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Xue G, Wang Z, Liu B, Li C, Lv A, Tian X, Wu J, Qiu H, Hao C. Short- and long-term post-nephrectomy outcomes for retroperitoneal liposarcoma from a high-volume sarcoma center: a propensity score matching analysis. Int J Clin Oncol 2024; 29:1035-1043. [PMID: 38652434 DOI: 10.1007/s10147-024-02530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/06/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Multivisceral en bloc resection with the ipsilateral kidney is commonly performed in patients with retroperitoneal liposarcoma (RLPS). We evaluated the effect of nephrectomy on short- and long-term outcomes in patients with RLPS. METHODS Data from a prospectively maintained database of the Peking University Cancer Hospital Sarcoma Center between April 2011 and August 2022 were analyzed. We classified the RLPS patients who underwent surgery into nephrectomy group (NP) and non-nephrectomy group (non-NP). Patients were matched using a 1:1 propensity score to eliminate baseline differences between groups. Postoperative renal function outcomes, major morbidity, and mortality were analyzed to compare short-term outcomes after nephrectomy. Differences in local recurrence-free survival (LRFS) and overall survival (OS) were compared by Kaplan-Meier analysis with respect to oncological benefits. RESULTS In the matched cohort, patients in the NP group had significantly higher postoperative eGFR and CKD stages, but none required dialysis. Patients between NP and non-NP had a comparable major morbidity (p = 0.820) and 60-day mortality (p = 0.475). Patients in the NP group had a higher 5-year LRFS rates than those in the non-NP group (34.5 vs. 17.8%, p = 0.015), and similar 5-year OS rates (52.4 vs. 47.1%, p = 0.401). Nephrectomy was an independent risk factor for LRFS, but not for major morbidity or OS. CONCLUSIONS RLPS resection with nephrectomy is related to a mild progression of renal impairment; however, dialysis is rare. En bloc nephrectomy for complete resection of RLPS is safe and improves local control.
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Affiliation(s)
- Guoqiang Xue
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Zhen Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Bonan Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Chengpeng Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Ang Lv
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Xiuyun Tian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Jianhui Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Hui Qiu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China.
| | - Chunyi Hao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China.
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Ruff SM, Heh V, Konieczkowski DJ, Onuma A, Dunlop HM, Kim AC, Grignol VP, Contreras CM, Pawlik TM, Pollock R, Beane JD. Radiation therapy for retroperitoneal sarcoma: practice patterns in North America. Radiat Oncol 2024; 19:38. [PMID: 38491404 PMCID: PMC10943830 DOI: 10.1186/s13014-024-02407-8] [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: 11/15/2023] [Accepted: 01/16/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The addition of radiation therapy (RT) to surgery in retroperitoneal sarcoma (RPS) remains controversial. We examined practice patterns in the use of RT for patients with RPS over time in a large, national cohort. METHODS Patients in the National Cancer Database (2004-2017) who underwent resection of RPS were included. Trends over time for proportions were calculated using contingency tables with Cochran-Armitage Trend test. RESULTS Of 7,485 patients who underwent resection, 1,821 (24.3%) received RT (adjuvant: 59.9%, neoadjuvant: 40.1%). The use of RT decreased annually by < 1% (p = 0.0178). There was an average annual increase of neoadjuvant RT by 13% compared to an average annual decrease of adjuvant RT by 6% (p < 0.0001). Treatment at high-volume centers (OR 14.795, p < 0.0001) and tumor > 10 cm (OR 2.009, p = 0.001) were associated with neoadjuvant RT. In contrast liposarcomas (OR 0.574, p = 0.001) were associated with adjuvant RT. There was no statistically significant difference in overall survival between patients treated with surgery alone versus surgery and RT (p = 0.07). CONCLUSION In the United States, the use of RT for RPS has decreased over time, with a shift towards neoadjuvant RT. However, a large percentage of patients are still receiving adjuvant RT and this mostly occurs at low-volume hospitals.
