Skip to main content
Top
Published in: Annals of Surgical Oncology 4/2006

01-04-2006

Long-Term Results of Two Prospective Trials of Preoperative External Beam Radiotherapy for Localized Intermediate- or High-Grade Retroperitoneal Soft Tissue Sarcoma

Authors: Timothy M. Pawlik, MD, MPH, Peter W. T. Pisters, MD, Lynn Mikula, MD, Barry W. Feig, MD, Kelly K. Hunt, MD, Janice N. Cormier, MD, MPH, Matthew T. Ballo, MD, Charles N. Catton, MD, Julia J. Jones, MD, Brian O’Sullivan, MD, Raphael E. Pollock, MD, PhD, Carol J. Swallow, MD, PhD

Published in: Annals of Surgical Oncology | Issue 4/2006

Login to get access

Abstract

Background

The reported data on surgery plus radiotherapy for retroperitoneal soft tissue sarcomas (RPS) have been mostly from retrospective studies. We evaluated the long-term outcome of patients with operable RPS who were treated with protocol-based preoperative radiotherapy followed by complete surgical resection.

Methods

Data from two prospective trials that included preoperative radiotherapy and surgery for patients with radiographically resectable RPS were combined to define long-term relapse rates and survival.

Results

Seventy-two patients with intermediate- or high-grade RPS were treated with preoperative radiotherapy (median dose, 45 Gy; range, 18.0–50.4 Gy). Fifty-four patients (75%) had primary RPS, whereas 18 (25%) had recurrent disease. The median tumor size was 15.5 cm. Sixty-four patients completed the planned preoperative radiotherapy; 57 (89%) underwent laparotomy with curative intent, and 54 (95%) had a macroscopically complete (R0 or R1) resection. With a median follow-up of 40.3 months, 28 patients (52%) who received preoperative radiotherapy and underwent a macroscopically complete resection had recurrences. For the 54 patients who underwent R0 or R1 resection after preoperative radiotherapy, the 5-year local recurrence–free, disease-free, and overall survival rates were 60%, 46%, and 61%, respectively. The median overall survival has not been reached (>60 months).

