Skip to main content
Log in

Proton-Beam, Intensity-Modulated, and/or Intraoperative Electron Radiation Therapy Combined with Aggressive Anterior Surgical Resection for Retroperitoneal Sarcomas

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We sought to reduce local recurrence for retroperitoneal sarcomas by using a coordinated strategy of advanced radiation techniques and aggressive en-bloc surgical resection.

Methods

Proton-beam radiation therapy (PBRT) and/or intensity-modulated radiation therapy (IMRT) were delivered to improve tumor target coverage and spare selected adjacent organs. Surgical resection of tumor and adjacent organs was performed to obtain a disease-free anterior margin. Intraoperative electron radiation therapy (IOERT) was delivered to any close posterior margin.

Results

Twenty patients had primary tumors and eight had recurrent tumors. Tumors were large (median size 9.75 cm), primarily liposarcomas and leiomyosarcomas (71%), and were mostly of intermediate or high grade (81%). PBRT and/or IMRT were delivered to all patients, preferably preoperatively (75%), to a median dose of 50 Gy. Surgical resection included up to five adjacent organs, most commonly the colon (n = 7) and kidney (n = 7). Margins were positive for disease, usually posteriorly, in 15 patients (54%). IOERT was delivered to the posterior margin in 12 patients (43%) to a median dose of 11 Gy. Surgical complications occurred in eight patients (28.6%), and radiation-related complications occurred in four patients (14%). After a median follow-up of 33 months, only two patients (10%) with primary disease experienced local recurrence, while three patients (37.5%) with recurrent disease experienced local recurrence.

Conclusions

Aggressive resection of retroperitoneal sarcomas can achieve a disease-negative anterior margin. PBRT and/or IMRT with IOERT may possibly deliver sufficient radiation dose to the posterior margin to control microscopic residual disease. This strategy may minimize radiation-related morbidity and reduce local recurrence, especially in patients with primary disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Brennan MF, Lewis JL. Diagnosis and management of soft tissue sarcoma. London: Martin Dunitz; 2002.

    Google Scholar 

  2. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225–49.

    Article  PubMed  Google Scholar 

  3. Gronchi A, Lo VS, 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;27:24–30.

    Article  PubMed  Google Scholar 

  4. 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;27:31–7.

    Article  PubMed  Google Scholar 

  5. Pisters PW. Resection of some—but not all—clinically uninvolved adjacent viscera as part of surgery for retroperitoneal soft tissue sarcomas. J Clin Oncol. 2009;27:6–8.

    Article  PubMed  Google Scholar 

  6. 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;16:197–203.

    CAS  PubMed  Google Scholar 

  7. DeLaney TF, Kepka L, Goldberg SI, et al. Radiation therapy for control of soft-tissue sarcomas resected with positive margins. Int J Radiat Oncol Biol Phys. 2007;67:1460–9.

    PubMed  Google Scholar 

  8. Zagars GK, Ballo MT. Significance of dose in postoperative radiotherapy for soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 2003;56:473–81.

    Article  PubMed  Google Scholar 

  9. Lewis JJ, Leung D, Woodruff JM, Brennan MF. Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg. 1998;228:355–65.

    Article  CAS  PubMed  Google Scholar 

  10. Stoeckle E, Coindre JM, Bonvalot S, et al. Prognostic factors in retroperitoneal sarcoma: a multivariate analysis of a series of 165 patients of the French Cancer Center Federation Sarcoma Group. Cancer. 2001;92:359–68.

    Article  CAS  PubMed  Google Scholar 

  11. van Dalen T, Plooij JM, Van Coevorden F, et al. Long-term prognosis of primary retroperitoneal soft tissue sarcoma. Eur J Surg Oncol. 2007;33:234–8.

    Article  PubMed  Google Scholar 

  12. DeLaney TF, Trofimov AV, Engelsman M, Suit HD. Advanced-technology radiation therapy in the management of bone and soft tissue sarcomas. Cancer Control. 2005;12:27–35.

    PubMed  Google Scholar 

  13. Brada M, Pijls-Johannesma M, De RD. Proton therapy in clinical practice: current clinical evidence. J Clin Oncol. 2007;25:965–70.

    Article  PubMed  Google Scholar 

  14. Willett CG, Czito BG, Tyler DS. Intraoperative radiation therapy. J Clin Oncol. 2007;25:971–7.

    Article  PubMed  Google Scholar 

  15. Bossi A, De Wever I, Van Limbergen E, Vanstraelen B. Intensity modulated radiation-therapy for preoperative posterior abdominal wall irradiation of retroperitoneal liposarcomas. Int J Radiat Oncol Biol Phys. 2007;67:164–70.