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Affiliation(s)
- Samantha M Ruff
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Victor Heh
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - David J Konieczkowski
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Amblessed Onuma
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Hayley M Dunlop
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Alex C Kim
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Valerie P Grignol
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Carlo M Contreras
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Raphael Pollock
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Joal D Beane
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA.
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Vlăsceanu VI, Soroceanu RP, Timofte DV, Iordache AG, Strobescu CC, Timofeiov S. Retroperitoneal liposarcoma: unveiling diagnostic delays and multimodal treatment dilemmas. Arch Clin Cases 2023; 10:187-190. [PMID: 38098695 PMCID: PMC10719986 DOI: 10.22551/2023.41.1004.10272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Liposarcomas are a prevalent subtype of soft tissue sarcomas, constituting less than 1% of all malignancies. Originating in the adipose tissue, they can manifest in various locations and are categorized by the World Health Organization into several subtypes: well-differentiated liposarcomas, dedifferentiated liposarcomas, myxoid liposarcomas, pleomorphic liposarcomas and mixed-type liposarcomas. These tumors typically affect middle-aged and older individuals, and their incidence has been progressively increasing over the years. As liposarcomas advance they tend to encase blood vessels and major organs, particularly in the retroperitoneal area. Often asymptomatic initially, symptoms arise as the tumor reaches a considerable size, exerting pressure on adjacent tissues and organs. This report features a 54-year-old patient incidentally diagnosed with a substantial retroperitoneal tumor extending to the antero-lateral abdominal wall and inner thigh via the right inguinal ligament. The patient, with a previous three-year history of a right inguinal mass, sought acute care for a perianal abscess The histological examination revealed morphological aspects consistent with a low-grade myxoid liposarcoma. While surgery remains the primary treatment for retroperitoneal liposarcomas, controversies exist regarding the role of radiotherapy and chemotherapy in improving survival rates. This case highlights the challenges in managing retroperitoneal tumors and underscores the importance of a personalized, multidisciplinary approach to optimize patient outcomes.
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Affiliation(s)
- Vlad Ionuţ Vlăsceanu
- 3 Surgical Unit, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iaşi, Romania
| | - Radu Petru Soroceanu
- 3 Surgical Unit, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iaşi, Romania
- Department of Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania
| | - Daniel Vasile Timofte
- 3 Surgical Unit, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iaşi, Romania
- Department of Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania
| | - Andi Gabriel Iordache
- 3 Surgical Unit, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iaşi, Romania
| | - Cristina Ciobanu Strobescu
- 3 Surgical Unit, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iaşi, Romania
- Vascular Surgical Unit, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iaşi, Romania
| | - Sergiu Timofeiov
- 3 Surgical Unit, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iaşi, Romania
- Department of Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania
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Zheng J, Zhuang A, Xia X, Miao F, Wang Z, Kong X, Ren Y, Ma Y, Lin Z, Lu W, Li W. Nomogram development and external validation for predicting overall survival and cancer-specific survival in patients with primary retroperitoneal sarcoma: a retrospective cohort study. Discov Oncol 2023; 14:197. [PMID: 37910291 PMCID: PMC10620366 DOI: 10.1007/s12672-023-00804-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Primary retroperitoneal sarcoma (RPS) comprises over 70 histologic subtypes, yet there are limited studies that have developed prognostic nomograms for RPS patients to predict overall survival (OS) and cancer-specific survival (CSS). The objective of this study was to construct prognostic nomograms for predicting OS and CSS in RPS patients. METHODS We identified a total of 1166 RPS patients from the Surveillance, Epidemiology and End Results (SEER) database, and an additional 261 cases were collected from a tertiary cancer center. The study incorporated various clinicopathological and epidemiologic features as variables, and prediction windows for overall survival (OS) and cancer-specific survival (CSS) were set at 3, 5, and 7 years. Multivariable Cox models were utilized to develop the nomograms, and variable selection was performed using a backward procedure based on the Akaike Information Criterion. To evaluate the performance of the nomograms in terms of calibration and discrimination, we used calibration plots, coherence index, and area under the curve. FINDINGS The study included 818 patients in the development cohort, 348 patients in the internal validation cohort, and 261 patients in the external validation cohort. The backward procedure selected the following variables: age, French Federation of Cancer Centers Sarcoma Group (FNCLCC) grade, pre-/postoperative chemotherapy, tumor size, primary site surgery, and tumor multifocality. The validation results demonstrated that the nomograms had good calibration and discrimination, with C-indices of 0.76 for OS and 0.81 for CSS. Calibration plots also showed good consistency between the predicted and actual survival rates. Furthermore, the areas under the time-dependent receiver operating characteristic curves for the 3-, 5-, and 7-year OS (0.84, 0.82, and 0.78, respectively) and CSS (0.88, 0.88, and 0.85, respectively) confirmed the accuracy of the nomograms. INTERPRETATION Our study developed accurate nomograms to predict OS and CSS in patients with RPS. These nomograms have important clinical implications and can assist healthcare providers in making informed decisions regarding patient care and treatment options. They may also aid in patient counseling and stratification in clinical trials.
