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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.
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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
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Jo SJ, Park SSW, Yoo GS, Kim KD, Lim SH, Kim J, Kim MJ, Yu JI, Park JB, Lee KW. Effect of pre-operative radiation therapy on surgical outcome in retroperitoneal sarcoma. Front Surg 2023; 10:1209698. [PMID: 37377670 PMCID: PMC10291121 DOI: 10.3389/fsurg.2023.1209698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Background A high rate of locoregional recurrence is one of the major difficulties in successful treatment of retroperitoneal sarcoma (RPS). Although pre-operative radiation therapy (RT) is considered a potential way to improve local recurrence, concerns about the associated treatment toxicity and risk of peri-operative complications need to be addressed. Hence, this study investigates the safety of pre-operative RT (preRTx) for RPS. Methods A cohort of 198 patients with RPS who had undergone both surgery and RT was analyzed for peri-operative complications. They were divided into three groups according to the RT scheme: (1) preRTx group, (2) post-operative RT without tissue expander, and (3) post-operative RT with tissue expander. Results The preRTx was overall well tolerated and did not affect the R2 resection rate, operative time, and severe post-operative complications. However, the preRTx group was associated with higher incidence of post-operative transfusion and admission to intensive care unit (p = 0.013 and p = 0.036, respectively), where preRTx was an independent risk factor only for the post-operative transfusion (p = 0.009) in multivariate analysis. The median radiation dose was the highest in preRTx group, although no significant difference was demonstrated in overall survival and local recurrence rate. Conclusion This study suggests that the preRTx does not add significant post-operative morbidity to the patients with RPS. In addition, radiation dose elevation is achievable with the pre-operative RT. However, a meticulous intra-operative bleeding control is recommended in those patients, and further high-quality trials are warranted to evaluate the long-term oncological outcomes.
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Affiliation(s)
- Sung Jun Jo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sean S W Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeong Deok Kim
- Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - So Hee Lim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jinseob Kim
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Min Jung Kim
- Department of Surgery, Seoul Medical Center, Seoul, Republic of Korea
| | - Jeong Il Yu
- Department of Surgery, Seoul Medical Center, Seoul, Republic of Korea
| | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyo Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Mor E, Assaf D, Shemla S, Ben-Ami E, Halfon M, Laks S, Perelson D, Zippel D, Ben-Yaacov A, Lawrence Y, Symon Z, Nissan A, Adileh M. IOeRT in retroperitoneal sarcoma: Towards more organ preservation with comparable oncological outcomes. Surg Oncol 2023; 48:101940. [PMID: 37079981 DOI: 10.1016/j.suronc.2023.101940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/25/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Retroperitoneal sarcomas (RPS) present a surgical challenge with high rates of local recurrence (LR). We investigated the role of intraoperative electron radiotherapy (IOeRT) in reducing LR after surgical resection of RPS. METHODS A retrospective analysis of all patients who underwent surgical resection for RPS between 2014 and 2021 at a tertiary academic referral center (n = 172). Patients included underwent surgical resection of their RPS and received IOeRT (n = 36) and were compared by case control matching to patients with similar tumor characteristics (recurrence status and tumor grade) that did not receive IOeRT (n = 36). RESULTS The median length of hospitalization was 8 days (range, 4-34) in the IOeRT group and 10 days (range, 2-42) in the non-IOeRT group (p = 0.25). The mean operating room (OR) time was 4h (±1.3) and 4h (±1.9) in the IOeRT and non-IOeRT groups respectively, (p = 0.37). Complete resection with R0 margins was achieved in 30 patients (83.3%) and 24 patients (66.6%) in the IOeRT and non-IOeRT groups, respectively (p = 0.1). R1 resection was achieved in 6 patients (16.6%) and 12 patients (33.3%) respectively, (p = 0.1). The resected organ weighted score was significantly different between the groups; score 0 observed in 19 (52.7%) patients in the IOeRT group and 3 (8.3%) in the non-IOeRT group (p < 0.001), score 1 observed in 7 (19.4%) in the IOeRT group and 17 (47.2%) in the non-IOeRT group (p = 0.012). The rate of severe complications (CD score>3) did not differ between the groups, 5 (13.8%) patients in the IOeRT group and 9 (25%) patients in the non-IOeRT group (p = 0.23). No radiation associated complications were noted. The 2-year local recurrence free survival (LRFS) was 75.9% in the IOeRT group and 60.3% in the non-IOeRT group (p = 0.4). The 2-year IOeRT field recurrent free survival (IRFS) was 88.4% in the IOeRT group and 60.3% in the non-IOeRT group (p = 0.04). CONCLUSIONS The use of IOeRT did not increase the rate of surgical complications and was associated with superior local control in the radiation field, improved organ preservation without an impact on overall survival.
