Role of Radiation Therapy in Retroperitoneal Sarcoma

Authors: Kilian E. Salerno MD1 and Elizabeth H. Baldini MD, MPH2,3
View More View Less
  • 1 Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; and
  • | 2 Harvard Medical School, and
  • | 3 Sarcoma Center, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Boston, Massachusetts.

Retroperitoneal sarcoma comprises a small subset of all soft tissue sarcoma and includes various histopathologic subtypes, each with unique patterns of behavior and differential risks for local recurrence and hematogenous metastatic spread. The primary treatment modality is surgery, although even with complete macroscopic resection, recurrence is common. The rationale for the addition of radiotherapy to resection is to improve local control; however, the use of radiation therapy for retroperitoneal sarcoma is controversial, and existing data are suboptimal to guide management. Treatment decisions should be determined with multidisciplinary input and shared decision-making. When used in selected patients, radiation therapy should be delivered preoperatively; postoperative treatment is not recommended.

Submitted February 25, 2022; final revision received May 19, 2022; accepted for publication May 19, 2022.

Disclosures: Dr. Baldini has disclosed receiving royalties from UpToDate, Inc. Dr. Salerno has disclosed having no financial interests, arrangements, affiliations, or commercial interests with manufacturers of any products discussed in this article or their competitors.

Correspondence: Kilian E. Salerno, MD, Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Building 10 CCR, Room B2-3500, Bethesda, MD 20892. Email: kilian.salerno@nih.gov
  • 1.

    WHO Classification of Tumours Editorial Board. WHO Classification of Tumours of Soft Tissue and Bone, 5th ed. Lyon, France: IARC Publications; 2020.

    • Search Google Scholar
    • Export Citation
  • 2.

    Gronchi A, Strauss DC, Miceli R, et al. Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma (RPS): a report on 1007 patients from the multi-institutional collaborative RPS working group. Ann Surg 2016;263:10021009.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Tan MCB, Brennan MF, Kuk D, et al. Histology-based classification predicts pattern of recurrence and improves risk stratification in primary retroperitoneal sarcoma. Ann Surg 2016;263:593600.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Tseng W, Martinez SR, Tamurian RM, et al. Histologic type predicts survival in patients with retroperitoneal soft tissue sarcoma. J Surg Res 2012;172:123130.

  • 5.

    Swallow CJ, Strauss DC, Bonvalot S, et al. Management of primary retroperitoneal sarcoma (RPS) in the adult: an updated consensus approach from the Transatlantic Australasian RPS Working Group. Ann Surg Oncol 2021;28:78737888.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Salerno KE, Alektiar KM, Baldini EH, et al. Radiation therapy for treatment of soft tissue sarcoma in adults: executive summary of an ASTRO clinical practice guideline. Pract Radiat Oncol 2021;11:339351.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Gronchi A, Miah AB, Dei Tos AP, et al. Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2021;32:13481365.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Callegaro D, Raut CP, Ng D, et al. Has the outcome for patients who undergo resection of primary retroperitoneal sarcoma changed over time? A study of time trends during the past 15 years. Ann Surg Oncol 2021;28:17001709.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Bonvalot S, Gaignard E, Stoeckle E, et al. Survival benefit of the surgical management of retroperitoneal sarcoma in a reference center: a nationwide study of the French Sarcoma Group from the NetSarc Database. Ann Surg Oncol 2019;26:22862293.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Martin-Broto J, Hindi N, Cruz J, et al. Relevance of reference centers in sarcoma care and quality item evaluation: results from the prospective registry of the Spanish Group for Research in Sarcoma (GEIS). Oncologist 2019;24:e338346.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Blay JY, Honoré C, Stoeckle E, et al. Surgery in reference centers improves survival of sarcoma patients: a nationwide study. Ann Oncol 2019;30:11431153.

  • 12.

    Blay JY, Soibinet P, Penel N, et al. Improved survival using specialized multidisciplinary board in sarcoma patients. Ann Oncol 2017;28:28522859.

  • 13.