Conclusions

Patients with intermediate- or high-grade RPS treated with preoperative radiotherapy plus complete resection had a median survival >60 months. This compares favorably to historical data for similar patients treated with surgery alone.
Literature
1.
go back to reference Jemal A, Murray T, Ward E, et al. Cancer statistics, 2005. CA Cancer J Clin 2005;55:10–30PubMed Jemal A, Murray T, Ward E, et al. Cancer statistics, 2005. CA Cancer J Clin 2005;55:10–30PubMed
2.
go back to reference Karakousis CP, Gerstenbluth R, Kontzoglou K, Driscoll DL. Retroperitoneal sarcomas and their management. Arch Surg 1995;130:1104–9PubMed Karakousis CP, Gerstenbluth R, Kontzoglou K, Driscoll DL. Retroperitoneal sarcomas and their management. Arch Surg 1995;130:1104–9PubMed
3.
go back to reference Jaques DP, Coit DG, Hajdu SI, Brennan MF. Management of primary and recurrent soft-tissue sarcoma of the retroperitoneum. Ann Surg 1990;212:51–9PubMed Jaques DP, Coit DG, Hajdu SI, Brennan MF. Management of primary and recurrent soft-tissue sarcoma of the retroperitoneum. Ann Surg 1990;212:51–9PubMed
4.
go back to reference Makela J, Kiviniemi H, Laitinen S. Prognostic factors predicting survival in the treatment of retroperitoneal sarcoma. Eur J Surg Oncol 2000;26:552–5CrossRefPubMed Makela J, Kiviniemi H, Laitinen S. Prognostic factors predicting survival in the treatment of retroperitoneal sarcoma. Eur J Surg Oncol 2000;26:552–5CrossRefPubMed
5.
go back to reference Catton CN, O’Sullivan B, Kotwall C, Cummings B, Hao Y, Fornasier V. Outcome and prognosis in retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys 1994;29:1005–10PubMed Catton CN, O’Sullivan B, Kotwall C, Cummings B, Hao Y, Fornasier V. Outcome and prognosis in retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys 1994;29:1005–10PubMed
6.
go back to reference McGrath PC, Neifeld JP, Lawrence W Jr, et al. Improved survival following complete excision of retroperitoneal sarcomas. Ann Surg 1984;200:200–4PubMed McGrath PC, Neifeld JP, Lawrence W Jr, et al. Improved survival following complete excision of retroperitoneal sarcomas. Ann Surg 1984;200:200–4PubMed
7.
go back to reference Stoeckle E, Coindre JM, Bonvalot S, et al. Prognostic factors in retroperitoneal sarcoma: a multivariate analysis of a series of 165 patients of the French Cancer Center Federation Sarcoma Group. Cancer 2001;92:359–68CrossRefPubMed Stoeckle E, Coindre JM, Bonvalot S, et al. Prognostic factors in retroperitoneal sarcoma: a multivariate analysis of a series of 165 patients of the French Cancer Center Federation Sarcoma Group. Cancer 2001;92:359–68CrossRefPubMed
8.
go back to reference Lewis JJ, Leung D, Woodruff JM, Brennan MF. Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg 1998;228:355–65CrossRefPubMed Lewis JJ, Leung D, Woodruff JM, Brennan MF. Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg 1998;228:355–65CrossRefPubMed
9.
go back to reference Hassan I, Park SZ, Donohue JH, et al. Operative management of primary retroperitoneal sarcomas: a reappraisal of an institutional experience. Ann Surg 2004;239:244–50PubMed Hassan I, Park SZ, Donohue JH, et al. Operative management of primary retroperitoneal sarcomas: a reappraisal of an institutional experience. Ann Surg 2004;239:244–50PubMed
11.
go back to reference Kilkenny JW III, Bland KI, Copeland EM III. Retroperitoneal sarcoma: the University of Florida experience. J Am Coll Surg 1996;182:329–39PubMed Kilkenny JW III, Bland KI, Copeland EM III. Retroperitoneal sarcoma: the University of Florida experience. J Am Coll Surg 1996;182:329–39PubMed
12.
go back to reference Salvadori B, Cusumano F, Delledonne V, De Lellis R, Conti R. Surgical treatment of 43 retroperitoneal sarcomas. Eur J Surg Oncol 1986;12:29–33PubMed Salvadori B, Cusumano F, Delledonne V, De Lellis R, Conti R. Surgical treatment of 43 retroperitoneal sarcomas. Eur J Surg Oncol 1986;12:29–33PubMed
13.
go back to reference Bevilacqua RG, Rogatko A, Hajdu SI, Brennan MF. Prognostic factors in primary retroperitoneal soft-tissue sarcomas. Arch Surg 1991;126:328–34PubMed Bevilacqua RG, Rogatko A, Hajdu SI, Brennan MF. Prognostic factors in primary retroperitoneal soft-tissue sarcomas. Arch Surg 1991;126:328–34PubMed
14.
go back to reference Windham TC, Pisters PW. Retroperitoneal sarcomas. Cancer Control 2005;12:36–43PubMed Windham TC, Pisters PW. Retroperitoneal sarcomas. Cancer Control 2005;12:36–43PubMed
15.
go back to reference Heslin MJ, Cordon-Cardo C, Lewis JJ, Woodruff JM, Brennan MF. Ki-67 detected by MIB-1 predicts distant metastasis and tumor mortality in primary, high grade extremity soft tissue sarcoma. Cancer 1998;83:490–7CrossRefPubMed Heslin MJ, Cordon-Cardo C, Lewis JJ, Woodruff JM, Brennan MF. Ki-67 detected by MIB-1 predicts distant metastasis and tumor mortality in primary, high grade extremity soft tissue sarcoma. Cancer 1998;83:490–7CrossRefPubMed
16.
go back to reference Shibata D, Lewis JJ, Leung DH, Brennan MF. Is there a role for incomplete resection in the management of retroperitoneal liposarcomas? J Am Coll Surg 2001;193:373–9CrossRefPubMed Shibata D, Lewis JJ, Leung DH, Brennan MF. Is there a role for incomplete resection in the management of retroperitoneal liposarcomas? J Am Coll Surg 2001;193:373–9CrossRefPubMed
17.