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Li X, Dong R, Xiao M, Min L, Luo C. Neoadjuvant radiotherapy for resectable retroperitoneal sarcoma: a meta-analysis. Radiat Oncol 2022; 17:215. [PMID: 36578082 PMCID: PMC9795731 DOI: 10.1186/s13014-022-02159-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/14/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Neoadjuvant radiotherapy (NRT) for resectable retroperitoneal sarcoma (RPS) has been shown to be systematically feasible. Whether NRT has equivalent or better clinical effects compared to surgery alone for RPS patients remains controversial. METHODS We performed a systematic literature search of PubMed, Web of Science, Embase, ASCO Abstracts, and Cochrane library databases for studies in humans with defined search terms. Articles were independently assessed by 2 reviewers, and only randomized controlled trials and cohort studies were included. The hazard ratios (HRs) of overall survival (OS), recurrence-free survival (RFS), and local recurrence (LR) were extracted from included studies. Heterogeneity among study-specific HRs was assessed by the Q statistic and I2 statistic. Overall HR was assessed by random-effects or fixed-effects models. Publication bias was tested by Begg's tests, and the quality of each study was assessed with the Newcastle Ottawa Scale. RESULTS A total of 12 eligible studies with 7778 resectable RPS patients were finally included in this study. The pooled analysis revealed the distinct advantages of NRT as compared to surgery alone, including longer OS (HR = 0.81, P < 0.001), longer RFS (HR = 0.58, P = 0.04), and lower LR (HR = 0.70, P = 0.03). No evidence of publication bias was observed. CONCLUSION NRT is likely to be beneficial for resectable RPS patients in terms of OS and RFS. However, more multicenter clinical trials are needed to confirm these findings.
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Affiliation(s)
- Xiangji Li
- grid.449412.eDepartment of Retroperitoneal Tumor Surgery, Peking University International Hospital, 1 Shengmingyuan Road, Changping District, Beijing, People’s Republic of China ,grid.411610.30000 0004 1764 2878Department of Gastroenterology, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ruihan Dong
- grid.414367.3Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Mengmeng Xiao
- grid.449412.eDepartment of Retroperitoneal Tumor Surgery, Peking University International Hospital, 1 Shengmingyuan Road, Changping District, Beijing, People’s Republic of China
| | - Li Min
- grid.411610.30000 0004 1764 2878Department of Gastroenterology, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Chenghua Luo
- grid.449412.eDepartment of Retroperitoneal Tumor Surgery, Peking University International Hospital, 1 Shengmingyuan Road, Changping District, Beijing, People’s Republic of China
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Roeder F, Morillo V, Saleh-Ebrahimi L, Calvo FA, Poortmans P, Ferrer Albiach C. Intraoperative radiation therapy (IORT) for soft tissue sarcoma - ESTRO IORT Task Force/ACROP recommendations. Radiother Oncol 2020; 150:293-302. [PMID: 32679306 DOI: 10.1016/j.radonc.2020.07.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To describe guidelines for the use of intraoperative radiation therapy (IORT) in the treatment of soft-tissue sarcomas (STS). METHODS A panel of experts in the field performed a systematic literature review, supplemented their clinical experience and developed recommendations for the use of IORT in the treatment of STS. RESULTS Based on the evidence from the systematic literature review and the clinical experience of the panel members, recommendations regarding patient selection, incorporation into multimodal treatment concepts and the IORT procedure itself are made. The rationale for IORT in extremity and retroperitoneal STS is summarized and results of the major series in terms of patient and treatment characteristics, oncological outcome and toxicity are presented. We define surgical factors, volumes for irradiation, technical requirements, dose prescription, recording and reporting, treatment delivery and care during the course of IORT covering the main IORT techniques used for the treatment of STS. In extremity STS, evidence originates from a few small prospective and mainly from retrospective single centre studies. Based on those reports, IORT containing-approaches result in very high local control rates with low rates of acute and late toxicity. In retroperitoneal sarcomas, evidence is derived from one prospective randomized trial, a few prospective and a large number of retrospective studies. The randomized trial compared IORT combined with moderate doses of postoperative external-beam radiation therapy (EBRT) to high-dose postoperative EBRT alone after gross total resection, clearly favouring the IORT-containing approach. These results have been confirmed by the prospective and retrospective studies, which similarly showed high local control rates with acceptable toxicity, mainly favouring combinations of preoperative EBRT and IORT. CONCLUSIONS IORT-containing approaches result in high rates of local control with low to acceptable toxicity rates. Based on the available evidence, we made recommendations for the use of IORT in STS. Clinicians and researchers are encouraged to use these guidelines in clinical routine as well as in the design of future trials.
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Affiliation(s)
- Falk Roeder
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria.