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Affiliation(s)
- Jialiang Zheng
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Aobo Zhuang
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Xiaogang Xia
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Fenglin Miao
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Zhao Wang
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Xu Kong
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Yantao Ren
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Yuan Ma
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
| | - Zhenhang Lin
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
| | - Weiqi Lu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200000, China.
| | - Wengang Li
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China.
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China.
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Li Y, Ding J, Zheng H, Xu L, Li W, Zhu M, Zhang X, Ma C, Zhang F, Zhong P, Liang D, Han Y, Zhang S, He L, Li J. Speculation on optimal numbers of examined lymph node for early-stage epithelial ovarian cancer from the perspective of stage migration. Front Oncol 2023; 13:1265631. [PMID: 37810975 PMCID: PMC10556677 DOI: 10.3389/fonc.2023.1265631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/24/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction In early-stage epithelial ovarian cancer (EOC), how to perform lymphadenectomy to avoid stage migration and achieve reliable targeted excision has not been explored in depth. This study comprehensively considered the stage migration and survival to determine appropriate numbers of examined lymph node (ELN) for early-stage EOC and high-grade serous ovarian cancer (HGSOC). Methods From the Surveillance, Epidemiology, and End Results database, we obtained 10372 EOC cases with stage T1M0 and ELN ≥ 2, including 2849 HGSOC cases. Generalized linear models with multivariable adjustment were used to analyze associations between ELN numbers and lymph node stage migration, survival and positive lymph node (PLN). LOESS regression characterized dynamic trends of above associations followed by Chow test to determine structural breakpoints of ELN numbers. Survival curves were plotted using Kaplan-Meier method. Results More ELNs were associated with more node-positive diseases, more PLNs and better prognosis. ELN structural breakpoints were different in subgroups of early-stage EOC, which for node stage migration or PLN were more than those for improving outcomes. The meaning of ELN structural breakpoint varied with its location and the morphology of LOESS curve. To avoid stage migration, the optimal ELN for early-stage EOC was 29 and the minimal ELN for HGSOC was 24. For better survival, appropriate ELN number were 13 and 8 respectively. More ELNs explained better prognosis only at a certain range. Discussion Neither too many nor too few numbers of ELN were ideal for early-stage EOC and HGSOC. Excision with appropriate numbers of lymph node draining the affected ovary may be more reasonable than traditional sentinel lymph node resection and systematic lymphadenectomy.
