Department of Radiation Oncology; Duke University Medical Center; Durham North Carolina
| | - David G. Kirsch
- Department of Surgery; Duke University Medical Center; Durham North Carolina
| | - Douglas S. Tyler
- Department of Surgery; Duke University Medical Center; Durham North Carolina
| | - Dan G. Blazer
- Department of Surgery; Duke University Medical Center; Durham North Carolina
| |
Collapse
|