| | - Virginia Morillo
- Department of Radiation Oncology, Instituto de Oncologia, Hospital Provincial de Castellon, Spain
| | | | - Felipe A Calvo
- Department of Oncology, Clínica Universidad de Navarra, Madrid, Spain
| | | | - Carlos Ferrer Albiach
- Department of Radiation Oncology, Instituto de Oncologia, Hospital Provincial de Castellon, Spain
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Cytoreductive Surgery for Metastatic Gastrointestinal Stromal Tumors Treated With Tyrosine Kinase Inhibitors: A 2-institutional Analysis. Ann Surg 2019; 268:296-302. [PMID: 28448384 DOI: 10.1097/sla.0000000000002281] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To refine treatment recommendations for patients with metastatic gastrointestinal stromal tumors (GISTs) treated with tyrosine kinase inhibitors (TKIs) and surgery. BACKGROUND Early reports suggested that patients with metastatic GIST responding to TKIs treated with surgery may have favorable outcomes. However, identification of prognostic factors was limited by small cohorts. METHODS Progression-free survival (PFS) and overall survival (OS) from time of surgery and from start of initial TKI was determined. Multivariate analysis was conducted on all patients undergoing GIST metastasectomy between 2001 and 2014 at 2 institutions. RESULTS We performed 400 operations on 323 patients with metastatic GIST on TKIs. Radiographic response at time of surgery was classified as responsive disease (RD, n = 64, 16%), stable disease (SD, n = 100, 25%), unifocal progressive disease (UPD, n = 132, 33%), and multifocal progressive disease (MPD, n = 104, 26%). For patients on imatinib before surgery, radiographic response was predictive of PFS from time of surgery (RD 36 months, SD 30 months, UPD 11 months, MPD 6 months; P < 0.001) and from imatinib initiation (RD 71 months, SD 51 months, UPD 47 months, MPD 33 months; P < 0.001). Radiographic response was predictive of OS from time of surgery (RD not reached, SD 110 months, UPD 59 months, MPD 24 months; P < 0.001), and from imatinib initiation (RD not reached, SD 144 months, UPD 105 months, MPD 66 months; P = 0.005). Radiographic response was not predictive of PFS/OS for patients on sunitinib. Metastatic mitotic index ≥5/50 HPF, MPD, and R2 resection were prognostic of worse PFS/OS; primary mutation was not. CONCLUSIONS Surgery in metastatic GIST patients in the absence of MPD on imatinib is associated with outcomes at least comparable with second-line sunitinib and may be considered in select patients.
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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%.
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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
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Mastoraki A, Schizas D, Papanikolaou IS, Bagias G, Machairas N, Agrogiannis G, Liakakos T, Arkadopoulos N. Management of primary retroperitoneal synovial sarcoma: A case report and review of literature. World J Gastrointest Surg 2019; 11:27-33. [PMID: 30705737 PMCID: PMC6354068 DOI: 10.4240/wjgs.v11.i1.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/11/2018] [Accepted: 12/30/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Synovial sarcoma (SS) is a rare type of soft tissue sarcoma that is usually developed from areas where synovial tissue exists, especially at the extremities. Nevertheless, several cases of retroperitoneal SS (RSS) have been described. We herein report a case of RSS presented in our institution.
CASE SUMMARY A 69-year-old female patient was admitted with a large, palpable, firm mass in the right abdominal space SS. Computerized tomography scan depicted a concentric, sharply marinated retro-peritoneal lesion which was displacing the right kidney and the lower edge of the liver. Subsequently, the patient underwent surgical excision of the mass with additional right nephrectomy and resection of the right adrenal gland and a part of the diaphragm. The final histological diagnosis of the tumour was grade II monophasic RSS.
CONCLUSION RSS is encountered in the biphasic type, the monophasic fibrous, and the monophasic epithelial category as well. Relevant clinical manifestations are not always documented at early stages. Therefore, the final diagnosis is posed after complete histological examination taking into consideration the results of immunochemistry and genetic analysis. Therapeutic approach happens often late when metastases at the lungs and the liver are apparent. Thus, 5-year survival rates remain low.
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Affiliation(s)
- Aikaterini Mastoraki
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens 12462, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens 11527, Greece
| | - Ioannis S Papanikolaou
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens 12462, Greece
| | - George Bagias
- Hannover Medical School, Clinic for General, Visceral and Transplant Surgery, Hannover 30625, Germany
| | - Nikolaos Machairas
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens 12462, Greece
| | - George Agrogiannis
- 1st Department of Pathology, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Theodore Liakakos
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens 11527, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens 12462, Greece
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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.
