Multimodality treatment in retroperitoneal sarcoma

Abstract

9579 Background: Soft tissue sarcomas account for less than 1% of all malignancies; 10% of them arise in the retroperitoneal tissues. Surgical resection is considered as the most important treatment but it is often difficult to perform because of late presentation, anatomical conditions and invasion of adjacent structures. Adjuvant treatments have limited efficacy. Methods: We evaluate two year survival rate and safety profile of multimodal treatment in retroperitoneal sarcomas. Between Jan 1999 - Dec 2003, 37 patients with retroperitoneal sarcomas were treated in our institution. Median age 48.2 years (range 20 - 70), sex ratio M:F - 15:22, PS ECOG 0:1:2 - 25:8:4, tumor grading G1:G2:G3 - 8:14:15. Surgery was performed in 34 cases (29 complete resection, 5 partial resection) and 3 patients were only biopsied. All the patients received adjuvant radiochemotherapy and 4 more chemotherapy cycles thereafter. The chemotherapy regimen consisted of Ifosfamide 1,500 mg/sqm/day day 1–5 with mesna uroprotection and Epirubicin 50 mg/sqm day 1, repeated on days 29–33 during RT. They received external beam RT up to 45 - 50 Gy, conventional fractionation. The Ifosfamide and Epirubicin doses were increased at 1,800 mg/sqm and 75 mg/sqm respectively after chemoradiotherapy if no grade 3–4 toxicities occurred. Results: The overall 2 year survival rate was 70.27%. The 2 year survival rate was 100% - 71.43% - and 53.33% for G1, G2 and G3 tumors respectively; the figures are 82.75% - 40% and 0% for complete resection, partial resection and diagnostic biopsy respectively. All patients received the intended treatment. There were only 8 cycle delays for grade 3 toxicities. 6 patients had grade 3–4 hematological toxicities and 4 patients had grade 3–4 digestive toxicities. Retroperitoneal fibrosis occurred in 3 cases. Conclusions: This combined modality treatment can be successfully delivered. We have no major toxicities. We obtained similar results as cited in the literature. Better results could be obtained with newer radiation techniques (conformal RT or IMRT). No significant financial relationships to disclose.