    Gronchi A, Lo Vullo S, Fiore M, et al. Aggressive surgical policies in a retrospectively reviewed single-institution case series of retroperitoneal soft tissue sarcoma patients. J Clin Oncol 2009;27:2430.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Bonvalot S, Rivoire M, Castaing M, et al. Primary retroperitoneal sarcomas: a multivariate analysis of surgical factors associated with local control. J Clin Oncol 2009;27:3137.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Rosenberg SA, Tepper J, Glatstein E, et al. The treatment of soft- tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg 1982;196:305315.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 1998;16:197203.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Haas RLM, Bonvalot S, Miceli R, et al. Radiotherapy for retroperitoneal liposarcoma: a report from the Transatlantic Retroperitoneal Sarcoma Working Group. Cancer 2019;125:12901300.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Kelly KJ, Yoon SS, Kuk D, et al. Comparison of perioperative radiation therapy and surgery versus surgery alone in 204 patients with primary retroperitoneal sarcoma: a retrospective 2-institution study. Ann Surg 2015;262:156162.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Bishop AJ, Zagars GK, Torres KE, et al. Combined modality management of retroperitoneal sarcomas: a single-institution series of 121 patients. Int J Radiat Oncol Biol Phys 2015;93:158165.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Le Péchoux C, Musat E, Baey C, et al. Should adjuvant radiotherapy be administered in addition to front-line aggressive surgery (FAS) in patients with primary retroperitoneal sarcoma? Ann Oncol 2013;24:832837.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Pawlik TM, Pisters PWT, Mikula L, et al. Long-term results of two prospective trials of preoperative external beam radiotherapy for localized intermediate- or high-grade retroperitoneal soft tissue sarcoma. Ann Surg Oncol 2006;13:508517.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Chouliaras K, Senehi R, Ethun CG, et al. Role of radiation therapy for retroperitoneal sarcomas: an eight-institution study from the US Sarcoma Collaborative. J Surg Oncol 2019;120:12271234.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Nussbaum DP, Speicher PJ, Gulack BC, et al. Long-term oncologic outcomes after neoadjuvant radiation therapy for retroperitoneal sarcomas. Ann Surg 2015;262:163170.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Diamantis A, Baloyiannis I, Magouliotis DE, et al. Perioperative radiotherapy versus surgery alone for retroperitoneal sarcomas: a systematic review and meta-analysis. Radiol Oncol 2020;54:1421.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Albertsmeier M, Rauch A, Roeder F, et al. External beam radiation therapy for resectable soft tissue sarcoma: a systematic review and meta-analysis. Ann Surg Oncol 2018;25:754767.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Sindelar WF, Kinsella TJ, Chen PW, et al. Intraoperative radiotherapy in retroperitoneal sarcomas. Final results of a prospective, randomized, clinical trial. Arch Surg 1993;128:402410.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Bonvalot S, Gronchi A, Le Péchoux C, et al. Preoperative radiotherapy plus surgery versus surgery alone for patients with primary retroperitoneal sarcoma (EORTC-62092: STRASS): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol 2020;21:13661377.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Baldini EH, Wang D, Haas RLM, et al. Treatment guidelines for preoperative radiation therapy for retroperitoneal sarcoma: preliminary consensus of an international expert panel. Int J Radiat Oncol Biol Phys 2015;92:602612.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Swanson EL, Indelicato DJ, Louis D, et al. Comparison of three-dimensional (3D) conformal proton radiotherapy (RT), 3D conformal photon RT, and intensity-modulated RT for retroperitoneal and intra-abdominal sarcomas. Int J Radiat Oncol Biol Phys 2012;83:15491557.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Paumier A, Le Péchoux C, Beaudré A, et al. IMRT or conformal radiotherapy for adjuvant treatment of retroperitoneal sarcoma? Radiother Oncol 2011;99:7378.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Bossi A, De Wever I, Van Limbergen E, et al. Intensity modulated radiation-therapy for preoperative posterior abdominal wall irradiation of retroperitoneal liposarcomas. Int J Radiat Oncol Biol Phys 2007;67:164170.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Tzeng CWD, Fiveash JB, Popple RA, et al. Preoperative radiation therapy with selective dose escalation to the margin at risk for retroperitoneal sarcoma. Cancer 2006;107:371379.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Baldini EH, Bosch W, Kane JM III, et al. Retroperitoneal sarcoma (RPS) high risk gross tumor volume boost (HR GTV boost) contour delineation agreement among NRG sarcoma radiation and surgical oncologists. Ann Surg Oncol 2015;22:28462852.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    DeLaney TF, Chen YL, Baldini EH, et al. Phase 1 trial of preoperative image guided intensity modulated proton radiation therapy with simultaneously integrated boost to the high risk margin for retroperitoneal sarcomas. Adv Radiat Oncol 2017;2:8593.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    White JS, Biberdorf D, DiFrancesco LM, et al. Use of tissue expanders and pre-operative external beam radiotherapy in the treatment of retroperitoneal sarcoma. Ann Surg Oncol 2007;14:583590.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Waddell BE, Rodriguez-Bigas MA, Lee RJ, et al. Prevention of chronic radiation enteritis. J Am Coll Surg 1999;189:611624.

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 660 660 657
PDF Downloads 460 460 457
EPUB Downloads 0 0 0