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Affiliation(s)
- Yuan Li
- Department of Obstetrics and Gynecology, First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Jiashan Ding
- Department of Gynecological Oncology, Xiangya Hospital Central South University, Central South University, Changsha, Hunan, China
| | - Huimin Zheng
- Department of Obstetrics and Gynecology, First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Lijiang Xu
- Department of Obstetrics and Gynecology, First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Weiru Li
- Department of Obstetrics and Gynecology, First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Minshan Zhu
- Department of Obstetrics and Gynecology, First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Xiaolu Zhang
- Department of Obstetrics and Gynecology, First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Cong Ma
- Department of Obstetrics and Gynecology, First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Fangying Zhang
- Department of Obstetrics and Gynecology, First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Peiwen Zhong
- Department of Obstetrics and Gynecology, First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Dong Liang
- Department of Obstetrics and Gynecology, First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Yubin Han
- Department of Obstetrics and Gynecology, First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Siyou Zhang
- Department of Obstetrics and Gynecology, First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Linsheng He
- Department of Gynecologic Oncology, Jiangxi Maternal and Child Health Hospital, Nanchang Medical College, Nanchang, Jiangxi, China
| | - Jiaqi Li
- Department of Gynecologic Oncology, Jiangxi Maternal and Child Health Hospital, Nanchang Medical College, Nanchang, Jiangxi, China
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Qiu M, Lin DR, Xiong ZK. Survival of a patient with five recurrences of retroperitoneal liposarcoma over a period of 13 years: A case report and review. Oncol Lett 2023; 26:367. [PMID: 37559572 PMCID: PMC10407717 DOI: 10.3892/ol.2023.13953] [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: 03/08/2023] [Accepted: 06/28/2023] [Indexed: 08/11/2023] Open
Abstract
Retroperitoneal liposarcoma (RPLS) is a rare tumor that occurs in the retroperitoneal region and accounts for ~0.2% of all malignant tumor incidence. The present study describes the treatment of a surviving patient with RPLS that recurred five times in 13 years. This case has a long survival time and numerous relapses, which is a rare occurrence. The 40-year-old female patient was admitted to Shaoxing Second Hospital (Shaoxing, China) with an abdominal mass. Abdominal computed tomography (CT) scan revealed multiple liposarcoma recurrences in the abdominal, pelvic and retroperitoneal areas. As the diagnosis of RPLS was the fifth recurrence, cytoreductive surgery was performed and post-operative pathology suggested mixed liposarcoma. The patient underwent six cycles of doxorubicin and ifosfamide regimen chemotherapy and targeted therapy with anlotinib following surgery; no evidence of disease progression was found on abdominal CT scan during follow-up. The present study also reviewed the literature in terms of the clinical diagnosis, treatment, pathological characteristics and similar cases of liposarcoma with the aim of improving diagnosis and treatment.
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Affiliation(s)
- Miao Qiu
- Department of Tumor Radiotherapy, Shaoxing Second Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - De-Rong Lin
- Department of Tumor Radiotherapy, Shaoxing Second Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - Zhong-Kui Xiong
- Department of Tumor Radiotherapy, Shaoxing Second Hospital, Shaoxing, Zhejiang 312000, P.R. China
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Ng D, Bertrand A, Sanfilippo R, Callegaro D. Deciding individual treatment for primary retroperitoneal sarcoma. Expert Rev Anticancer Ther 2023; 23:1169-1178. [PMID: 37791587 DOI: 10.1080/14737140.2023.2266137] [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: 06/14/2023] [Accepted: 09/28/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION Retroperitoneal sarcomas (RPS) are rare mesenchymal tumors that account for only 0.1-0.2% of all malignancies. Management of this disease is challenging, and resection remains the cornerstone of treatment. Ongoing international collaboration has expanded our knowledge of this disease, allowing for a more personalized approach to RPS patients resulting in improved survival over time. Due to the heterogeneity of RPS, with differing recurrence patterns and sensitivities to neoadjuvant therapies based on histology and grade, management of RPS should be tailored to the individual patient. AREAS COVERED Our review focuses on a histology-driven approach in the management of primary RPS. We searched relevant articles from 1993 to 2023 that investigated prognostic factors and treatment of patients with RPS and summarized recent advances and future directions in the field. EXPERT OPINION Deeper understanding of the role of neoadjuvant radiotherapy and ongoing trials investigating the role of neoadjuvant chemotherapy will potentially contribute to the development of individualized treatment pathways.