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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]
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Cheng H, Miura JT, Lalehzari M, Rajeev R, Donahue AE, Bedi M, Gamblin TC, Turaga KK, Johnston FM. Neoadjuvant radiotherapy for retroperitoneal sarcoma: A systematic review. J Surg Oncol 2016; 113:628-34. [PMID: 26990903 DOI: 10.1002/jso.24221] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/28/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES The multi-modal treatment of retroperitoneal sarcoma has seen increased use of neoadjuvant radiation. However, its effect on local recurrence and survival remain controversial. We aimed to synthesize and evaluate the literature. METHODS The review was conducted according the recommendation of the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) group with pre-specified inclusion and exclusion criteria. RESULTS Of 8,701 citations collected, 15 articles reported on 464 patients. The median age was 56 years (45-64). The predominant histological subtypes were liposarcoma (51.54%) and leiomyosarcoma (23.26%). Tumor differentiation composed of 37.1% well-, 12.8% moderate-, 46.0% poorly-, and 4.1% undifferentiated. Most studies featured external beam radiation therapy (EBRT) treatment regimen with some who included patients treated with IMRT instead. Median follow-up averaged 41.4 months (19-106 months). Median 5-year OS, PFS, and LRR rates were 58%, 71.5%, and 25%. Using the NCI CTCAE, toxicities from Grade 1 (Mild) through Grade 5 (death) were experienced by 18.8%, 10.2%, 16.3%, 0.7%, and 1.6% of patients. CONCLUSIONS NART is a safe to use for RPS, but its effect toward survival and local control remains unclear. Without randomized control trials, common reporting criteria for pro- and retrospective studies are needed to allow comparison between studies. J. Surg. Oncol. 2016;113:628-634. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hao Cheng
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John T Miura
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mona Lalehzari
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rahul Rajeev
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy E Donahue
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Meena Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - T Clark Gamblin
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kiran K Turaga
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Fabian M Johnston
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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12
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Long-term Oncologic Outcomes After Neoadjuvant Radiation Therapy for Retroperitoneal Sarcomas. Ann Surg 2015; 262:163-70. [PMID: 25185464 DOI: 10.1097/sla.0000000000000840] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate long-term survival among patients undergoing radiation therapy (RT), followed by surgical resection of retroperitoneal sarcomas (RPS). BACKGROUND Despite a lack of level 1 evidence supporting neoadjuvant RT for RPS, its use has increased substantially over the past decade. METHODS The 1998-2011 National Cancer Data Base was queried to identify patients who underwent resection of RPS. Subjects were grouped by use of neoadjuvant RT. Perioperative variables and outcomes were compared. Multivariable logistic regression was performed to assess predictors of neoadjuvant RT. Groups were propensity matched using a 2:1 nearest neighbor algorithm and short-term outcomes were compared. Finally, long-term survival was evaluated using the Kaplan-Meier method, with comparisons based on the log-rank test. RESULTS A total of 11,324 patients were identified. Neoadjuvant RT was administered to 696 patients (6.1%). During the study period, preoperative RT use increased from 4% to nearly 15%. Male sex, tumor size larger than 5 cm, treatment at an academic/research program, and higher tumor grade all predicted neoadjuvant RT administration. After propensity matching, the only difference in baseline characteristics was the use of neoadjuvant chemotherapy. Although neoadjuvant RT was associated with a higher rate of negative margins (77.5% vs 73.0%; P = 0.014), there was no corresponding improvement in 5-year survival (53.2% vs 54.2%; P = 0.695). CONCLUSIONS Despite the increasing use of neoadjuvant RT for patients with RPS, the survival benefit associated with this treatment modality remains unclear. Continued investigation is needed to better define the role of RT among patients with RPS.
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Matthyssens LE, Creytens D, Ceelen WP. Retroperitoneal liposarcoma: current insights in diagnosis and treatment. Front Surg 2015; 2:4. [PMID: 25713799 PMCID: PMC4322543 DOI: 10.3389/fsurg.2015.00004] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/28/2015] [Indexed: 12/15/2022] Open
Abstract
Retroperitoneal liposarcoma (RLS) is a rare, biologically heterogeneous tumor that present considerable challenges due to its size and deep location. As a consequence, the majority of patients with high-grade RLS will develop locally recurrent disease following surgery, and this constitutes the cause of death in most patients. Here, we review current insights and controversies regarding histology, molecular biology, extent of surgery, (neo)adjuvant treatment, and systemic treatment including novel targeted agents in RLS.
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Affiliation(s)
| | - David Creytens
- Department of Pathology, Ghent University Hospital , Ghent , Belgium
| | - Wim P Ceelen
- Department of Surgery, Ghent University Hospital , Ghent , Belgium
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14
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15
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Fairweather M, Wang J, Devlin PM, Hansen J, Baldini EH, Ready JE, Sugarbaker DJ, Bertagnolli MM, Raut CP. Safety and efficacy of radiation dose delivered via iodine-125 brachytherapy mesh implantation for deep cavity sarcomas. Ann Surg Oncol 2014; 22:1455-63. [PMID: 25341749 DOI: 10.1245/s10434-014-4171-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Radiation delivered as brachytherapy (BRT) via catheters placed during extremity soft tissue sarcoma (STS) resection results in acceptable local control rates; however, there are limitations in deep cavities. (125)I seeds embedded in mesh provide a flexible BRT platform that may be contoured to irregular deep cavities surfaces, but the risks and benefits are unknown. METHODS Patients with thoracic, abdominal, pelvic, retroperitoneal, and deep truncal STS undergoing resection and implantation of permanent (125)I mesh BRT at our institution were reviewed. Local recurrence rates within the tumor bed covered by mesh (in field) and postoperative complications were analyzed. RESULTS Between 2000 and 2010, a total of 46 patients were treated for primary (n = 8, 17 %) or recurrent (n = 38, 83 %) deep cavity STS (median follow-up 34.8 months); 74 % received external-beam radiotherapy for this or a prior presentation. In-field recurrences were observed in 9 patients (19.5 %). Crude cumulative incidences of in-field, regional, and distant recurrences at 5 years were 26.3, 54.2, and 54.1 %, respectively. 5-year overall survival rate was 47.2 %; median survival was 44.0 months. Twenty-two patients (48 %) experienced complications, half of whom (24 %) developed grade III/IV complications requiring percutaneous intervention (n = 6) or reoperation (n = 5) at a median of 35.5 days. There were no postoperative deaths. CONCLUSIONS To our knowledge, this is the first study to report safety and efficacy for permanent (125)I mesh BRT implantation after resection of deep cavity STS. Local in-field recurrence rates were relatively low in this high-risk population. However, 24 % developed complications requiring intervention. (125)I mesh BRT appears effective, but it should be used with caution.