go back to reference Cheifetz R, Catton CN, Kandel RA, O’Sullivan B, Couture J, Swallow CJ. Recent progress in the management of retroperitoneal sarcoma. Sarcoma 2001;5:17–26 Cheifetz R, Catton CN, Kandel RA, O’Sullivan B, Couture J, Swallow CJ. Recent progress in the management of retroperitoneal sarcoma. Sarcoma 2001;5:17–26
18.
go back to reference Pisters PW, Harrison LB, Leung DH, Woodruff JM, Casper ES, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 1996;14:859–68PubMed Pisters PW, Harrison LB, Leung DH, Woodruff JM, Casper ES, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 1996;14:859–68PubMed
19.
go back to reference Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 1998;16:197–203PubMed Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 1998;16:197–203PubMed
20.
go back to reference Pisters PW, O’Sullivan B. Retroperitoneal sarcomas: combined modality treatment approaches. Curr Opin Oncol 2002;14:400–5CrossRefPubMed Pisters PW, O’Sullivan B. Retroperitoneal sarcomas: combined modality treatment approaches. Curr Opin Oncol 2002;14:400–5CrossRefPubMed
21.
go back to reference Pisters PW, Ballo MT, Fenstermacher MJ, et al. Phase I trial of preoperative concurrent doxorubicin and radiation therapy, surgical resection, and intraoperative electron-beam radiation therapy for patients with localized retroperitoneal sarcoma. J Clin Oncol 2003;21:3092–7CrossRefPubMed Pisters PW, Ballo MT, Fenstermacher MJ, et al. Phase I trial of preoperative concurrent doxorubicin and radiation therapy, surgical resection, and intraoperative electron-beam radiation therapy for patients with localized retroperitoneal sarcoma. J Clin Oncol 2003;21:3092–7CrossRefPubMed
22.
go back to reference Jones JJ, Catton CN, O’Sullivan B, et al. Initial results of a trial of preoperative external-beam radiation therapy and postoperative brachytherapy for retroperitoneal sarcoma. Ann Surg Oncol 2002;9:346–54CrossRefPubMed Jones JJ, Catton CN, O’Sullivan B, et al. Initial results of a trial of preoperative external-beam radiation therapy and postoperative brachytherapy for retroperitoneal sarcoma. Ann Surg Oncol 2002;9:346–54CrossRefPubMed
23.
go back to reference Catton C, Swallow C, O’Sullivan B. A pilot study of external beam radiotherapy and pulsed dose rate brachytherapy for resectable retroperitoneal sarcomas. Radiother Oncol 1998;47:S30.CrossRef Catton C, Swallow C, O’Sullivan B. A pilot study of external beam radiotherapy and pulsed dose rate brachytherapy for resectable retroperitoneal sarcomas. Radiother Oncol 1998;47:S30.CrossRef
24.
go back to reference Chiappa A, Zbar AP, Biffi R, et al. Primary and recurrent retroperitoneal sarcoma: factors affecting survival and long-term outcome. Hepatogastroenterology 2004;51:1304–9PubMed Chiappa A, Zbar AP, Biffi R, et al. Primary and recurrent retroperitoneal sarcoma: factors affecting survival and long-term outcome. Hepatogastroenterology 2004;51:1304–9PubMed
25.
go back to reference Ferrario T, Karakousis CP. Retroperitoneal sarcomas: grade and survival. Arch Surg 2003;138:248–51PubMed Ferrario T, Karakousis CP. Retroperitoneal sarcomas: grade and survival. Arch Surg 2003;138:248–51PubMed
26.
go back to reference Gieschen HL, Spiro IJ, Suit HD, et al. Long-term results of intraoperative electron beam radiotherapy for primary and recurrent retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys 2001;50:127–31CrossRefPubMed Gieschen HL, Spiro IJ, Suit HD, et al. Long-term results of intraoperative electron beam radiotherapy for primary and recurrent retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys 2001;50:127–31CrossRefPubMed
27.
go back to reference Sindelar WF, Kinsella TJ, Chen PW, et al. Intraoperative radiotherapy in retroperitoneal sarcomas. Final results of a prospective, randomized, clinical trial. Arch Surg 1993;128:402–10PubMed Sindelar WF, Kinsella TJ, Chen PW, et al. Intraoperative radiotherapy in retroperitoneal sarcomas. Final results of a prospective, randomized, clinical trial. Arch Surg 1993;128:402–10PubMed
28.
go back to reference Alektiar KM, Hu K, Anderson L, Brennan MF, Harrison LB. High-dose-rate intraoperative radiation therapy (HDR-IORT) for retroperitoneal sarcomas. Int J Radiat Oncol Biol Phys 2000;47:157–63PubMed Alektiar KM, Hu K, Anderson L, Brennan MF, Harrison LB. High-dose-rate intraoperative radiation therapy (HDR-IORT) for retroperitoneal sarcomas. Int J Radiat Oncol Biol Phys 2000;47:157–63PubMed
29.
go back to reference Stojadinovic A, Yeh A, Brennan MF. Completely resected recurrent soft tissue sarcoma: primary anatomic site governs outcomes. J Am Coll Surg 2002;194:436–47CrossRefPubMed Stojadinovic A, Yeh A, Brennan MF. Completely resected recurrent soft tissue sarcoma: primary anatomic site governs outcomes. J Am Coll Surg 2002;194:436–47CrossRefPubMed
Metadata
Title
Long-Term Results of Two Prospective Trials of Preoperative External Beam Radiotherapy for Localized Intermediate- or High-Grade Retroperitoneal Soft Tissue Sarcoma
Authors
Timothy M. Pawlik, MD, MPH
Peter W. T. Pisters, MD
Lynn Mikula, MD
Barry W. Feig, MD
Kelly K. Hunt, MD
Janice N. Cormier, MD, MPH
Matthew T. Ballo, MD
Charles N. Catton, MD
Julia J. Jones, MD
Brian O’Sullivan, MD
Raphael E. Pollock, MD, PhD
Carol J. Swallow, MD, PhD
Publication date
01-04-2006
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 4/2006
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/ASO.2006.05.035

Other articles of this Issue 4/2006

Annals of Surgical Oncology 4/2006 Go to the issue