Abstract

Retroperitoneal sarcoma (rps) encompasses a heterogeneous group of malignancies with a high recurrence rate after resection. Neoadjuvant radiotherapy (nrt) is often used in the hope of sterilizing margins and decreasing local recurrence after excision. We set out to compare local recurrence-free survival (lrfs) and overall survival (os) in patients treated with or without nrt before resection. Patients diagnosed with rps from February 1990 to October 2014 were identified in the Alberta Cancer Registry. Patients with complete gross resection of rps and no distant disease were included. Patient, tumour, treatment, and outcomes data were abstracted in a primary chart review. Baseline characteristics were compared using the Wilcoxon nonparametric test for continuous data and the Fisher exact test for dichotomous and categorical data. Survival was analyzed using Kaplan-Meier curves with log-rank test. Cox regression was performed to control for age, sex, tumour size, tumour grade, date of diagnosis, multivisceral resection, and intraoperative rupture. Resection alone was performed in 62 patients, and resection after nrt, in 40. Use of nrt was associated with multivisceral resection and negative microscopic margins. On univariate analysis, nrt was associated with superior median lrfs (89.3 months vs. 28.4 months, p = 0.04) and os (119.4 months vs. 75.9 months, p = 0.04). On multivariate analysis, nrt, younger age, and lower tumour grade predicted improved lrfs and os; sex, tumour size, date of diagnosis, multivisceral resection, and tumour rupture did not. In this population-based study, nrt was associated with superior lrfs and os on both univariate and multivariate analysis. When feasible, nrt should be considered until a randomized controlled trial is completed.

Highlights

  • Retroperitoneal sarcoma encompasses a heterogeneous group of malignancies with a high recurrence rate after resection

  • Use of nrt was associated with multivisceral resection and negative microscopic margins

  • Chemotherapy is minimally effective in most settings[5,6], but it potentially has roles in downsizing borderline resectable lesions and in treating the small proportion of chemosensitive subtypes of rps such as dedifferentiated liposarcoma, undifferentiated pleomorphic sarcoma, and leiomyosarcoma[7]

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Summary

Introduction

Retroperitoneal sarcoma (rps) encompasses a heterogeneous group of malignancies with a high recurrence rate after resection. Neoadjuvant radiotherapy (nrt) is often used in the hope of sterilizing margins and decreasing local recurrence after excision. We set out to compare local recurrence-free survival (lrfs) and overall survival (os) in patients treated with or without nrt before resection. Local recurrence affects more than 60% of patients, who can experience such a recurrence up to 15 years after treatment[4]. Chemotherapy is minimally effective in most settings[5,6], but it potentially has roles in downsizing borderline resectable lesions and in treating the small proportion of chemosensitive subtypes of rps such as dedifferentiated liposarcoma, undifferentiated pleomorphic sarcoma, and leiomyosarcoma[7]. The addition of chemotherapy to preoperative radiation therapy (rt) regimens as a radiosensitizer is a topic of new interest, but is as yet poorly understood[8]

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