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Affiliation(s)
- Mark Fairweather
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA,
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16
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Roeder F, Ulrich A, Habl G, Uhl M, Saleh-Ebrahimi L, Huber PE, Schulz-Ertner D, Nikoghosyan AV, Alldinger I, Krempien R, Mechtersheimer G, Hensley FW, Debus J, Bischof M. Clinical phase I/II trial to investigate preoperative dose-escalated intensity-modulated radiation therapy (IMRT) and intraoperative radiation therapy (IORT) in patients with retroperitoneal soft tissue sarcoma: interim analysis. BMC Cancer 2014; 14:617. [PMID: 25163595 PMCID: PMC4156610 DOI: 10.1186/1471-2407-14-617] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/20/2014] [Indexed: 12/04/2022] Open
Abstract
Background To report an unplanned interim analysis of a prospective, one-armed, single center phase I/II trial (NCT01566123). Methods Between 2007 and 2013, 27 patients (pts) with primary/recurrent retroperitoneal sarcomas (size > 5 cm, M0, at least marginally resectable) were enrolled. The protocol attempted neoadjuvant IMRT using an integrated boost with doses of 45–50 Gy to PTV and 50–56 Gy to GTV in 25 fractions, followed by surgery and IOERT (10–12 Gy). Primary endpoint was 5-year-LC, secondary endpoints included PFS, OS, resectability, and acute/late toxicity. The majority of patients showed high grade lesions (FNCLCC G1:18%, G2:52%, G3:30%), predominantly liposarcomas (70%). Median tumor size was 15 cm (6–31). Results Median follow-up was 33 months (5–75). Neoadjuvant IMRT was performed as planned (median dose 50 Gy, 26–55) in all except 2 pts (93%). Gross total resection was feasible in all except one patient. Final margin status was R0 in 6 (22%) and R1 in 20 pts (74%). Contiguous-organ resection was needed in all grossly resected patients. IOERT was performed in 23 pts (85%) with a median dose of 12 Gy (10–20 Gy). We observed 7 local recurrences, transferring into estimated 3- and 5-year-LC rates of 72%. Two were located outside the EBRT area and two were observed after more than 5 years. Locally recurrent situation had a significantly negative impact on local control. Distant failure was found in 8 pts, resulting in 3- and 5-year-DC rates of 63%. Patients with leiomyosarcoma had a significantly increased risk of distant failure. Estimated 3- and 5-year-rates were 40% for PFS and 74% for OS. Severe acute toxicity (grade 3) was present in 4 pts (15%). Severe postoperative complications were found in 9 pts (33%), of whom 2 finally died after multiple re-interventions. Severe late toxicity (grade 3) was scored in 6% of surviving patients after 1 year and none after 2 years. Conclusion Combination of neoadjuvant IMRT, surgery and IOERT is feasible with acceptable toxicity and yields good results in terms of LC and OS in patients with high-risk retroperitoneal sarcomas. Long term follow-up seems mandatory given the observation of late recurrences. Accrual of patients will be continued with extended follow-up. Trial registration NCT01566123.
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Affiliation(s)
- Falk Roeder
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
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17
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Nussbaum DP, Speicher PJ, Gulack BC, Ganapathi AM, Keenan JE, Stinnett SS, Kirsch DG, Tyler DS, Blazer DG. The effect of neoadjuvant radiation therapy on perioperative outcomes among patients undergoing resection of retroperitoneal sarcomas. Surg Oncol 2014; 23:155-60. [PMID: 25085344 DOI: 10.1016/j.suronc.2014.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/09/2014] [Accepted: 07/05/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Neoadjuvant radiation therapy (RT) has several theoretical benefits in the treatment of retroperitoneal sarcoma (RPS), but concerns remain about treatment toxicity and perioperative morbidity. There are limited data regarding its effect on perioperative outcomes, most of which come from small, single-institution series. The purpose of this study was to evaluate the short-term (30-day) postoperative morbidity and mortality associated with neoadjuvant RT following resection of RPS. METHODS The 2005-2011 National Surgical Quality Improvement Program Participant User File was queried for patients undergoing RPS resection. Subjects were stratified by use of neoadjuvant RT. Perioperative variables and short-term 30-day outcomes were compared. Groups were then propensity matched using a 2:1 nearest-neighbor algorithm and multivariable logistic regression was performed to assess neoadjuvant RT as a predictor of short-term 30-day outcomes. RESULTS A total of 785 patients were identified. Neoadjuvant RT was administered to 71 (9.0%). Patients who received neoadjuvant RT were slightly younger (56 vs. 62 years, p < 0.001), but otherwise the groups were similar. After propensity matching, all baseline characteristics were highly similar. Median operative time was longer in the neoadjuvant RT group (279 vs. 219 min, p < 0.01), but there were no differences in mortality (1.4 vs. 2.1%, p = 0.71), major complications (28.2 vs. 25.2%, p = 0.69), overall complications (35.2 vs.33.2%, p = 0.83), early reoperation (5.6 vs. 7.4%, p = 0.81), or length of stay (7 vs. 7 days, p = 0.56). Following further adjustment with logistic regression, we confirmed that there were no differences in 30-day mortality or morbidity between patients who did and did not receive neoadjuvant RT. CONCLUSIONS Neoadjuvant RT does not appear to increase short-term (30-day) morbidity or mortality following resection of RPS. Continued investigation is needed to better define the role for radiation therapy among patients with this disease.
