Top

Published in:

01-02-2006

Surgery Combined With Intraoperative Brachytherapy in the Treatment of Retroperitoneal Sarcomas

Authors: Wirginiusz Dziewirski, MD, Piotr Rutkowski, MD, Zbigniew I. Nowecki, MD, Maciej Sałamacha, MD, Tadeusz Morysiński, MD, Anna Kulik, MD, Maria Kawczyńska, PhD, Anetta Kasprowicz, MD, Jarosław Łyczek, MD, Włodzimierz Ruka, MD

Published in: Annals of Surgical Oncology | Issue 2/2006

Abstract

Background

The purpose of this study was to analyze the results of treatment of retroperitoneal soft tissue sarcomas (RSTS) by surgery combined with intraoperative brachytherapy (IOBRT).

Methods

Seventy adult patients with RSTS were considered for combined treatment (surgery plus IOBRT) between June 1998 and February 2004. There were 64 (91%) recurrent tumors, and 93% of tumors exceeded 5 cm. IOBRT was performed with high-dose-rate Gammamed 12 with iridium 192 (IOBRT time range, 20–87 minutes; median, 56 minutes).

Results

After intraoperative re-evaluation, 24 patients (34%) were found to be ineligible for IOBRT because of multiple intraperitoneal recurrences, macroscopically nonradical resection, poor general condition, and technical aspects. Thirty-seven patients underwent IOBRT immediately after surgery during the same general anesthesia procedure. Nine patients underwent delayed IOBRT within 1 to 3 days after the primary operation. Ten (21.5%) of 46 patients underwent reoperation because of surgical complications. One patient died in the postoperative period. After IOBRT, 24 patients (52%) underwent adjuvant external beam radiotherapy (EBRT) to a total dose of 50 Gy. Over a median follow-up time of 20 months, the estimated 5-year overall survival and local recurrence–free survival rates in IOBRT patients were 55% and 51%, respectively. Application of adjuvant EBRT showed a favorable local control rate.

Conclusions

The scheduled combined treatment (surgery plus IOBRT) was possible to perform in 66% of RSTS cases that received surgical treatment. The complication rate was high, but we consider it acceptable because of the necessity for extensive aggressive surgical treatment in regionally advanced RSTS. EBRT seems to be an indispensable part of treatment that provides better local control.

Jenkins MP, Alvaranga JC, Thomas JM. The management of retroperitoneal soft tissue sarcomas. Eur J Cancer 1996;32A:622–6PubMed

McGrath PC. Retroperitoneal sarcomas. Semin Surg Oncol 1994;10:364–8PubMed

Strander H, Turesson I, Cavallin-Stahl E. A systematic overview of radiation therapy effects in soft tissue sarcomas. Acta Oncol 2003;42:516–31PubMedCrossRef

O’Sullivan B, Ward I, Catton C. Recent advances in radiotherapy for soft-tissue sarcoma. Curr Oncol Rep 2003;5:274–81PubMed

Gilbeau L, Kantor G, Stoeckle E, et al. Surgical resection and radiotherapy for primary retroperitoneal soft tissue sarcoma. Radiother Oncol 2002;65:137–43CrossRefPubMed

Bobin JY, Al-Lawati T, Granero LE, et al. Surgical management of retroperitoneal sarcomas associated with external and intraoperative electron beam radiotherapy. Eur J Surg Oncol 2003;29:676–81CrossRefPubMed

Petersen IA, Haddock MG, Donohue JH, et al. Use of intraoperative electron beam radiation therapy in the management of retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys 2002;52:469–75CrossRefPubMed

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

Gieshen HL, Spiro IJ, Suit H, et al. Long-term results of intraoperative electron beam radiation therapy for primary and recurrent retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys 2001;50:127–31

10.

Bussieres E, Stockle EP, Richaud PM, et al. Retroperitoneal soft tissue sarcomas: a pilot study of intraoperative radiation therapy. J Surg Oncol 1996;62:49–56PubMed

11.

