A systematic review of population-based studies examining outcomes in primary retroperitoneal sarcoma surgery

Peacock, Oliver; Patel, Shailen; Simpson, Jayne; Walter, C.; Humes, David J.

doi:10.1016/j.suronc.2019.03.002

Cited by 18 publications

(13 citation statements)

References 53 publications

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“…Marginal or incomplete (R1 or R2) resection has been reported in up to 50% of the patients treated with curative intent. In these patients, local relapse appeared in 2/3 of them even though local failure rose to half of the patient after complete resection (29). These observations suggest neoadjuvant or adjuvant treatments to improve outcomes.…”

Section: Management In a Multidisciplinary High-volume Centermentioning

confidence: 79%

“…In a recent review discussing surgery in RTS, Peacock et al noted that NeoRT was more frequently used in academic hospitals, although AdjRT was preferred in local hospitals. Furthermore, NeoRT was more frequent during the 2007-2011 period than during the 2003-2006 period (29). Two positive factors of outcome improvement, academic hospital and recent period, favoring the use of NeoRT, can be considered biases.…”

Section: Radiotherapy Schedulesmentioning

confidence: 99%

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A critical narrative review of radiotherapy for retroperitoneal soft tissue sarcoma

et al. 2020

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Retroperitoneal sarcomas (RPSs) are rare diseases, and the 5-year overall survival rate remains low. Management of RPSs is challenging, and the quality of treatment strategy is a crucial prognostic factor.Treatment decisions and the treatment department to which the patients is referred must be centralized.Overall survival rate is positively correlated with the number of patients treated in the centers. En bloc surgery is the standard of care for effective treatment and potential for cure, whereas perioperative chemotherapy or radiotherapy has not yet been validated. Pre-or postoperative radiotherapy was considered controversial, but the STRASS trial publication illustrated that preoperative radiation could be useful in some conditions.Retroperitoneal liposarcoma might become a future target of prospective trials. Furthermore, some retrospective studies have shown that preoperative radiotherapy increases the rate of R0-R1 resections. This article reviews the role of external beam radiotherapy in the management of RPS and highlights the optimal volumes, doses, and radiotherapy techniques for the treatment of RPS. As accurately predicting prognosis in patients with RPS is challenging, we also emphasize the utility of nomograms in the field of radiotherapy.However, these nomograms do not include radiotherapy as a predictive factor. Although some authors could conclude that use of radiotherapy should be avoided based on the results of the STRASS trial, some data argue that radiotherapy still has utility in select cases.

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Section: Management In a Multidisciplinary High-volume Centermentioning

confidence: 79%

Section: Radiotherapy Schedulesmentioning

confidence: 99%

A critical narrative review of radiotherapy for retroperitoneal soft tissue sarcoma

et al. 2020

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“…[1][2][3][4][5] To date, surgical excision with R0 or R1 margins remains the best chance for cure, reinforcing the importance of abdominal recurrence-free survival (RFS). [6][7][8][9] Recurrence after treatment is common even after resection with negative margins and is associated with decreased survival. 10 Pathologic margin status is difficult to determine conclusively on large tumors and it is possible that even "marginnegative" resections may leave microscopic tumor behind.…”

Section: Introductionmentioning

confidence: 99%

“…Retroperitoneal and abdominopelvic sarcomas represent a histologically heterogeneous group of tumors that carry a poor prognosis compared to the more prevalent extremity sarcomas 1–5 . To date, surgical excision with R0 or R1 margins remains the best chance for cure, reinforcing the importance of abdominal recurrence‐free survival (RFS) 6–9 . Recurrence after treatment is common even after resection with negative margins and is associated with decreased survival 10 .…”

Section: Introductionmentioning

confidence: 99%

Factors associated with disease‐free and abdominal recurrence‐free survival in abdominopelvic and retroperitoneal sarcomas