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Affiliation(s)
| | | | | | | | | | - Sandra S Stinnett
- Duke University, Department of Biostatistics and Bioinformatics, USA
| | - David G Kirsch
- Duke University, Department of Radiation Oncology and Department of Pharmacology & Cancer Biology, USA
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18
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Radiation therapy for retroperitoneal sarcoma. Radiol Med 2014; 119:790-802. [DOI: 10.1007/s11547-013-0350-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 03/04/2013] [Indexed: 11/28/2022]
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19
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Bartlett EK, Roses RE, Meise C, Fraker DL, Kelz RR, Karakousis GC. Preoperative radiation for retroperitoneal sarcoma is not associated with increased early postoperative morbidity. J Surg Oncol 2013; 109:606-11. [PMID: 24374652 DOI: 10.1002/jso.23534] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 11/22/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Preoperative radiation (PR) in the management of retroperitoneal sarcoma (RPS) is controversial. Concern for increased perioperative morbidity may influence the decision to recommend PR. Here we compare 30-day morbidity and mortality (M + M) after resection of RPS with and without PR. METHODS Patients undergoing resection of RPS were identified using ACS NSQIP (2005-2011). Patients with known PR status within 90 days of operation were included. Univariate and multivariate logistic regression analyses were performed to identify factors associated with M + M. RESULTS Of 696 patients operated on for RPS, 70 (10%) underwent PR. PR patients were younger (mean 55 vs. 61 years), more frequently had hypoalbuminemia (<3 g/dl; 19% vs. 10%), concomitant kidney (29% vs. 18%), or pancreas resections (11% vs. 5%), longer operations (mean 327 vs. 253 min), and increased transfusion requirements (mean 4.1 vs. 2.1 units, each P < 0.05). Despite these differences, the M + M rate (31% with vs. 30% without PR, P = 0.75) was comparable between the two groups. After adjustment for confounders, no association was identified between PR and M + M. CONCLUSIONS In a national cohort of RPS patients, PR is infrequently utilized. Despite the increased prevalence of multiple risk factors, PR patients do not have an increased 30-day postoperative M + M.
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Affiliation(s)
- Edmund K Bartlett
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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20
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Shiraev T, Pasricha SS, Choong P, Schlicht S, van Rijswijk CSP, Dimmick S, Stuckey S, Anderson SE. Retroperitoneal sarcomas: A review of disease spectrum, radiological features, characterisation and management. J Med Imaging Radiat Oncol 2013; 57:687-700. [DOI: 10.1111/1754-9485.12123] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 09/02/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Timothy Shiraev
- School of Medicine; University of Notre Dame; Sydney New South Wales Australia
| | - Sundeep Singh Pasricha
- Southern Health; Department of Diagnostic Imaging; Monash Medical Centre; Melbourne Victoria Australia
| | - Peter Choong
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
- Department of Orthopaedics; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Bone and Soft Tissue Tumour Unit; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Stephen Schlicht
- Department of Medical Imaging; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | | | - Simon Dimmick
- School of Medicine; University of Notre Dame; Sydney New South Wales Australia
- Department of Radiology; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Stephen Stuckey
- Southern Health; Department of Diagnostic Imaging; Monash Medical Centre; Melbourne Victoria Australia
- Southern Clinical School; Faculty of Medicine; Nursing and Health Sciences; Monash University; Melbourne Victoria Australia
| | - Suzanne E Anderson
- School of Medicine; University of Notre Dame; Sydney New South Wales Australia
- Southern Health; Department of Diagnostic Imaging; Monash Medical Centre; Melbourne Victoria Australia
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21
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Sweeting RS, Deal AM, Llaguna OH, Bednarski BK, Meyers MO, Yeh JJ, Calvo BF, Tepper JE, Kim HJ. Intraoperative electron radiation therapy as an important treatment modality in retroperitoneal sarcoma. J Surg Res 2013; 185:245-9. [PMID: 23769633 DOI: 10.1016/j.jss.2013.05.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 04/18/2013] [Accepted: 05/03/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Local recurrence (LR) rates in patients with retroperitoneal sarcoma (RPS) are high, ranging from 40% to 80%, with no definitive studies describing the best way to administer radiation. Intraoperative electron beam radiation therapy (IOERT) provides a theoretical advantage for access to the tumor bed with reduced toxicity to surrounding structures. The goal of this study was to evaluate the role of IOERT in high-risk patients. METHODS An institutional review board approved, single institution sarcoma database was queried to identify patients who received IOERT for treatment of RPS from 2/2001 to 1/2009. Data were analyzed using the Kaplan-Meier method, Cox regression, and Fisher Exact tests. RESULTS Eighteen patients (median age 51 y, 25-76 y) underwent tumor resection with IOERT (median dose 1250 cGy) for primary (n = 13) and recurrent (n = 5) RPS. Seventeen patients received neoadjuvant radiotherapy. Eight high-grade and 10 low-grade tumors were identified. Median tumor size was 15 cm. Four patients died and two in the perioperative period. Median follow-up of survivors was 3.6 y. Five patients (31%) developed an LR in the irradiated field. Three patients with primary disease (25%) and two (50%) with recurrent disease developed an LR (P = 0.5). Four patients with high-grade tumors (57%) and one with a low-grade tumor (11%) developed an LR (P = 0.1). The 2- and 5-y OS rates were 100% and 72%. Two- and 5-y LR rates were 13% and 36%. CONCLUSIONS Using a multidisciplinary approach, we have achieved low LR rates in our high-risk patient population indicating that IOERT may play an important role in managing these patients.
