Radiotherapy and surgery—An indispensable duo in the treatment of retroperitoneal sarcoma

• Published in: Cancer Vol. 117; no. 19; pp. 4355 - 4364
• Main Authors: Van De Voorde, Lien, Delrue, Louke, van Eijkeren, Marc, De Meerleer, Gert
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-10-2011; Wiley-Blackwell
• Subjects: Abdomen; Adult; Biological and medical sciences; Combined Modality Therapy; Gastroenterology. Liver. Pancreas. Abdomen; Humans; local control; Medical sciences; overall survival; radiation; retroperitoneal; Retroperitoneal Neoplasms - radiotherapy; Retroperitoneal Neoplasms - surgery; sarcoma; Sarcoma - radiotherapy; Sarcoma - surgery; surgery; toxicity; Treatment Outcome; Tumors; Retroperitoneal; sarcoma; Toxicity; local control; Soft tissue sarcoma; Retroperitoneal disease; Malignant tumor; Radiotherapy; Survival; Cancerology; Treatment; radiation; Abdominal disease; Surgery; overall survival; Retroperitoneal sarcoma; Cancer
• ISSN: 0008-543X; 1097-0142; 1097-0142
• DOI: 10.1002/cncr.26071

The authors undertook a systematic review to designate the role that radiotherapy (RT) might play in the treatment of retroperitoneal sarcomas. Correlating with recent literature, the objective of this review was to evaluate whether there was enough evidence for the authors to develop an institutional treatment protocol concerning the use of RT in the treatment of retroperitoneal sarcoma. Furthermore, this was a call for surgeons to talk to radiation oncologists before performing surgery. The 2 objectives of this review were: 1) to determine the benefit of RT in terms of local control and/or survival in the treatment of retroperitoneal sarcomas and 2) to discover the optimal timing of RT in the treatment sequence. A computerized literature search was performed in the PubMed database, the Cochrane Library database, and reference lists; and journals also were searched by hand to identify all retrospective and prospective reports published since 1998 relating to RT treatment of adult retroperitoneal sarcoma. Mainly, analyses were sought that were based on a 5‐year local control rate (LCR), 5‐year disease‐free survival, and 5‐year overall survival (OS). If only 2 years follow‐up were available, then the authors also noted this outcome. Toxicity data were collected and analyzed separately. The synthesis of the literature was based on 9 prospectively nonrandomized studies and 10 retrospective studies that, together, reviewed a total of 1426 patients. The 5‐year LCR varied from 27% to 62%, and the results from other reports fell in between those values. The 5‐year OS rate ranged from 12% to 90%, and complete resection and tumor grade were the most important prognostic factors in most studies. This review resulted in 7 recommendations concerning the use of RT in the treatment of retroperitoneal sarcoma. The authors concluded that there is good evidence from multiple single‐institutions studies that RT improves the LCR in patients with retroperitoneal sarcoma. Until now, there has not been a translation of this approach into survival benefit. The current results indicated that preoperative external‐beam RT followed by radical surgery seems to be the preferred sequence, and adding intraoperative RT is a safe procedure for dose escalation in the upper abdomen. Cancer 2011;. © 2011 American Cancer Society.
There is good evidence from multiple single‐institutions studies that radiation therapy improves the local control rate in patients with retroperitoneal sarcoma. The results from this review indicate that preoperative external beam radiation followed by radical surgery seems to be the preferred sequence.