Alektiar KM, Hu K, Anderson L, et al. High dosed rate intraoperative radiation therapy (HDR-IORT) for retroperitoneal sarcomas. Int J Radiat Oncol Biol Phys 2000;47:157–63PubMed

12.

Willet CG, Suit HD, Tepper JE, et al. Intra-operative electron beam radiation of retroperitoneal soft tissue sarcoma. Cancer 1991;68:278–83

13.

Classen J, Hehr T, Lamprecht U, Zumbragel A, Bamberg M, Budach W. Hyperfractionated ¹⁹²Ir brachytherapy for recurrent retroperitoneal sarcoma: a technique for delivery of local tumor boost dose. Strahlenther Onkol 2003;179:118–22CrossRefPubMed

14.

Ellis RJ, Kim E, Kinsella TJ, Eisenberg BL. Intraoperative radiotherapy in the multimodality approach to bone and soft tissue cancers. Surg Oncol Clin North Am 2003;12:1015–29CrossRef

15.

Ferrario T, Karakousis CP. Retroperitoneal sarcomas: grade and survival. Arch Surg 2003;138:248–51PubMed

16.

Lewis JJ, Leung D, Woodruff JM, et al. Retroperitoneal soft tissue sarcoma. Analysis of 500 patients treated and followed at a single institution. Ann Surg 1998;228:355–65CrossRefPubMed

17.

Pisters PW, Harrison LB, Leung DH, et al. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 1996;14:859–68PubMed

18.

Heslin MJ, Lewis JJ, Nadler E, et al. Prognostic factors associated with long-term survival for retroperitoneal sarcoma: implications for management. J Clin Oncol 1997;15:2832–39PubMed

19.

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

20.

Wang YN, Zhu WQ, Shen ZZ, Li S, Liu SY. Treatment of locally recurrent soft tissue sarcomas of the retroperitoneum: report of 30 cases. J Surg Oncol 1994;56:213–6PubMed

21.

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

22.

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

23.

Gronchi A, Casali PG, Fiore M, et al. Retroperitoneal soft tissue sarcomas: patterns of recurrence in 167 patients treated at a single institution. Cancer 2004;100:2448–55CrossRefPubMed

24.

Cody HS, Turnbull AD, Fortner JG, Hajdu SI. The continuing challenge of retroperitoneal sarcomas. Cancer 1981;47:2147–52PubMed

25.

Jaques DP, Coit DG, Hajdu SI, Brennan MF. Management of primary and recurrent soft-tissue sarcoma of the retroperitoneum. Ann Surg 1990;212:51–9PubMedCrossRef

26.

Ballo MT, Lee AK. Current results of brachytherapy for soft tissue sarcoma. Curr Opin Oncol 2003;15:313–8CrossRefPubMed

27.

Van Doorn RC, Gallee MPW, Hart AAM, et al. Resectable retroperitoneal soft tissue sarcoma. The effect of extent of resection and post-operative radiation therapy on local tumor control. Cancer 1994;73:637–42PubMed

28.

Fein D, Corn BW, Lanciano RM, Herbert SH, Hoffman JP, Coia LR. Management of retroperitoneal sarcomas: does dose escalation impact on locoregional control? Int J Radiat Oncol Biol Phys 1995;31:129–34CrossRefPubMed

29.

Zagars GK, Ballo MT. Significance of dose in postoperative radiotherapy for soft tissue sarcoma. Int J Radiat Oncol Biol Phys 2003;56:473–81PubMed

30.

Tepper JE, Suit HD, Wood WC, et al. Radiation therapy of retroperitoneal soft tissue sarcomas. Int J Radiat Oncol Biol Phys 1984;10:825–30PubMed

31.

Nag S, Hu KS. Intraoperative high-dose-rate brachytherapy. Surg Oncol Clin North Am 2003;12:1079–97CrossRef

32.