Bredbeck

Delaney

Kathawate

et al. 2022

Journal of Surgical Oncology

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Background and Objectives Retroperitoneal and abdominopelvic sarcomas are rare heterogeneous malignancies. The only therapy proven to improve disease‐free survival (DFS) is R0/R1 surgical resection. We sought to analyze whether additional factors such as radiation and systemic therapy were associated with DFS and abdominal recurrence‐free survival (RFS). Methods Retrospective review of adults (≥18) with resectable abdominopelvic and retroperitoneal sarcomas who underwent intent‐to‐cure surgery at a high‐volume tertiary referral center between 1998 and 2015. The main outcome measures were DFS and abdominal RFS. Results Overall, 159 patients met the criteria for inclusion. Median follow‐up was 4.8 years (range 0.1–18.9 years). The most common histology was liposarcoma (49%). Systemic therapy was administered to 48% of patients and was not associated with improved outcomes. The neoadjuvant radiotherapy group (11%) had improved adjusted DFS (5.46 years, 95% CI [3.68, 7.24] vs. 3.1 years, 95% CI [2.48, 3.73]) and abdominal RFS (6.14 years, 95% CI [4.38, 7.89] vs. 3.22 years, 95% CI [2.61, 3.84]). The adjuvant radiotherapy group (19%) had no improvement. Conclusions In a cohort of patients undergoing resection for retroperitoneal or abdominopelvic sarcoma, neoadjuvant radiation improved DFS and abdominal RFS. A follow‐up of over three years was needed to appreciate a difference in outcomes.

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“…To improve local control and overall survival, adjuvant therapy (AT) such as adjuvant radiotherapy (ART) has been investigated. However, there are insu cient evidences to compile treatment guidelines due to the different conclusions based on limited retrospective clinical studies (RCSs) [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. For example, multiple analyses of the Surveillance, Epidemiology, and End Results (SEER) database and a retrospective analysis from French have shown that ART does not improve OS in patients with RPS [5,9,12,23], but Trovik et al [8] and others [10,18] who were published studies recently demonstrated a signi cant improvement in OS as well as recurrence-free survival (RFS) in patients undergoing ART, which is obviously confusing.…”

Section: Introductionmentioning

confidence: 99%

Adjuvant therapy for retroperitoneal sarcoma: a meta-analysis

Xiao

et al. 2020

Preprint

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Background Adjuvant therapy is a promising treatment to improve the prognosis of cancer patients, however, the evidence base driving recommendations for adjuvant radiotherapy (ART) or chemotherapy (ACT) in retroperitoneal sarcomas (RPS) primarily hinges on observational data. The aim of this study was to evaluate the effectiveness of adjuvant therapy in the management of RPS by pooling analysis. Methods We searched PubMed, Web of Science, Embase, ASCO Abstracts, and Cochrane Library for comparative studies (until January 2020) comparing adjuvant therapy versus surgery alone. Data on the following endpoints were evaluated: overall survival (OS), local recurrence (LR), recurrence-free survival (RFS), and metastasis-free survival (MFS). Data were summarized as hazard ratios (HR) with 95% confidence intervals (95%CI). Risk of bias of studies was assessed with Begg’s and Egger’s tests. Results A total of 15 trials were eligible, including 9076 adjuvant therapy and 20830 surgery alone cases (20 studies for OS, 6 studies for RFS, 2 studies for LR, and 2 studies for MFS). Meta-analysis showed that ART was associated with distinct advantages as compared to surgery alone, including a longer OS (HR = 0.80, P < 0.0001), a longer RFS (HR = 0.61, P = 0.0002), and a lower LR (HR = 0.31, P = 0.005). However, this meta-analysis failed to demonstrate a benefit of ACT for RPS, including OS (HR = 1.11, P = 0.19), RFS (HR = 1.30, P = 0.09) and MFS (HR = 0.69, P = 0.09). in the sensitivity analysis, ACT was associated with a worse OS (HR = 1.19, P = 0.0002). No evidence of publication bias was observed. Conclusions Overall, the quality of the evidence was moderate for most outcomes. The evidence supports that ART achieved a generally better outcome as compared to surgery alone.

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A systematic review of population-based studies examining outcomes in primary retroperitoneal sarcoma surgery

Cited by 18 publications

References 53 publications

A critical narrative review of radiotherapy for retroperitoneal soft tissue sarcoma

A critical narrative review of radiotherapy for retroperitoneal soft tissue sarcoma

Factors associated with disease‐free and abdominal recurrence‐free survival in abdominopelvic and retroperitoneal sarcomas

Adjuvant therapy for retroperitoneal sarcoma: a meta-analysis

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