Retroperitoneal Sarcoma

WORKUP

Incidence

  • 10-15% of all STS

Histology

  • 30-60% are Liposarcoma
  • 20-30% are leiomyosarcoma

Imaging

  • CT abdomen/pelvis with contrast
  • Core Biopsy if neoadjuvant therapy under consideration

TREATMENT

  • primary treatment is resection
  • consider neoadjuvant RT or chemotherapy or chemoradiation to make tumor resectable
  • If unresectable palliative or supportive care

Surgery

  • en-block resection of
    • tumor
    • viscera
    • margin of uninvolved tumor
    • 80-90% complete resection rate in recent series

Radiation

  • role remains controversial
  • Pre-op RT: minimal acute and late toxicity and no increase in wound healing. Under study.
  • Intra-op RT
    • MGH: 40-50 preop EBRT + intra-op electron showed improved local control (83%) and OS (74%) vs. no IORT 30% and 61% respectively.
    • Mayo Clinic also reported improved local control using similar treatment approach.
  • Post-op RT: limited data shows delay in local relapse (local relapse free survival 103 vs 30 months) but not prevention [1], [2]

RESULTS

  • local control rate of 40-60%
  • OS-5 of 50-60%
  • most deaths are caused by local rather than systemic recurrence
Bibliography
1. Catton CN, O'Sullivan B, Kotwall C, Cummings B, Hao Y, Fornasier V. Outcome and prognosis in retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 1994 Jul 30;29(5):1005-10.
2. Stoeckle E, Coindre JM, Bonvalot S, Kantor G, Terrier P, Bonichon F, Nguyen Bui B; French Federation of Cancer Centers Sarcoma Group. Prognostic factors in retroperitoneal sarcoma: a multivariate analysis of a series of 165 patients of the French Cancer Center Federation Sarcoma Group. Cancer. 2001 Jul 15;92(2):359-68.
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