Significance of intraoperative radiation therapy and high cumulative radiation doses in retroperitoneal soft tissue sarcoma. Issue 5 (May 2020)

• Record Type: Journal Article
• Authors: Willis, Franziska; Schimmack, Simon; Uhl, Matthias; Haefner, Matthias F.; Mechtersheimer, Gunhild; Hinz, Ulf; Schmidt, Thomas; Debus, Jürgen; Fröhling, Stefan; Schneider, Martin
• Is Part Of: European journal of surgical oncology. Volume 46:Issue 5(2020)
• Page Start: 905
• Page End: 913
• Publication Date: 2020-05
• Subjects: Retroperitoneal soft tissue sarcoma -- Surgery -- IORT -- Radiation therapy -- Recurrence analysis -- Survival analysis; STS soft tissue sarcoma -- LR local recurrence -- OS overall survival -- EBRT external beam radiation therapy -- IORT intraoperative radiation therapy -- cRD cumulative radiation dose -- DD-LPS dedifferentiated liposarcoma -- WD-LPS well-differentiated liposarcoma -- LMS leiomyosarcoma -- MPNST malignant peripheral nerve sheath tumor -- SFT intermediate malignancy: solitary fibrous tumor & desmoid fibromatosis; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2019.12.014
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Introduction: In retroperitoneal soft tissue sarcoma (STS) local recurrence (LR) rates remain high despite more aggressive surgical approaches. Since wide resection margins cannot be achieved in all patients, application of intraoperative radiation therapy (IORT) has been frequently discussed. Still, the significance of IORT in multimodal treatment of retroperitoneal STS remains unclear. Material and methods: Patients undergoing resection of primary or recurrent retroperitoneal STS at the University of Heidelberg Department of General, Visceral and Transplantation Surgery were retrospectively analyzed. Univariate Kaplan-Meyer and multivariate Cox regression analyses were performed to identify predictors of LR-free survival and to investigate the impact of IORT and high cumulative radiation doses. Analyses with propensity-score matched subgroups for IORT and cumulative radiation dose were performed to control for selection bias. Subgroup analyses for patients with retroperitoneal liposarcoma were likewise performed. Results: 272 patients were identified. Recurrent tumors, histology of dedifferentiated liposarcoma or unclassified sarcoma and microscopically incomplete resection were associated with decreased LR-free survival. In liposarcoma, only recurrent and dedifferentiated tumors were confirmed as poor prognostic factors concerning LR. IORT and cumulative radiation doses exceeding 60 Gy did not influence LR rates (estimated 5-year LR-free survival: IORT: 39%, non-IORT: 46%; p = 0.79). Conclusion: In this retrospective evaluation, additional application of IORT does not significantly influence oncological outcome in retroperitoneal soft tissue sarcoma. Randomized trials are needed to clarify the benefit of IORT.