Azinovic I, Martinez Monge R, Javier Aristu J, Salgado E. Intraoperative radiotherapy electron boost followed by moderate doses of external beam radiotherapy in resected soft-tissue sarcoma of the extremities. Radiother Oncol 2003;67:331–7CrossRefPubMed

33.

Catton CN, O’Sullivan B, Kotwall C, et al. Outcome and prognosis in retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys 1994;29:1005–10PubMed

34.

Youssef E, Fontanesi J, Mott M, et al. Long-term outcome of combined modality therapy in retroperitoneal and deep-trunk soft-tissue sarcoma: analysis of prognostic factors. Int J Radiat Oncol Biol Phys 2002;54:514–9CrossRefPubMed

35.

Mikula LA, Ko MA, Catton CN, et al. Long-term results of a prospective trial of preoperative radiation and postoperative brachytherapy for retroperitoneal sarcoma (abstract 9007). J Clin Oncol 2005;(Suppl):823s

36.

Gilbeau L, Kantor G, Stoeckle E, et al. Surgical resection and radiotherapy for primary retroperitoneal soft tissue sarcoma. Radiother Oncol 2002;65:137–43CrossRefPubMed

37.

McGrath PC, Neifeld JP, Lawrence W, et al. Improved survival following complete excision of retroperitoneal sarcomas. Ann Surg 1984;200:200–4PubMed

38.

Karakousis CP, Velez AF, Emrich LJ. Management of retroperitoneal sarcomas and patient survival. Am J Surg 1985;150:376–80CrossRefPubMed

39.

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

40.

Dalton RR, Donohue JH, Mucha P, van Heerden JA, Reiman HM, Chen SP. Management of retroperitoneal sarcomas. Surgery 1989;106:725–32PubMed

41.

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

42.

Storm FK, Mahvi DM. Diagnosis and management of retroperitoneal soft-tissue sarcoma. Ann Surg 1991;214:2–10PubMed

43.

Karakousis CP, Velez AF, Gerstenbluth R, Driscoll DL. Resectability and survival in retroperitoneal sarcomas. Ann Surg Oncol 1996;3:150–8PubMed

44.

van Dalen T, Hennipman A, Van Coevorden F, et al. Evaluation of a clinically applicable post-surgical classification system for primary retroperitoneal soft-tissue sarcoma. Ann Surg Oncol 2004;11:483–90CrossRefPubMed

Title: Surgery Combined With Intraoperative Brachytherapy in the Treatment of Retroperitoneal Sarcomas
Authors: Wirginiusz Dziewirski, MD
Piotr Rutkowski, MD
Zbigniew I. Nowecki, MD
Maciej Sałamacha, MD
Tadeusz Morysiński, MD
Anna Kulik, MD
Maria Kawczyńska, PhD
Anetta Kasprowicz, MD
Jarosław Łyczek, MD
Włodzimierz Ruka, MD
Publication date: 01-02-2006
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 2/2006
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/ASO.2006.03.026

At a glance: The STEP trials

Springer Medicine

Surgery Combined With Intraoperative Brachytherapy in the Treatment of Retroperitoneal Sarcomas

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2006

Diffuse Sclerosing Variant of Papillary Carcinoma of the Thyroid: A 35-Year Comparative Study at a Single Institution

The Role of Genetic Markers— NAP1L1, MAGE-D2, and MTA1—in Defining Small-Intestinal Carcinoid Neoplasia

Synergistic Effect of Interstitial Laser Coagulation and Doxorubicin in a Murine Tumor Recurrence Model of Solitary Colorectal Liver Metastasis

Expressing the Prochemotherapy Position on Treatment of Synchronous Colorectal Metastases in the Asymptomatic Patient

Induction Cisplatin and Paclitaxel Followed by Combination Chemoradiotherapy with 5-Fluorouracil, Cisplatin, and Paclitaxel Before Resection in Localized Esophageal Cancer: A Phase II Report

Macrophage Inflammatory Protein-2 Promotes Angiogenesis, Cell Migration, and Tumor Growth in Hepatic Metastasis