    PubMed  Google Scholar 

  16. Gieschen HL, Spiro IJ, Suit HD, et al. Long-term results of intraoperative electron beam radiotherapy for primary and recurrent retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 2001;50:127–31.

    CAS  PubMed  Google Scholar 

  17. Petersen IA, Haddock MG, Donohue JH, et al. Use of intraoperative electron beam radiotherapy in the management of retroperitoneal soft tissue sarcomas. Int J Radiat Oncol Biol Phys. 2002;52:469–75.

    PubMed  Google Scholar 

  18. Tzeng CW, Fiveash JB, Popple RA, et al. Preoperative radiation therapy with selective dose escalation to the margin at risk for retroperitoneal sarcoma. Cancer. 2006;107:371–9.

    Article  PubMed  Google Scholar 

  19. Kaplan E, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.

    Article  Google Scholar 

  20. Cox D. Regression models and life-tables. J R Stat Soc. 1972;34:187–220.

    Google Scholar 

  21. Pawlik TM, Ahuja N, Herman JM. The role of radiation in retroperitoneal sarcomas: a surgical perspective. Curr Opin Oncol. 2007;19:359–66.

    Article  PubMed  Google Scholar 

  22. Catton CN, O’Sullivan B, Kotwall C, et al. Outcome and prognosis in retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 1994;29:1005–10.

    CAS  PubMed  Google Scholar 

  23. Tepper JE, Suit HD, Wood WC, et al. Radiation therapy of retroperitoneal soft tissue sarcomas. Int J Radiat Oncol Biol Phys. 1984;10:825–30.

    CAS  PubMed  Google Scholar 

  24. Fein DA, Corn BW, Lanciano RM, et al. Management of retroperitoneal sarcomas: does dose escalation impact on locoregional control? Int J Radiat Oncol Biol Phys. 1995;31:129–34.

    CAS  PubMed  Google Scholar 

  25. van Doorn RC, Gallee MP, Hart AA, et al. Resectable retroperitoneal soft tissue sarcomas. The effect of extent of resection and postoperative radiation therapy on local tumor control. Cancer. 1994;73:637–42.

    Article  PubMed  Google Scholar 

  26. White JS, Biberdorf D, DiFrancesco LM, Kurien E, Temple W. Use of tissue expanders and pre-operative external beam radiotherapy in the treatment of retroperitoneal sarcoma. Ann Surg Oncol. 2007;14:583–90.

    Article  CAS  PubMed  Google Scholar 

  27. Zlotecki RA, Katz TS, Morris CG, Lind DS, Hochwald SN. Adjuvant radiation therapy for resectable retroperitoneal soft tissue sarcoma: the University of Florida experience. Am J Clin Oncol. 2005;28:310–6.

    Article  PubMed  Google Scholar 

  28. Ballo MT, Zagars GK, Pollock RE, et al. Retroperitoneal soft tissue sarcoma: an analysis of radiation and surgical treatment. Int J Radiat Oncol Biol Phys. 2007;67:158–63.

    PubMed  Google Scholar 

  29. Youssef E, Fontanesi J, Mott M, et al. Long-term outcome of combined modality therapy in retroperitoneal and deep-trunk soft-tissue sarcoma: analysis of prognostic factors. Int J Radiat Oncol Biol Phys. 2002;54:514–9.

    PubMed  Google Scholar 

  30. DeLaney TF, Kirsch DG. Bone and soft tissue. In: DeLaney TF, Kooy HM, editors. Proton and charged particle radiotherapy. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 172–85.

    Google Scholar 

  31. Suit HD, Chu W. History of charged particle radiotherapy. In: DeLaney TF, Kooy HM, editors. Proton and charged particle radiotherapy. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 1–7.

    Google Scholar 

  32. Pisters PW, Ballo MT, Fenstermacher MJ, et al. Phase I trial of preoperative concurrent doxorubicin and radiation therapy, surgical resection, and intraoperative electron-beam radiation therapy for patients with localized retroperitoneal sarcoma. J Clin Oncol.2003;21:3092–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

Thomas F. DeLaney received a speaker’s honorarium from IBA Proton Therapy, and David G. Kirsch is a consultant for Guidepoint Global.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sam S. Yoon MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yoon, S.S., Chen, YL., Kirsch, D.G. et al. Proton-Beam, Intensity-Modulated, and/or Intraoperative Electron Radiation Therapy Combined with Aggressive Anterior Surgical Resection for Retroperitoneal Sarcomas. Ann Surg Oncol 17, 1515–1529 (2010). https://doi.org/10.1245/s10434-010-0935-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-010-0935-1

Keywords

Navigation