Prognostic factors associated with long-term survival for retroperitoneal sarcoma: implications for management.

Heslin, Martin J.; Lewis, Jonathan J.; Nadler, Evan P.; Newman, Elliot; Woodruff, James M.; Casper, Ephraim S.; Leung, Denis H. Y.; Brennan, Murray F.

doi:10.1200/jco.1997.15.8.2832

Cited by 299 publications

(192 citation statements)

References 12 publications

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“…[2][3][4][5][6][7][8][9][10] In many series, the quality of surgery was the only significant prognostic factor for survival; therefore, extensive surgery has been advocated strongly. [2][3][4][5][6][7][8][9][10] However, even in series that produced excellent rates of resection, the local recurrence rate remained high. This most likely is related to the difficulty of ensuring truly tumor free margins in retroperitoneal sarcomas, no matter how experienced the surgeon.…”

Section: Discussionmentioning

confidence: 99%

“…The prognosis of patients with STS generally is poor, especially when they are assessed over the long term. [2][3][4][5][6][7][8][9][10] The contribution of adjuvant chemotherapy to the treatment of adult patients with STS remains questionable, whereas radiation therapy in patients with retroperitoneal STS is either unfeasible or is affected strongly by anatomic constraints (mainly related to the presence of kidneys and small bowel). Therefore, the main therapeutic burden is placed on surgery.…”

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confidence: 99%

“…Therefore, the main therapeutic burden is placed on surgery. [2][3][4][5][6][7][8][9][10] However, surgery alone is curative in only a relatively small number of patients. Available studies vary widely with regard to estimates of cured or long-term survivors, most likely depending on strong variations in the referral pattern of the various institutions.…”

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confidence: 99%

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Retroperitoneal soft tissue sarcomas

Gronchi

Casali

Fiore

et al. 2004

Cancer

157

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BACKGROUNDThe objective of this study was to assess long‐term prognosis and patterns of failure in patients with retroperitoneal soft tissue sarcoma who underwent surgery with curative intent at a single institution. Several series of patients with retroperitoneal sarcoma were reported, providing widely variable data regarding local and distant failure.METHODSOverall, 167 consecutive patients who underwent surgery for retroperitoneal soft tissue sarcoma over a 20 year span at a single referral center were reviewed retrospectively. Eighty‐two patients presented with primary disease, whereas 85 patients had recurrent locoregional tumors. Surgical resection was considered macroscopically complete in 147 of 167 patients (88%).RESULTSOverall survival at 10 years after definitive surgery was approximately 27%, and the disease‐free survival was approximately 16%. Only a minority of patients developed distant metastases. The risk of recurrence was correlated with whether patients underwent surgery for primary disease or for recurrent disease; the 10 year disease‐free survival rate was 27% in the former group and 4.6% in the latter group. Histotype and malignancy grade were other prognostic factors, with the former found to be predictive of the pattern of failure and the latter predictive of overall survival.CONCLUSIONSLocal recurrence after primary surgery and high‐grade malignancy were associated with the worst survival. Histologic subtype appeared to influence the pattern of recurrence, which mainly was local for patients with liposarcoma but was both local and distant for patients with the other histotypes. Cancer 2004. © 2004 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

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Retroperitoneal soft tissue sarcomas

Gronchi

Casali

Fiore

et al. 2004

Cancer

157

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“…The completeness of surgical resection is a predictor of long-term survival. 9 Unfortunately, obtaining a microscopically complete resection remains a heavy burden even in the hands of experienced surgeons. 8,[10][11][12][13] After undergoing macroscopically complete surgery alone, local recurrences develop in 20% to 75% of patients, and these can occur even after 5 years of follow-up.…”

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confidence: 99%

“…Opponents argue that the lack of an overall survival (OS) benefit renders RT a treatment of little value. 6,9,22,23 Defenders argue that RT is associated with a significant improvement in local control and even an OS benefit compared with surgery alone. [24][25][26][27] A major challenge for radiation oncologists is to combine the delivery of an effective radiation dose with an acceptable rate of radiation side effects.…”

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

Voorde

Delrue

Eijkeren

et al. 2011

Cancer

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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;117:4355-

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Retroperitoneal Sarcomas

Ferrario

Karakousis²

2003

Arch Surg

124

106

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Background: The survival of patients with retroperitoneal sarcomas depends on the feasibility of complete resection and the grade of the tumor. Hypothesis: A high rate of complete resection, wide rather than local excision when feasible, and a policy of prompt reoperation for local recurrence all improve survival. Methods: A review of 130 consecutive patients with retroperitoneal soft tissue sarcomas (1977-2001). Results: The complete resectability rate was 95%, being 99% (78/79) for the primary tumors and 90% (46/51) for tumors referred with local recurrence. Local recurrence after complete resection occurred in 41% (32/79) of those with primary tumors and in 61% (31/51) of those referred with local recurrence (P=.06). The local recurrence rate was 63% after local excision and 39% after wide resection (P=.02). Of 83 patients with relapse, 37 (45%) were rendered surgically disease free. The estimated 5-year (10-year in parentheses) survival from the first surgery at our center was 65% (56%) for patients with primary tumors and 53% (34%) for patients referred with local recurrence (P=.23). For the primary tumors, the 5-and 10-year survival rates were 70% and60%,respectively,afterwideresectionand47%and39%, respectively, after local excision (P=.04). For the primary tumors,the5-yearsurvivalwas92%,54%,and48%forgrades I, II, and III, respectively (P=.02). For those referred with local recurrence, the figures were 76%, 45%, and 19% for grades I, II, and III, respectively (PϽ.001). Conclusions: A high resectability rate (95%) is possible in retroperitoneal sarcomas. The survival estimates are similar to those following resection of extremity soft tissue sarcomas given an effective reoperation policy for local recurrences. Wide resection lowers the local recurrence and improves survival significantly. Survival varies significantly according to the grade of the tumor.

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Prognostic factors associated with long-term survival for retroperitoneal sarcoma: implications for management.

Cited by 299 publications

References 12 publications

Retroperitoneal soft tissue sarcomas

Retroperitoneal soft tissue sarcomas

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

Retroperitoneal Sarcomas

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