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Affiliation(s)
- Raeshell S Sweeting
- Division of Surgical Oncology, University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
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22
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Mullinax JE, Zager JS, Gonzalez RJ. Current diagnosis and management of retroperitoneal sarcoma. Cancer Control 2011; 18:177-87. [PMID: 21666580 DOI: 10.1177/107327481101800305] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Retroperitoneal sarcomas are rare neoplasms that often present with multivisceral involvement. Treatment for these tumors requires careful decision making requiring a combination of surgery, chemotherapy, and radiation therapy. METHODS We reviewed the scientific literature pertaining to the diagnosis and management of retroperitoneal sarcomas. We also identify recent developments in treatment and discuss future trends in the care of patients with this disease. RESULTS Retroperitoneal tumors often present as large, locally advanced lesions. Evaluation of these tumors requires careful consideration of a multimodality approach. Retrospective data and historical prospective series have demonstrated the survival benefit of radical resection for these tumors with en bloc resection of involved structures. Compartmental resections in the retroperitoneum along with debulking of high-grade disease and regional therapy are controversial approaches with significant morbidity that can lead to long-term survival. The application of neoadjuvant and adjuvant therapies in select tumor histologies may improve local control and survival. CONCLUSIONS The management of retroperitoneal sarcomas requires a multidisciplinary approach and is best accomplished at high-volume centers specializing in the care of patients with these complex malignancies. Current data suggest that radical resection remains the only chance for cure and that chemotherapy and radiation therapy may confer a survival benefit.
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Affiliation(s)
- John E Mullinax
- Department of Surgery at The University of South Florida College of Medicine, Tampa, Florida, USA
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23
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Llacer-Moscardo C, Quenet F, Azria D, Fenoglietto P. Feasibility study of volumetric modulated arc therapy for the treatment of retroperitoneal sarcomas. Radiat Oncol 2010; 5:83. [PMID: 20854661 PMCID: PMC2949680 DOI: 10.1186/1748-717x-5-83] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 09/20/2010] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Radiotherapy for retroperitoneal sarcomas remains controversial and a technical challenge considering the threshold of contiguous critical organs tolerance. We performed consecutive RapidArc dosimetric plans in preoperative or postoperative setting. METHODS A dosimetric study was carried out from six preoperative (group A) and four postoperative (group B) CT-scans, performed in 7 patients.Prescribed dose was 45 and 50 Gy for groups A and B, respectively. The planning target volume (PTV) was defined as the clinical target volume (CTV) plus 5 mm. The CTV encompassed the gross tumor volume (GTV) plus 10 mm or the tumoral bed. The dosimetric plans were optimized on a RapidArc Eclipse console using the progressive resolution algorithm, PRO version 8.8. Normalization method allowed the coverage of 99% of the PTV by 95% of the dose. RESULTS Mean PTV were 2318.5 ± 2223.9 cc [range 348-6198 cc] and 698.3 ± 216.6 cc [range 463 -933 cc] for groups A and B, respectively. Plans were optimized for single arcs in group B and for single or two arcs in group A. The contralateral kidney volume receiving 5 Gy (V5Gy) was 21.5 ± 23.3% [range 0-55%] and 3.1 ± 2.6% [range 0-7.3%] for groups A and B, respectively. The mean dose received by 1% of the kidney (D1%) was 5.6 ± 2.4 Gy [range 3.6 -7.6 Gy] for group A and 5.4 ± 0.7 Gy [range 4.3-6 Gy] for group B. The volume of small bowel excluding the PTV (small bowel-PTV) that received 40 Gy and 30 Gy (V40Gy and V30Gy) in group A were 7.5 ± 4.4% [range 5.4-14.1%] and 18.5 ± 7.1% [range 10-30.4%], respectively.In group B, small bowel-PTV V40Gy and V30Gy were 4.7 ± 3.3% [range 3.3-8%] and 21.6 ± 7.5% [range 9.4-30%] respectively. In a second step, we treated two patients in the postoperative group. Treatment time delivery with one arc was 74 seconds. No severe acute toxicity was observed. CONCLUSION RapidArc technology for retroperitoneal sarcomas showed acceptable dosimetric results in preoperative or postoperative clinical situation. From the first treated patients, acute tolerability was good to excellent.
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Affiliation(s)
- Carmen Llacer-Moscardo
- Department of Radiation Oncology, CRLC Val D'Aurelle Paul-Lamarque, Montpellier, France.