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Affiliation(s)
- Deanna Ng
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Roberta Sanfilippo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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8
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Álvarez Álvarez R, Manzano A, Agra Pujol C, Artigas Raventós V, Correa R, Cruz Jurado J, Fernandez JA, Garcia Del Muro X, Gonzalez JA, Hindi N, Lozano Lominchar P, Martínez-Trufero J, Méndez R, Muñoz M, Muñoz Casares C, Orbis Castellanos F, Orellana Fernandez R, Paniagua González M, Redondo A, Valverde Morales C, Asencio JM. Updated Review and Clinical Recommendations for the Diagnosis and Treatment of Patients with Retroperitoneal Sarcoma by the Spanish Sarcoma Research Group (GEIS). Cancers (Basel) 2023; 15:3194. [PMID: 37370803 DOI: 10.3390/cancers15123194] [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: 05/16/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Soft tissue sarcomas (STS) are an uncommon and biologically heterogeneous group of tumors arising from mesenchymal cells. The incidence is estimated at five cases per 100,000 people per year. Retroperitoneal sarcomas (RPS) account for 10-15% of all STS, and their management depends on their anatomical characteristics and histotype. Due to their very low incidence, it is recommended that RPS be treated in reference centers and evaluated by an experienced multidisciplinary team (MDT). In Spain, the Spanish Group for Research in Sarcomas (GEIS) brings together experts from various specialties to promote research on sarcomas and improve treatment results. This paper summarizes the GEIS recommendations for the diagnosis, treatment, and follow-up of patients with RPS.
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Affiliation(s)
- Rosa Álvarez Álvarez
- Medical Oncology Department, Instituto de Investigacion Sanitaria Gregorio Marañon, Hospital Universitario Gregorio Marañon, 28007 Madrid, Spain
| | - Aránzazu Manzano
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, 28040 Madrid, Spain
| | - Carolina Agra Pujol
- Pathology Department, Hospital Universitario Gregorio Marañon, Complutense University, 28007 Madrid, Spain
| | - Vicente Artigas Raventós
- Surgery Department, Hospital Universitario Sant Pau, Universidad Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Raquel Correa
- Radiation Oncology Department, Hospital Virgen de la Victoria, 29010 Malaga, Spain
| | - Josefina Cruz Jurado
- Medical Oncology Department, Hospital Universitario Canarias, 38320 Santa Cruz de Tenerife, Spain
| | - Juan Angel Fernandez
- Sarcoma Multidisciplinary Unit, Surgery Department, Hospital Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Xavier Garcia Del Muro
- Sarcoma Multidisciplinary Unit, Medical Oncology Department, Idibell, Instituto Catalan Oncología Hospitalet, 08908 Barcelona, Spain
| | - Jose Antonio Gonzalez
- Surgery Department, Hospital Universitario Sant Pau, Universidad Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Nadia Hindi
- Medical Oncology Department, Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain
- Medical Oncology Department, Hospital General de Villalba, 28400 Madrid, Spain
- Health Research Institute-Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid (UAM), 28040 Madrid, Spain
| | - Pablo Lozano Lominchar
- Surgery Department, Hospital Universitario Gregorio Marañon, Complutense University, 28040 Madrid, Spain
| | | | - Ramiro Méndez
- Radiology Department, Hospital Universitario Clínico San Carlos, 28040 Madrid, Spain
| | - Mercedes Muñoz
- Radiation Oncology Department, Hospital Universitario Gregorio Marañon, Complutense University, 28007 Madrid, Spain
| | | | - Francisco Orbis Castellanos
- Sarcoma Multidisciplinary Unit, Surgery Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | | | - Miguel Paniagua González
- Radiology Department, Hospital Universitario Gregorio Marañon, Complutense University, 28007 Madrid, Spain
| | - Andres Redondo
- Medical Oncology Department, Hospital Universitario La Paz-IdiPAZ, 28046 Madrid, Spain
| | | | - Jose Manuel Asencio
- Surgery Department, Hospital Universitario Gregorio Marañon, Complutense University, 28040 Madrid, Spain
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Cheng SH, Huang YS, Lee HH, Yen HH, Jhong YP, Chao TY. Case report and literature review: Conversion surgery for initially unresectable huge retroperitoneal liposarcoma after preoperative radiotherapy. Front Oncol 2023; 12:1096411. [PMID: 36686723 PMCID: PMC9852908 DOI: 10.3389/fonc.2022.1096411] [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: 11/12/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023] Open
