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

Abstract

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.

The Role of Surgery in Oligometastatic Retroperitoneal Sarcoma

“…Histopathology is the greatest predictor of disease-specific death, overall survival, local recurrence, and distant metastasis following primary resection in sarcoma patients. This is followed by the completeness of the initial surgical resection, with negative margins leading to better outcomes and higher tumor grades associated with poorer outcomes [ 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. The different histologic subtypes have specific patterns of recurrence and metastasis, such as predicting the time and location of spread and response to therapy, which informs the management approach of each patient [ 15 ].…”

“…This is followed by the completeness of the initial surgical resection, with negative margins leading to better outcomes and higher tumor grades associated with poorer outcomes [ 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. The different histologic subtypes have specific patterns of recurrence and metastasis, such as predicting the time and location of spread and response to therapy, which informs the management approach of each patient [ 15 ]. In Table 1 we summarize the typical patterns of retroperitoneal sarcoma recurrence and metastasis in order to review the correlation between histology, patterns of metastasis, and overall survival.…”

“…Radiation therapy is utilized in ~25% of primary sarcoma cases, primarily extremity sarcomas, with randomized clinical trials showing evidence of a decrease in local recurrence but no survival benefit [ 44 , 45 ]. Several prospective and retrospective studies on selected patients with retroperitoneal sarcoma show that there may be a role for RT in local recurrence prevention [ 15 , 46 , 47 , 48 ]. The randomized controlled STRASS trial investigated the role of preoperative radiotherapy plus surgery versus surgery alone for primary retroperitoneal sarcoma, with the endpoint of abdominal recurrence-free survival (ARFS) [ 49 ].…”