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24
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Gadgeel SM, Harlan LC, Zeruto CA, Osswald M, Schwartz AG. Patterns of care in a population-based sample of soft tissue sarcoma patients in the United States. Cancer 2009; 115:2744-54. [PMID: 19396819 PMCID: PMC2778465 DOI: 10.1002/cncr.24307] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Soft tissue sarcomas (STS) are relatively uncommon tumors. Data regarding the patterns of care of patients with STS and its consistency with available guidelines are relatively sparse. The authors conducted a detailed analysis of STS patients diagnosed in 2002 and sampled from the Surveillance, Epidemiology, and End Results registries. METHODS The authors sampled 1369 patients with invasive sarcomas. Hospital records were reabstracted, and treating physicians were contacted to verify the therapy provided to each patient. RESULTS The median age of patients was 60 years. There was a slight male predominance among the patients with nongynecologic sarcomas. Fifty percent of the patients had localized stage sarcoma. Most patients received surgery, but negative margins were obtained in only 50% of patients. Complete resection was less frequent in patients >or=50 years old. Radiation therapy was used in 53% of patients with extremity sarcomas but in only 20% to 30% of the patients with sarcomas at other sites. About 27% of all patients received chemotherapy. Tumor grade was significantly associated with the use of radiation and chemotherapy. Surgical resection, tumor grade, tumor size, use of radiation therapy, and age significantly influenced survival. CONCLUSIONS Patterns of care of STS differ based on the site of the tumor. The patterns of care for extremity sarcomas are fairly consistent with the available recommendations, but the patterns of care for other sites are less consistent. In addition to certain tumor characteristics, age of the patient was significantly associated with therapy and patient outcome.
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Grants
- N01-PC-35,141 NCI NIH HHS
- N01-PC-35,142 NCI NIH HHS
- N01-PC-54,405. NCI NIH HHS
- N01-PC-35,138 NCI NIH HHS
- N01PC35135 NCI NIH HHS
- N01PC35137 NCI NIH HHS
- N01PC35138 NCI NIH HHS
- N01-PC-35,133 NCI NIH HHS
- N01PC54402 NCI NIH HHS
- N01-PC-54,402 NCI NIH HHS
- N01PC35145 NCI NIH HHS
- N01PC35136 NCI NIH HHS
- N01PC35139 NCI NIH HHS
- N01PC35141 NCI NIH HHS
- N01PC35143 NCI NIH HHS
- N01PC54405 NCI NIH HHS
- N01-PC-54,404 NCI NIH HHS
- N01-PC-35,145 NCI NIH HHS
- N01-PC-35,135 NCI NIH HHS
- N01 PC065064 NCI NIH HHS
- N01-PC-35,137 NCI NIH HHS
- N01PC35142 NCI NIH HHS
- N01PC54404 NCI NIH HHS
- N01-PC-35,136 NCI NIH HHS
- N01-PC-35,143 NCI NIH HHS
- N01-PC-35,139 NCI NIH HHS
- N01PC35133 NCI NIH HHS
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Affiliation(s)
- Shirish M Gadgeel
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA.
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25
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Schwarzbach MHM, Hohenberger P. Current concepts in the management of retroperitoneal soft tissue sarcoma. Recent Results Cancer Res 2009; 179:301-319. [PMID: 19230548 DOI: 10.1007/978-3-540-77960-5_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Soft tissue sarcomas (STS) in the retroperitoneum are usually diagnosed at the late stages. Surgery is the mainstay of treatment. The technique of resection is standardized. After dissection of the retroperitoneal blood vessel, a retroperitoneal plane of dissection adjacent to the spinal foramina is established in between the layers of the abdominal wall. Complete resection with tumor-free resection margins is the primary goal in retroperitoneal sarcoma surgery. Preoperative assessment of pathoanatomical growth patterns with respect to retroperitoneal vascular structures--as well as to visceral and retroperitoneal organs--influences surgical strategies and thus the surgical outcome. Blood vessel replacement and a multivisceral en bloc approach improve the quality of resection. Blood vessel involvement is stratified in type I (arterial and venous involvement), type II (arterial involvement), type III(venous involvement), and type IV (no vascular involvement). Adjuvant and neoadjuvant treatment options (chemotherapy, targeted therapy, and radiation therapy) are currently being investigated. A prospective randomized phase III trial has shown a positive effect of neoadjuvant chemotherapy combined with regional hyperthermia in disease-free survival, response rate, and local control. Subsets of liposarcomas (myxoid and round cell type) are selectively responsive to novel drugs, such as trabectedin, a DNA-binding agent. Radiotherapy is applied in higher-grade locally advanced retroperitoneal STS. The optimal technique of delivering radiotherapy remains to be determined. The restricted number of patients with retroperitoneal STS and unsatisfying results in local tumor control and long-term survival indicate the need for multi-institutional cooperative studies. An international effort is required to improve the evidence level on multimodal treatment algorithms.
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Affiliation(s)
- Matthias H M Schwarzbach
- Department of Surgery, University Clinic of Mannheim, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany.
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26
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Pisters PWT. Retroperitoneal Sarcomas—An SOS to Colleagues in Europe. Ann Surg Oncol 2007; 14:1787-9. [PMID: 17406946 DOI: 10.1245/s10434-007-9382-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 10/18/2006] [Indexed: 11/18/2022]
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