Abstract
Background Retroperitoneal liposarcoma (RPLS) is a rare malignancy that is notorious for recurrence. Surgical resection with clean margin is the current treatment of choice. However, owing to the large retroperitoneal space, RPLSs often grow to significant sizes before being diagnosed. Neoadjuvant and adjuvant therapies have potentials to improve long term treatment outcome. Case presentation A 55-year-old Han Chinese male presented to the general surgery department with a one-year history of abdominal fullness and a one-week history of palpable right inguinal mass. At first, he was diagnosed with incarcerated inguinal hernia. However, abdominal computer tomography (CT) and biopsy confirmed his final diagnosis to be retroperitoneal well-differentiated liposarcoma, cT2bN0M0, stage IIb. The tumor, which measured 44.5cm in maximum diameter, was too large for primary surgical resection. Neoadjuvant radiotherapy with 70 Gy in 35 fractions was delivered to the tumor, which shrunk the target volume from 6300 cc to 4800 cc, as observed in the middle of the radiotherapy course. The right testicular mass also received 70Gy/35Fx. Conversion surgery was performed after radiotherapy. Unfortunately, due to residual tumor, adjuvant chemotherapy consisting of AIM (ifosfamide, Mesna, and doxorubicin) and MAID (Mesna, doxorubincin, ifosfamide, and dacarbazine) regimens were administered sequentially. Afterward, debulking surgery was conducted, plus another 18 cycles of ifosfamide monotherapy when residual tumor was still seen on CT. Since the completion of ifosfamide chemotherapy, the patient has been cancer free with no evidence of tumor recurrence for more than 26 months. Conclusion Despite conflicting evidence in the literature, our case supports the use of high dose neoadjuvant radiotherapy and adjuvant chemotherapy in treating large, unresectable RPLSs. It also highlights the importance of using individualized, multidisciplinary approach in achieving cure for large, unresectable rare tumors.
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Affiliation(s)
- Sarah Hsin Cheng
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Shuo Huang
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Hua Lee
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan,Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan,Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan,*Correspondence: Hsin-Hua Lee,
| | - Heng-Hsuan Yen
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Pei Jhong
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Yuan Chao
- Department of Radiation Oncology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
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Ruff SM, Grignol VP, Contreras CM, Pollock RE, Beane JD. Morbidity and Mortality after Surgery for Retroperitoneal Sarcoma. Curr Oncol 2022; 30:492-505. [PMID: 36661688 PMCID: PMC9858026 DOI: 10.3390/curroncol30010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
Retroperitoneal sarcoma (RPS) is a rare disease with over 100 histologic types and accounts for 10-15% of all soft tissue sarcomas. Due to the rarity of RPS, sarcoma centers in Europe and North America have created the Transatlantic RPS Working Group (TARPSWG) to study this disease and establish best practices for its management. Current guidelines dictate complete resection of all macro and microscopic disease as the gold standard for patients with RPS. Complete extirpation often requires a multi-visceral resection. In addition, recent evidence suggests that en bloc compartmental resections are associated with reduced rates of local recurrence. However, this approach must be balanced by the potential for added morbidity. Strategies to mitigate postoperative complications include optimization of the patient through improved preoperative nutrition and pre-habilitation therapy, referral to a high-volume sarcoma center, and implementation of enhanced recovery protocols. This review will focus on the factors associated with perioperative complications following surgery for RPS and outline approaches to mitigate poor surgical outcomes in this patient population.
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Affiliation(s)
| | | | | | | | - Joal D. Beane
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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